Complaint 1
N&A refuses to explain codes/re-bill session despite my in-depth research & explanation citing session empirical data & CPT code docs written by AMA. N&A:
1. unbundled 99214 (evaluation & management[E/M], Moderate level medical decision making[MDM]) into 99214 & 90833 (code for psychotherapy[PT] added onto E/M) with PT performed w/o my scheduling/knowledge/consent violating medical ethical tenet Autonomy. N&A describes PT as "coaching, problem-solving, education related to side effects of med[s], & how to mitigate these" but these not true PT & if necessary part of psychiatric E/M, already included in 99214; otherwise unnecessary so no code allowed. also unnecessary as I already had N&A psychotherapist.
2. upcoded 99213 (E/M, Low level MDM) to 99214 when session only qualifies for 99213 as at 25 minutes, 20 documented PT thus 5 left for E/M (may not double count time) & MDM level was Low not Moderate as session covered single med lemborexant with potential generally manageable side effects for single stable chronic illness(SCI) of insomnia, tolerated well for 39 days at 5 mg feeling need more so increased to 10 mg as planned last session. Other conditions all SCIs & meds long tolerated weren't worked on.
Provider themself stated assigned Moderate like for 99214 not Low like for 99213 with any change in med/dose, but this isn't sufficient condition. With element of MDM "Risk of Complications &/or Morbidity or Mortality of Patient Management", "Rx drug management" is example only & med/dose change isn't criterion; risk level is. If med/dose change doesn't pose "Moderate risk of morbidity from additional diagnostic testing or treatment", then it alone doesn't justify Moderate. N&A providers have been using this too loose decision rule to assign Moderate, so undoubtedly very many N&A sessions have been upcoded & over-billed in fraud for profit exploitable population patients, especially mental health. Same true of unbundling & upcoding described above (many of my sessions).
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Complaint 2
sent N&A this message many times; ignored: I must contact N&A patient rep/advocate/liaison, ombudsperson, & HR & demand my rights as (former) patient healthcare institution N&A be upheld. Despite many pleas, N&A denies rights, blocks my email from all N&A emails & all phone # except 1 QA who refuses to help & tried call as N&A coerces & they dictate I don't have concern to address & hung up on me mid-sentence saying need help. Zero N&A people to count on. QA ignores all voicemails & emails, 5+ different unresolved problems I explained in depth multiple times, neglects some over 4 months since 5/6/2024. many questions no answer. probable discrimination as I persist bill dispute backed by my in-depth research citing session empirical data & AMA's CPT codes (see other complaint).
QA fails fulfill role & member duty as neutral, independent mediator between institution/company & patients, instead puts N&A interests ahead (so many upset patients: see BBB, Yelp, etc.) clear bias toward N&A/against patients, disregarding well-being, violating medical ethical tenet Beneficence. Mistreatment by N&A not only QA neglect/callous dismissal/bullying (form of abuse) but also insult & threat degrade my mental health: feeling help/hopelessness, low self-worth, futility contribute depression. On edge & thoughts race can anything do/say make N&A help contribute anxiety. Seeing facts & my concerns denied/ignored as if no exist contribute sense reality breakdown.
I mentioned these negative mental health effects to N&A "mental healthcare institution" many times, but N&A continues cause them contra medical ethical tenet Non-Maleficence. stated many times impossible resolve 5+ problems N&A over phone, only email works, & even no longer feel safe call as family threatened throw me out if call N&A because strife for us though no income currently & don't know where to live, but N&A still refuses email. All above N&A must stop.
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I welcome others' messages to compare notes, find common problems N&A could make N&A stop if informed it caused multiple patients same problems. strength numbers/preponderance evidence. For all patients all wrong codes must be corrected, re-billed, refunded.
N&A written contract w/ me signed via email stating it must explain the coding of all my sessions in detail or re-bill with no CPT codes assigned. N&A refuses do either so in violation thus theft. I allow codes I must now determine actually qualify myself from 10 yrs. training & exp. as researcher/scientist & 5 months research CPT codes since Apr. 2024 doing N&A's job for it 100s hours unpaid labor knowing N&A coding practices incorrect due to misinterpretation AMA's CPT code docs for profit/incompetence despite my extensive instruction from 9 yrs. exp. part-time instructor/teach assist/tutor.
Since N&A breaks contracts with patients such as mine above & as with me too its Billing & Consent, I urge you not to sign them.
-patient, PhD read more
