ComplaintsforGood Samaritan Hospital
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Complaint Details
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Initial Complaint
01/03/2022
- Complaint Type:
- Product Issues
- Status:
- Unanswered
I visited the ER at Good Samaritan Hospital in *** **** on *** 17th, 2021. I came to the ER with cellulitis, redness, and pain in my right foot. The visit with the attending physician lasted 5-10 minutes. He asked if I had pre-existing conditions, and I told him I had Reflex Sympathetic Dystrophy, or CRPS. He immediately said, 'This looks like RSD' and I agreed, as I had had the condition for two years already and this episode was behaving exactly like a flare up of that condition. He told me I would need to go home and ice it to help with the pain, but first we should do an ultrasound to check for a clot. I did not take up a bed, there were not multiple doctors involved, and this was not the first time I've had a flare up of my condition so it did not even need to be diagnosed for the first time. I have good insurance. I later received a bill from the radiologist and the doctor - I had to pay a combined $200 or so for these. I received a third bill from the hospital for $****** for 'ancillary services' which is so vague I could not tell what I was even charged for. My portion of this bill was nearly $****. After some wrangling on the phone, I was able to get the medical billing codes that had been used. The ER services portion of the visit was fraudulently billed under CPT code XXXXX, when XXXXX should have been used, as this case was a straightforward diagnosis of a minor problem that required only elevation and ice. According to CPT code definitions on the American Medical Association website, XXXXX is reserved for "Medical decision making of high complexity". It requires "coordination with other care providers...." and is for "high severity problems that pose an immediate significant threat to life or physiologic function." Charging my insurance $****** under XXXXX for a recommendation of elevation and ice is fraudulent medical billing, and I should be refunded the money that I had to pay to my insurance company for that hospital bill.
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Customer Complaints Summary
2 total complaints in the last 3 years.
1 complaints closed in the last 12 months.