ComplaintsforCalifornia Pacific Medical Center

• Initial Complaint

  04/19/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  Over the last year, I have called the **** Lab, ******** Campus *************), numerous times, and then, when presented by a recording with options, have chosen the option for Phlebotomy Draws (option 4). In all of those numerous calls, it has never once happened that my phone call was answered.On each occasion, I have left a voicemail message requesting information, and leaving a phone number so that my call could be returned. It has never once happened that any of my calls have been returned.I wish **** to investigate this matter to determine what the problem is that voice messages in this mailbox never receive replies, and correct the problem. **** should also investigate whether there are other phone numbers in the system that are never answered, and/or voice mailboxes where messages never receive replies.

• Initial Complaint

  11/06/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  The healthcare facility, CA Pacific Medical Center knowingly did not disclose its out-of-network status to patients this also is an unfair business practice because it didnt disclose important information to customers. What is more, CPMC applies the adjusted procedure without noticing the patient which also was a violation of patients privacy right.******************** was referred by her ** *********************** to CPMC.In Mar, ********* had two blood tests in the CA PACIFIC MED CTR (the Hospital). Each time she submitted her insurance card to the hospital but was not told that the hospital was out-of-network.********* was admitted to the hospital on the evening of Mar.26, 2022 night because of a full-term pregnancy and the ** referred her to be admitted to the hospital. During the whole time ********* stayed in the hospital, never did she hear anything about the provider being Out-of-Network. ******************** was discharged in April.1, 2022 Until we received the bill, we knew that the hospital was not In-Network although this is the same PPO and same Insurance ******* April 4th, 2022, a mail was received by ***********************, which stated that an application for In-Network this service was denied. The letter was mailed out on Mar. 30, 2022. It took ********* a while to learn that the application was filed by the hospital without her notice and consent.

  Business response

  11/16/2022

  Upon review of this account by a ****** Representative, it was confirmed the claim was processed out-of-network correctly. The ****** Representative spoke to the patient and her husband and advised. It is ultimately the patients responsibility to know benefits and ensure they are rendering services at an in-network facility and by contracted providers. The account balance has been adjusted to reflect the in- network rate as provided by their plan and remains on long term payment plan.

  Customer response

  11/21/2022

   
  Complaint: 18367026
  
  I am rejecting this response because: 

  1. The new bill that **** provided did not consider the Max out of pockage of the in-network of the patient. Therefore, the patient sitll needs to pay a large sum of money to ****. 

  2. The **** did not give a reasonable explain  why it applied to insurance company Cigna to adjust fee as In-Network without noticing patient that it was out-of-network.  
  
  Sincerely,
  
  ********************

  Business response

  12/02/2022

  A ****** Representative reviewed and adjusted according to the patients Out of Pocket met prior to the service. The account has been partially adjusted with some remaining balance. A voice message was left with the patient with a follow up letter being sent with the details regarding adjustment and the remaining balance.

  Customer response

  12/07/2022

   
  Complaint: 18367026
  
  I am rejecting this response because: The hospital adjusted the amount to $6394.70 on December 1,2022. However, please review the document (Insurance plan coverage for in network services) I submitted on November 22, 2022. My current out-of-pocket Maximum Remaining is $4319.10,not $6394.70. I already met $2080.90, which was also mostly paid for the same surgery at the hospital.  
  
  Sincerely,
  
  ********************

  Business response

  12/16/2022

  A ****** Representative spoke with the patient today. The patient acknowledged receipt of the letter with the details of the additional adjustment. We adjusted this claim to the in-network amount as shown in her benefits before service rendered. She was referred to her health plan to discuss what her out-of-pocket amount was prior to this claim being processed.

  Customer response

  12/20/2022

   
  Complaint: 18367026
  
  I am rejecting this response because:

  CPMC committed fraud to the patient by withholding material facts. The patient was never informed by CPMC that CPMC is an out-of-network facility. CPMC knew that the patient may not use its service if the service was out-of-network. Without informing the patient first, CPMC applied for In-network benefit to the insurance company Cigna on behalf of the patient in March. The patient found out after receiving the denial letter from ******

  CPMC had strong motive to commit fraud because CPMC billed $78,792.46 in total. From two Cigna explanation of benefits, CPMC billed Cigna $64,872.34 and $13,920.12 for its service and the patient had to pay $12,488.40. This is a surprise medical bill and an undue burden to me. If I was informed by CPMC before receiving the service, I wouldnt suffer from financial stress and distraught while recovering. CPMC and Cigna have all bill breakdown and details at hand.However, CPMC was reluctant to consider my current in-network out-of-pocket maximum remaining shown on the Cignas official website. CPMC asked me to address this with ***** directly. In order to get more evidence and to compensate the damage, I will bring this case to the court through discovery if needed and will also request penalties for ***** wrongdoing.
  

  In addition, CPMC miscalculated my in-network out-of-pocket maximum remaining. I already paid $2,080.90 for in-network service under my Cigna plan. One of the in-network payment $2,060 is for the anesthetists service on March 27 at CPMC. The disputed claim $64,872.34 (patient bill $12,488.40) is for the services from March 26 to March 30, 2022. CPMC shouldve used March 30 as the service date since thats the date the service has completed. This bill must be calculated by CPMC after the service was completed and after the patient was discharged under Doctors order because CPMC wouldnt know whether the patient will be discharged from the hospital as planned. (Its up to patients recovering status and doctors order.) Another CPMC claim $13,920.12 is for the service on March 27, 2022. CPMC shouldve added these two CPMC bills ($78,792.46 in total)first while calculating my in-network out-of-pocket maximum remaining. Therefore,CPMC miscalculated it and refused to adjust it on the December 16 response. The current adjusted CPMC bill is still $6,394.7. Im requesting my remaining balance should be adjusted additional $2080.90.
  
  Sincerely,
  
  ********************

• Initial Complaint

  10/07/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  ****-****** Health has been harassing me due to a COVID-19 related emergency room hospital visit. **** failed to and still has failed to bill the correct entity. I am a medi-cal recipient. This should have been billed to them but the hospital tried billing me personally for $3,000. COVID-19 is NOT MY FAULT! I should NOT be stuck with a bill for something uncontrollable. *** reached out several times to try to get issue resolved. I will not be paying such bill when I was never given a room all day at the hospital, they had me sit to the side where I was told by multiple staff to get up until someone finally intervened. I still was never given a room just told to stay in a specific section of the hospital. No bed. I had to sit in uncomfortable positions in the hard wooden furniture in the lounge area. When the doctor finally seen me at 4:30pm I was only brought to a triage room, prescribed some regular medicine and sent home. I was at the hospital all day since 11am and only in the triage room for less than 1hr. From the time I got there until seen I sat in pain. I had to ask a black staff member to retake my temperature since arriving because I felt worse as I sat there all day crying- my temperature had increased by that time to 103.4F, I couldnt even get water until 3pm after tricking another staff member into giving me water after being told no multiple times. I do not appreciate them trying to Pin this bill on me as ******** is an undue hardship, burden, deadly virus and unfortunate/unforeseen circumstance that is uncontrollable. This bill needs to be handled by the ************* ****************** As I am not the entity responsible for starting, controlling, spreading, or of any nature the cause for or due to COVID-19. Visit date 7/11.

  Business response

  10/17/2022

  Good Afternoon,

  The patient posted identical complaints on 2 separate BBB sites, the BBB Serving ********************** and Northern Coastal California (ID of ********* and the BBB Serving Northeast California (ID *********.
  
  The complaint posted to the BBB Serving Northeast California (ID ********* has a response posted on the BBB site.
  
  

  Best,

  *********************

  **** Risk Management

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩