ComplaintsforCleveland Clinic Foundation

• Initial Complaint

  01/10/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On July 21, 2021, I visited my primary care doctor (Dr. ******) at Cleveland Clinic Foundation (CCF) in ************* **, as I have done for many years. In accordance with my health plan through ******, visits to my primary care doctor are $30.00, which is the amount I paid for this visit. ****** returned an Explanation of Benefits indicating a total of $77.13 is due for this visit. This was appealed with ******, which responded as follows (emphasis added): {{It is the responsibility of this in-network provider [CCF] to determine the coding for the service provided. ****** is required to process your claims as received. The provider [CCF] billed this claim with the place of service, 19 – Off Campus-Outpatient Hospital. For your office visit copay to apply, the claim would is [sic] required to be submitted with place of service, 11 – Office. Per the place of service submitted for this date of service, the maximum allowed amount correctly applied to your 2021 deductible for this claim. ****** is not responsible for the actual care you receive or the acts or omissions of a provider.}} After receiving the response from ******, I called CCF on 11/19/21 and talked to ******, who indicated the claim would be resubmitted with the correct code. Nothing happened, so on 12/02/21 I called CFF again and talked to ********, who informed me that CCF submitted the claim correctly and ****** is wrong. So, I am stuck with a fight between two big medical companies. This is the first time that an office visit to my primary care doctor has not been processed correctly.

  

  Business response

  01/11/2022

  
  Dear Ms. *****,
  
  This letter is in response to the billing complaint filed by Ms. ****** to the Ohio Better Business Bureau on 01/08/2022.
  
  I have reviewed Ms. ******’s concerns regarding the place of service coding for date of service 07/21/2021. Cleveland Clinic is a provider based facility. This means that the ************ family health center where services were rendered is an extension of Cleveland Clinic hospital. This is why the claim was billed with the place of service, 19 – Off Campus-Outpatient Hospital. We are unable to change to place of service, 11 – Office Visit. There are no financial or billing errors on the claim. ****** was billed $240.00, they paid $0.00, adjusted $162.87 and left $77.13 towards patient responsibility for deductible.
  
  Thank you for allowing us the opportunity to address Ms. ******’s concerns. If I can be of any further assistance, please feel free to contact me directly at ************.
  
  Respectfully,
  
  
  Natalie G
  Financial Ombudsman
  Revenue Cycle Management, CCHS
  
  

• Initial Complaint

  12/27/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My son’s surgeon scheduled an appointment with a behavioral health doctor during his 8/05/2021 pre-op visit after financial clearance only to receive a bill for $456.00. I made several calls to billing explaining the circumstance to be told to do an appeal with my insurance and that they will revise the codes. Four months have passed with no resolution. Please help. Sincerely ****** *********

  

  Business response

  01/06/2022

  January 5th, 2022

  Dear ******,
  
  This letter is in response to the billing complaint filed by Ms. *********, mother of patient ****** ********* to the Ohio Better Business Bureau on 12/27/21. I would first like to offer my sincere apology for any frustration this may have caused Ms. *********.
  
  A thorough investigation has been completed on ****** *********’s account. As part of the investigation, the account was sent to our coding department, where an audit on the charges was performed. It was determined that the diagnosis code Z71.89 had been added to the claim and rebilled to Anthem on 10/21/21. On 11/11/21 Anthem sent an explanation of benefits to the Cleveland Clinic, stating diagnosis code(s) for the services rendered on August 5th, 2021 denied as non-covered.
  
  As of January 3rd, 2022, Anthem representative, ***** (Ref#**********) stated she has sent the claim back for review and asked to allow 30-45 days for additional information on the denial.   
  
  Thank you for allowing us the opportunity to address Ms. *********’s concerns. If we can be of any further assistance, please feel free to contact me directly at ************
  
  Respectfully,
  Brendan *******, Financial Ombudsman
  

  
  

• Initial Complaint

  12/13/2021

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  This complaint involves an incorrect bill charge from my visit on 11/8/2021 at the Cleveland Clinic Family Medicine **** **** facility. I visit them every two weeks for a testosterone injection by the 'nurse'. I bring my own medication and here on this bill they even charged me for it. The shot is requested by my Endocinologist, ****** ******, MD at the Cleveland Clinic . I have made many past visits with no charges through the nurse but this visit I'm being charged $235.12. I called billing customer service, 866-621-6385 and was told they need to rebill it to Medicare and to wait 10 days. That was on 11/16/21. After waiting more than 10 days, I still see the charge and on 12/1/21 I called again and she said they need to rebill it again to Medicare and to wait 10 days. So I called a third time on 12/10/21 and was told to contact Medicare about this 11/8/21 charge. I called Medicare and was told it is "not in there data base" and have the doctor call the Medicare line 866-276-9558. I wrote the doctor's department to call on 12/10/21. I then call back the customer service billing (866-621-6385) and the lady told me this time it could take a month (not 10 days) for it to go through because there are 400 people ahead of me. Every time I go into an office visit to 'check in' I see this charge I owe on the screen. I keep getting different answers. This is the most inefficient medical department that I have ever come across, I'm so disappointed in it !!!.

  

  Business response

  12/17/2021

  
  
  Dear ****** *****,
  
  This letter is in response to a rebuttal filed in your office by Mr. ***** ******* to the Ohio Better Business Bureau on 12/13/2021. The complaint was sent to the Financial Ombudsman department to review and respond back to you.
  
  A thorough investigation has been completed on Mr. *******’s account. Mr. ******* stated he brought his own medication to his visit on 11/08/2021. His account was reviewed by our Reimbursement Managers who confirmed he did bring his own medication. We have reversed the drug charge of $35.15 and will bill his insurance a corrected claim.
  
  Thank you for allowing us the opportunity to address Mr. *******’s concerns. If we can be of further assistance, please feel free to contact me directly at ************
  
  
  Respectfully,
  
  Stacy ************
  

  Customer response

  12/20/2021

  [A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. 
  
  Regards,
  
  ***** *******
  
  I spoke to Stacy ************ this noon, 12:10 pm, that she will be processing the remainder portion of this bill of $200 to be submitted to Medicare for removal from my bill.

  **** *******

• Initial Complaint

  12/08/2021

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  On June 25, 2021 I was diagnosed with type 2 diabetes at the Clinic. I was given an assessment plan which included a “consult to diabetes education”. This consult took place on August 11. The Clinic’s After Visit Summary to me said the issue addressed was “Diabetes education”. This is a covered benefit by my insurer, Medicare. The Clinic submitted the claim for this to Medicare as “Established patient outpatient visit, minimal presenting problem”. A Medicare representative said the claim presented by the Clinic was for routine care, which is not a covered benefit. The claim was not approved leaving me responsible for the full payment of $61. I have twice asked the Clinic to resubmit the claim and they have refused. They said they had a responsibility to bill accurately “based on services provided at the time of the encounter”. The Clinic’s documentation to me differs significantly from what they provided to Medicare, yet they have failed to explain why. Customer Service said the coding was correct based on the physicians (sic) documentation”, but the Clinic’s documentation to me said I received diabetes education. The Clinic sent me a past due notice, so I have paid the bill, even while I have an appeal pending with Medicare. Regardless of the outcome of the appeal, I should owe nothing given that the Clinic sold me one thing and billed Medicare for something else. If the documentation received by the coding department is different from what I received, that is an internal Clinic problem. Because of the Clinic’s inaccurate coding I am being denied a Medicare benefit to which I am entitled. I want the Clinic to refund my payment of $61, and either resubmit the claim to Medicare as diabetes education or write the claim off.

  

  Business response

  12/16/2021

  
  
  Dear ****** *****,
  
  This letter is in response to the billing complaint filed by Mr. ***** to the Ohio Better Business Bureau, filed on 12/8/21.
  
  A thorough investigation has been completed on Mr. *****’s account. Per my review, it was determined that the coding and billing for date of service 8/11/21, is correct. The appointment scheduled on 8/11/21 was for Diabetes Education and was not for a DMSE/T appointment nor did it meet the criteria of a DSME/T appointment. Mr. ***** received a generalized counseling visit for his diabetes which will bill out as an Established Patient visit. A DMSE/T appointment is a more in-depth diabetes counseling visit  tailored to a patients specific needs with managing their diabetes through education and counseling. The order placed by Mr. *****’s doctor was for a DMSE/T (Diabetes Self-Management Training/Education) appointment which according to Medicare is covered up to 10 hours of the initial DSMT (1 hour of individual training and 9 hours of group training). It is extremely important when setting up appointments to ensure that the proper visit is set up with the provider to prevent issues such as this where a service is rendered that is not a covered service by the patient’s insurance.
  
  Due to Mr. ***** not receiving an actual DMSE/T appointment, he can call our appointment center at 216-444-2273, and set up a visit for a DMSE/T appointment.
  
  As a one-time courtesy, I have requested this balance be adjusted off from date of service 8/11/21 in the amount of $61.00. I have also requested a refund and Mr. ***** will receive the refund up to 4 weeks from today.
  
  Thank you for allowing me the opportunity to address Mr. *****’s concerns. If I can be of any further assistance regarding this matter, please feel free to contact me directly at ************.
  
  Best Regards,
  
  
  Tiffany *******
  Financial Ombudsman
  Revenue Cycle Management, CCHS
  
  Cc: *****,*****

  Customer response

  12/27/2021

  [A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. 
  
  Regards,
  
  ***** *****
  
  
  

• Initial Complaint

  12/01/2021

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  My clinic ID number is ***********. Years ago the Cleveland clinic took away my privileges of using my chart to communicate with my doctors because they said I was making too many calls to my doctor. And they were right. But that was years ago and I no longer call my doctors except for maybe one time a year when it is medically necessary. But the Cleveland clinic refuses to believe that a person can get better from a mental health standpoint, and a clinic refuses to reinstate my privilege of being able to send my chart messages to my doctor. Instead I have to call my doctor wait on hold for an hour and a half, and then wait a few days for a response if I'm lucky. The Cleveland clinic is not treating me fairly as they apparently refuse to believe that people can get better from a mental health standpoint, and the clinic refuses to believe that people's behaviors can change. I just want to be treated like a normal person would. But the clinic wants to label me as someone with a mental health issue who can't get better apparently. This is absolutely disgusting behavior from a facility that is supposed to be world class. I want the clinic to review my records and they will see that I don't call my doctors ever unless it is an emergency, and that is maybe once a year. I need to get a message to my family doctor and I don't want to call and be on hold for hours and wait days for a call back. Treat me with respect like the person I am and reinstate my privileges so that I can send my chart messages to my primary care physician. Show that you are not treating me unfairly. Act like the world class organization you claim to be

  

  Business response

  12/02/2021

  We will send this to our team to review for potential reinstatement. Thank you

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