UPDATE 5/16/2017 -
So, not only should UCLA & UC Regents fall under the definition of a corrupt organization, but it should be fully investigated for fraudulent medical billing practices. When my attempts to resolve the issue (see below) directly with the medical office were met with disdain, I turned to what I understood to be the next channel of authority - my insurance company. Surely, Blue Cross would want to know & investigate the fact they were billed over $2,000 for 1 single visit that the UCLA billing department decided to code in such a way as to state that my annual physical exam necessitated 4 separate billing codes.
To my shock and surprise, Blue Cross told me that my word - and that of the patient - meant absolutely nothing. They must abide by the coding of the medical office.
OK, next I went to what was surely to be an impartial 3rd Party in such matters - the Department of Managed Health Care. Again, I was met with the same response - they must abide by the medical office billing. Furthermore, since the insurance did not dispute the charges, they saw no reason to further the investigation.
My final attempt was to file a claim with the California Medical Board for fraudulent billing practices. After months of no response to my calls and messages, I finally received a standard form letter in which they stated that my case was closed. Moreover, I decided to follow up as I had a suspicion that no one had in fact reviewed the pages of evidence that I had submitted. Sure enough, not only was the material never reviewed but the matter never investigated. I was eventually told that I needed to go back to my insurance and take it up with them.
WOW - if this is not the definition of unscrupulous, unethical and corrupt organization then I don't know what is.
At the end of the day, UCLA continues to send me bills for a $45.00 co-pay that they are NOT entitled to received due to the reasons I have already explained.
Let me begin by saying that I had been a patient with UCLA for more than 10 years. During that time, my PCP was Dr Grossman - who was fantastic!!! When my insurance changed, so did my PCP.
I had a total of 2 visits with the office - I am using very specific wording here, so please keep that in mind. At the time, I had an HMO which allows for 1 preventative, screening/physical per year at $0 cost out of pocket - no co-pay, 100% covered by insurance. When I scheduled this physical for 3/8/2016, I specifically explained that the purpose for my visit was that of my annual physical exam. When I arrived to my appointment, not only did I specifically tell the receptionist this same thing, but I reiterated it to the nurse who took my vitals. An hour after my initial appointment, the doctor arrived and I, again, told her the same thing: the reason for my visit is for my annual physical & subsequent labs. She proceeds to only then, begin reviewing my medical history and saw that I had been a patient with Dr Grossman. She begins asking me follow up questions about those previous visits - which had NO bearing on the visit in question. Anyway, after she spent all of 5 minutes with me, I checked in with the receptionist so as to ensure that I did not owe anything. She confirmed that because this was my annual physical, there was no charge.
I scheduled a follow up for 3/31/2016 to review the results of my lab work with the Dr. At that time, I was fully aware that I would be responsible for my $45 co-pay, which I happily paid after my visit.
So, why would I received a "summary of benefits" and "statement of financial responsibility" showing that I owed a $45 co-pay for my visit on 3/8/2016? It turns out that UCLA decided that in order to get the most bang for their buck, they would bill my insurance for 3 separate "billing codes" for the one single visit on 3/8/2016. My insurance was charged more than $1,200 for a physical exam, which they paid, but I was still responsible for a $45 co-pay for the same visit because "we discussed other issues." These so-called other issues were my responses to the doctor's questions.
I filed a claim with my insurance at the time. Of course, they have no choice but to abide by what the doctor office sends them. So, I then went to the CA Department of Managed Health Care who, of course, also sided with UCLA.
I have since filed a claim with the California Medical Board. Not only do I believe this is a case of fraudulent billing, but these doctors need to be held just as accountable as insurance companies.
At the end of the day, even if I were to agree that I was responsible for a co-pay for the visit on 3/8/2016, you would think that after collecting more than $2,000 from my insurance, UCLA would simply just let it go. Nope.
I used to believe that it was the insurance companies that were the doers of evil...sadly, it actually begins with the the doctors.
P.S. I love Dr Grossman. He was never anything but kind, sincere and fair. read more