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Escapee Medical Clinc - Advice Anyone?


AlexP

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Medical issues are complex and thinking that errors won't happen is not realistic. But when they do, what do you do? Sorry this is long....

We have had great luck with Escapees. From Boot Camp, to bringing our first rig to Livingston, to "Becoming a Texan", to Escapades and visits to many of the parks. So not having had physicals in 5+ years we saw the Escapee Clinic in the Escapee Magazine and thought we would see how that was. In Livingston we heard good things about Dusty Peterson, and we made an appointment on Nov 4th. We are not on any meds and mostly healthy so we are not too complicated. We were impressed with Dusty, engaging, sensitive and smart. We left having given blood and normal checkup stuff at the clinic and thought another good deal from Escapees.

A few days later her nurse called me and explained that my blood showed elevated Bilirubin, and suggested that I come to the hospital for a gallbadder ultrasound and some additional blood work. "Come to the clinic get some paperwork and take that over to the hospital, and they will take it from there." This I did on Nov 11th. The following week her nurse again called and explained that the wrong blood tests were done and to come back to the clinic and they would redo the correct ones. On Nov 15 I came into the clinic and again gave blood which was sent for the intended tests. Dusty and I discussed the results and everything felt good and it felt like we had successfully transitions to new, good medical care.

Then the bills came in. And from the EOBs it appears that the blood test in the hospital was a repeat of the one in the clinic the week before. Only in the clinic from the EOBs, I was billed $22.52 for the blood test, and in the hospital for the same thing I am being billed $987.56. Since it was a mistake and not what was intended, I object to paying for that mistake.

I called the hospital billing department, and talked to the nice lady there. She looked up the piece of paper that I brought over and verified that it requested what was done. Since that was the case I needed to address my concern to Dusty. Ok. Called office on Dec 21st and asked for Dusty. Discussed situation with a gal, I think she said her name was Amanda, assured me someone would get back to me. Called again on Dev 29, talked to I think Paulette in the Clinics billing department. She assured me she could help me, if it had to do with the clinic, but since it was the hospital, someone else would need to help me, and she would see that they did. Tried again on Jan 6th. Nancy answered the phone and told me I would need to talk to Paulette, who was on vacation and to call back on Monday. I explained that Paulette already told me she couldn't help me and wasn't there an office manager who might be able to handle this affair. She assured me that I needed to talk to Paulette. Over the weekend I documented this whole thing and sent it into their email "portal" to Dusty. At the end of the week I thought I would try again, but I waited until Fri afternoon and the clinic was closed. The hospital has patient advocates. Google revealed two separate phone numbers for CHI patient advocates. One is obviously disconnected as I got a fast busy. The second rings for a time and then a gal explains that this mailbox is not monitored and offers another number. That number rings to the CHI's Emergency room.

As you might expect I am getting a little frustrated and am questioning the wisdom of my actions at this point. What would be my best course of action at this point?

Does Escapees, which obviously is endorsing them, do they have a business contact that would be willing to help me?

Should I start writing letters to the CMO of the Memorial Clinics?

The Administrator of the Hospital? Hospital is going to say we did what Physician requested and that is another business entity, but there is a 3 foot poster of Dusty in the Hospital Lobby, so that doesn't really wash.

Grateful for any thoughts.
Alex

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Calling would NOT be my route.

 

My DW, RIP, had many medical issues over our 14+ yrs of FT. At one time, I added them up and had a total of over $2million in claims. Her last and final episode with doctors and hospitals was well over another million in billings. She had medical services in at least 36 states that I remember. I have zero experience with the SKPs clinic or Livingston area providers but my general experience is that medical providers are generally shoddy when it comes to billing accuracy. I believe, personally, that they think most patients are either insured and therefore paying only a smaller copay and so don't pay that much attention to the billing, or that another great segment is uninsured and will never pay anyway so they don't care what the med industry bills and thirdly that most people don't pay that much attention to, or are sedated or in stress mode, whatever the details are of their care.

 

I found conversations were with the bottom dwellers in the medical world. They never could remember the story that they told you yesterday. As for keeping the simplest of promises like "i'll call you back", they seem to have the attitude that you will die before you'll ever hear from them.

 

Keep good records and then when there is a discrepancy, write letters to the offender with a copy to any ordering physician if it was a service ordered by one. Be specific about your doubts. Ask that they provide a WRITTEN RESPONSE to the very specific questions you ask. Finalize your letter with a separate one sentence paragraph "Under the terms of the Fair Debt Collection Act, I dispute this charge." (As you get older and need more medical service and have more of these imbeciles billing you, you will find it worthwhile to actually google the fair debt collection act and read your rights and procedures)

 

Over time you will find that you are basically writing the same type of letter over and over and all you need to do is pull up an old one, change the facts and dates and addressee, print and mail. Copy your insurance company if you wish (if you believe the ins. company should claw back any payments they made).

 

Not that it will help. Not that the vendor will be responsive. Not that they will actually do anything. Their computer will just continue to spit out more bills showing things to be getting older and older and every time you get another bill, you send another "I dispute" letter along with a copy of your earlier letter printed on the back. You will build quite a collection of letters for each vendor. But at least you'll be able to prove your responsiveness in writing and prove their unresponsiveness. The situation would be the same if you were using the phone, you just would be able to prove it. If and when it finally goes to collection, you can just tell the collector to 'go to h..." (in writing) and provide the collector with copies of your dispute letters. Tell the collector that you continue to dispute the billing until your issues have been addressed and that as an outside collector it has a special place in the enforcement world should they ignore your warning. They get a piece of what they collect and besides it being legal that they no longer contact you, it's not going to be profitable dealing with you. Your written record will also protect you and reverse any possible credit report dings.

 

The mantra should be - "I will pay for legitimate service upon presentation of a correct itemized invoice. If you (provider) cannot provide correct billing, it is NOT my job to fix your billing problems. I'll tell you once what problems I see and what I need in the way of a fix. Ignore that at your own risk."

 

You've got a record of the facts, who said what conflicting statements when. Write it to the two parties and tell them to work it out. This is not a medical issue. It is a contracts issue and uniformly covered across all state lines by the Uniform Commercial Code. Make it work for you and then you can relax.

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Well I called the Escapee's business office. The gal went and checked with Management and called me back and gave me a couple phone numbers along with a couple apologies that they couldn't do any more. Well it turns out that these two numbers are the main number of the Clinic and their fax number. So no help there.

 

I did do a search for the Escapee Medical Clinic in these forums before I made my appointment, so maybe this post will cause future Alex's to rethink. This experience is causing me to redouble my efforts to exercise and eat right!!

 

Avan, sounds like this little thing is small potatoes for you. Do you send these dispute letters to the address on the bills? There is a MT address and AL address on the bill and Hospital is in Livingston? Wondering if I might contact you offline for a little coaching.

 

Alex

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Wondering if I might contact you offline for a little coaching.

Try sending him a Private Message. If you hover the mouse pointer over his name at the top, left of his post a window will open with the option of "send message" on the lower left side.

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Alex,

 

If you are looking at EOBs, then there is an insurance company involved. That is who you should be talking too. Your bottom line is the "Patient May Owe" column. There will be a lot of back and forth between providers and insurance companies over coding, etc. Are you under Medicare or personal insurance. Remember, what they BILL and what insurance pays are to entirely different things. Often you will see charges that make you scratch your head at the huge difference, but remember that 'difference' will be listed as a lost on their balance sheet and has nothing to do with how much the test/procedure costs. Anyway, call the insurance company and tell them that you believe they are being charged for the wrong tests, etc. and let them handle it.

 

Barb

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Barb, I took your advice & called Aetna:

 

Anastasia: Allow me a few moments to contact them to see what information I can get.

Anastasia: Who was the ordering physician?

ALEX: I would appreceiate that. Frances Peterson

Anastasia: Thank you for your patience, I spoke with the nurse and stated the hospital ran the correct ordered lab work. When your being asked to have more extensive testing of a repeat but through the hospital.

ALEXANDER PATTERSON: Not sure I understand second sentence

Anastasia: Bascially the hospital did the correct test that where ordered by the provider.

Anastasia: Generally when they need a more extensive test they refer you to the hospital for a repeat of what you already had done.

ALEX: Ok So when I look at the EOBs there is an EOB from Quest on the 4th that list 4 blood tests.

ALEX: Those same 4 blood tests were done by the hospital on the 11th. What they wanted was the Bilirubin panel and the Hepatitis panels, but the order was coded wrongly.

ALEX: Doesn't make sense to order same exact tests a week apart.

Anastasia: Correct, that was the initial test that where done and from those results they felt there was a repeat needed but more extensive and referred you to the hospital.

Anastasia: For better understanding of the test you had done or why you can contact the nurse at 936-327-7799

Anastasia: .

ALEX: Do you have a name?

Anastasia: I spoke with Karen.

 

So Karen who was not the nurse I worked with appears to be speculating that the original tests were not trusted and were repeated. The nurse that called me after these tests said "Wrong tests were ordered and blood has been discarded. Would you come in for another draw?"

 

So if I were under medicare, they would have paid the bulk of this and the copay would not be worth the hassle. Unfortunately I have corporate insurance and several decades ago the deductible went from several hundred to several thousand, and I haven't hit that since. So this is mine.

 

If Escapees is serious about attracting Xscapers they need to get the Escapee name off this outfit. Or rename it the "Escapee Medicare Clinic".

 

Alex

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Many people try to get health care on the cheap. I don't blame them because the cost

for health care is for the most part way out of line. Many people go to NP's or PA's. They

are cheaper but I wouldn't expect the level of care to be that of a MD.

I just retired on September 1, 2015 and for 38 years, as the CEO, of a company with just under 500 employees,

I learned a great deal regarding health insurance and how to buy it for all of those employees.

If it looks to good to be true and is not in line with what the other companies charge, beware.

Cost of health insurance include, claims, re-insurance for large claims, administration cost to run the plan and profit

for the company. Does anybody think that if two or more health insurance company's operate in the same area that their cost will be much different?

All that you can do is to reduce benefits to save money.

Two years before I retired we went with a self funded plan and the monthly cost went from a little over $900 down to $700 for the same level

of benefits. It is a very good plan, $500 deductible, $15 doctor co-pay, total $3,000 out of pocket then 100%. We have saved in excess of $500,000

over the two years. Down side is that if we have a lot of big claims the plan will cost up to 125% of total premiums. I had to buy re-insurance to put the stop gap at 125%.

I would think that Escapees would put distance between the clinic and then. I wouldn't want that liability. Good Luck

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  • 2 weeks later...

whj, You treated your people well. I work for a household name with 300-400,000 worldwide and they are not so generous.

 

But I would like to just close the loop on this. I received a call from Dusty Peterson this afternoon. She could not have been nicer. She explained that she was responding to my letter (Thank you Avan.) She said her boss had been involved and his boss had been involved as well as some folks on the hospital side. She said her boss had personally gone over to hospital to resolve this. She told me the at I would receive a zero balance bill from the hospital with an "administrative credit". And if anything should go wrong, and I should get another bill or so, to contact her.

 

Empathetic and pleasant interaction.

 

Alex

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It does pay to question, question, question and keep on until you finally get the person(s) who can resolve an issue. I never have paid off an an EOB, but have always required a detailed billing of all charges and payments. Often will find 'charges' that did not occur, but were 'routine' and most people didn't notice - I NOTICED. When it comes to health care, we have to be our own (or a family member) most strident advocate.

 

Glad you have things progressing towards a satisfactory conclusion.

 

Barb

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