Beware Richens Eye Center BILLING overcharge practice:
MODERATE ISSUE: Richens initially tried to get me to pay more than double what my Medicare Advantage insurance would have approved & paid for an eye exam. When I called them out on that, I found they hadn't even submitted a claim to my insurance). Their billing representative ("Dar") dismissed it as trivial, "We all make mistakes." Well OK, but after that, it gets worse...
SEVERE ISSUE: When my insurance processed the claim, I discovered Richens "UP-CODED" the claim...
1. ...Billing for a SPECIALIST exam (code 99204) as a MEDICAL claim.
instead of...
2. ...Billing for a ROUTINE eye exam (coded 92004 or S0620) as a VISION claim.
In so doing, they OVER-CHARGED my Medicare Advantage, and left me with a $20 co-pay. This is contrary to what I made abundantly clear both when making my appointment, and again on arrival - I came for the "ROUTINE exam with $0 co-pay." I had no eye problems - only the need for a new lenses & frames.
When I again confronted Richens, this time "Dar" justified the up-coding by falsely and repeatedly (6 times) characterizing both the Richens Sunset office, and Dr. Jed Lister, as an "OPHTHALMOLOGIST" and a "SPECIALIST."
Richens own website shows Dr. Lister is an OPTOMETRIST (which is a primary care doc for vision) - NOT an MD, NOT an "OPHTHALMOLOGIST" or a "SPECIALIST." In fact, the front desk told me that Dr. Lister is the only doc in that Sunset office - no OPHTHALMOLOGISTS there.
After this, in a final desperate attempt to justify the up-coding, "Dar" tried to make a big deal out of Dr. Lister noticing I had mild cataracts. Well, of course. That's one of the many things an OPTOMETRIST is SUPPOSED to look for during a ROUTINE exam (along with glaucoma and macular degeneration).
But there was no referral to an OPHTHALMOLOGIST for treatment. Likewise, all 4 of my other OPTOMETRISTS in the past 11 years observed the same cataracts, but none tried to get "extra credit" for noticing it, and all billed insurance honestly, using the correct code, resulting in $0 copay.
"Dar" refused to correct the billing, ruling out the possibility of another "honest mistake," and went on to confess, "WE BILL LIKE THIS EVERY SINGLE DAY." Wow, so it's not a "one-off," but something that gets past a lot of patients who aren't experts on billing codes.
She then threatened collection action, and encouraged me to "go ahead" (and leave bad reviews). So, here you go. I really don't blame "Dar," since she was certainly trained to do exactly as she has done, and say what she has said.
End note: Of course, if Richens and Dr. Lister want to insist he performed a more advanced exam (99204) instead of, or in addition to, what I came in for (92004 or S0620), then he did so WITHOUT MY INFORMED CONSENT. Now that's a more serious matter. read more