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Health Care Facility reviews in Twin City

  • F

    Procedure was scheduled as ASAP.  Authorization was obtained through National Imaging Association on behalf of Coventry Health Care Insurance.  Peer to Peer review was required in order to get approval due to the STAT nature of the scan.  We went for the MRI on 02/27/2015 .  At that time I was advised of the IN NET WORK charges / Estimate of $1771.20.  We proceeded to the back to have the scan done.  After the scan was complete (Said Employee) took  me back to her desk to do a review of the benefits.  She then proceeds to ask me if I was aware that the scan would be considered (OUT OF NETWORK) per my insurance.  My reply was NO, its a little late to be telling me this now, don't you think?  She then proceeds to try to figure the estimate and cost as out of network to see what my charges would be. The estimate did not change or adjust for Out of Network.  I explained to her that I do have Out of Net work benefits with my Insurance . She then proceeded to tell me that I would be able to make payments regarding this service since the charges may be more.   Well......   I have now received the EOB from Coventry ( which they have denied all charges due to no out of network contract with the Hospital) If I had known this ahead of time, I would have went else where!

    Received the Statement from the Hospital today $ 3,221.77 ( patient to pay complete amount as service was out of network).  I then called the billing dept. ,  Overall the staff was very nice. One particular said employee reviewed my case and said that per the notes in the system, I was aware that the service was out of network!  That is all she cared to hear.  I tried to explain to her that I was told that after the scan was done, yes I was aware . She told me to call my insurance and argue with them. I did, per Coventry , they will not cover the MRI because of no out of network contract with the Hospital.  That was per Coventry's claim adjuster.  Call back to the hospital and speak with a billing supervisor  who I then plead this case to all over again, who seems to realize that they made an error. She needs to go discuss this with someone else and call me back.  She calls back, admits this was their error in retaining the benefits on the day of the scan and offers me a deal with a 40% cost break. which would be $1933.06 .  The catch is that I had to pay that amount right now!!  Or keep the original statement amount of $3221.77.  (Even though they admitted they did wrong)  She new that I was unable to pay the entire amount to begin with.  I had already told her that I needed a payment plan.  * So let me get this straight, She  can give me a 40% deduction ( because her employees made a mistake in doing their job appropriately but yet she is  going to penalize me for not being able to pay the full amount today.  That is just bad business.  This is a fine example of why the Health care system is falling apart for so many facilities and providers.  I work in the medical field and I do insurance verification and precertification every day.  If I ever made a mistake like this , I would have to answer for it with my providers and it would not be my patient that had to pay the cost for it.

    I will never use  or refer any of my patients to this hospital / facility for any kind of medical care or service, and  I  do a lot of referring via my medical practice that I work for. / Gina

    On a Positive Note: The MRI Technician  , Imaging Atmosphere and Imaging staff were AWESOME!  I do not want the billing departments short comings to reflect the actually patient care that was provided by the Imaging center.


    - Gina J.
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Health Care Facilities in Twin City

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