A very embarrassing and time-wasting experience. I have never felt so uncomfortable with a doctor's clinic in my life.
On February 2nd, I had an appointment with Leah (unknown if that is a first or last name), PA-C. Before the scheduling, I had spoken to PCP for non-invasive surgery to remove moles on my face --- a procedure I had done twice before. The front desk affirmed she was a surgeon (she is not).
During the visit, I explained my expectations of treatment to the provider. Eventually, I was handed a piece of paper with "CBT Codes" written. Dr. Leah explained that she was unsure if my Insurance (Tri-Care East) would cover the procedure. Perplexed, I inquired as to how they would not know. Dr. Leah informed me it is not CDGs policy to consult with insurance companies on what they will cover; it is the patient's responsibility. According to Dr. Leah, Doctors only have time to call some patients' insurance companies -- but not mine.
I spoke with the front office and the Office Manager, Tyina, I
and explained that my insurance covers the procedure.
Tyina said I would need a new referral from my PCP to be seen again. She took the "CBT Codes" to make a copy, and she would ensure the correct referral was placed.
Tyina called me 45 mins later while I wanted in the parking lot and told me I was "all set" for my next appointment. A few days later, I received a phone call from CDG stating that my Insurance approved the referral sent by my PCP, and I could schedule the procedure.
I was informed that this would require multiple visits (maybe 4 or more).
When I arrived for the procedure in the examination room, I was told my Insurance did not cover my procedure. I explained the above to the assistant of Dr. Pimento about my conversation with Tyina and that she spoke with my PCP after I did, and the referral covers the procedure.
Outside the door, I could hear the conversations about me, and it sounded like I was being called a liar; that the discussion with Tyina never happened, and I was told I would be paying out of pocket and chose to come anyways (which was not true)
When Dr. Pinto entered the room---I was not greeted warmly. He walked in and said, "I'm Dr. Pinto. What do you want to have done?" I found this odd for someone who would be trusted with cutting my face. I also found it strange that he would ask me this when I overheard the conversation through the door about why I was there and what I wanted to have done.
After briefly looking at my face, he had me sit on the examining table and said: "This is cosmetic, and you will have to pay out of pocket." I again explained how I spoke to my Insurance, PCP, and the front officer. Neither Dr. Pinto nor his assistant said anything. They stared at me until I felt so uncomfortable that I walked to the front office to talk to the manager.
I had to ask three times to speak to the person who booked my appointments. Eventually, Tyina said I was now being charged out of pocket. Tyina, without any substance to the claim, stated it was possible that I or my previous surgeon engaged in "Insurance fraud." She handed me a copy of the referral to my provider that she had filled out. She told me that she never included the codes on the referral with the codes. When I said yes, you did; you called me and said, "everything was submitted."
Tyina replied. "No, I did not do that." Then she explained it was a favor to me so I could be seen a second time. I then asked why we were not speaking about this issue in private, and the reply was, "you decided to talk about it in the lobby, not me. you wanted everyone to hear about your problem".
Tyina made an error and then lied about it. They refused to contact my insurance company. BL: the procedure is covered by my insurance, but they just kept lying about who I would be seeing or leaving out information to bill my insurance. I am very appalled by CDG. After leaving six messages, no one has called me back. I filed a complaint with my insurance company and the state board of health. read more