ComplaintsforKettering Health

• Initial Complaint

  03/14/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I went to the ER in May of 2022 for an allergic reaction to a medication I was prescribed. I have no complaints about my care received - the staff at KHN were great, and I was in and out quickly. My issue is with the billing department. They incorrectly coded my visit as being for dental, which it absolutely was not, and as such my medical insurance is denying my claim. I specifically selected this hospital because they're in my network. I was told my claim is considered dental because my dentist prescribed me the medication I was allergic to. If you review my claim, you'll see that I did not receive treatment for any dental issues or pain. I was prescribed an anti-nausea medication and injection. To add insult to injury, the ER physician's bill was corrected and resubmitted to my insurance, but the hospital refuses to update their coding, citing "insurance fraud". Is it insurance fraud, or does KHN not want to award the discount I'm entitled to because the hospital is in-network? I have filed appeals with KHN and my insurance company to no avail. Of course my medical insurance isn't going to cover it, the claim is marked as a dental service! I have been dealing with this issue since September of 2022 when I first discovered my claim was denied. I've talked to probably 8 different people with no resolution in sight. It really is a shame because the treatment I received was great, but the issues I've had from the billing side will ensure I never return to KHN for services in the future.

  

  Business response

  03/17/2023

  The coding was thoroughly reviewed by our coding department and determined to be coded properly, per physician documentation.
  Our claim was denied by insurance as non-covered. There is no contractual adjustment indicated on the explanation of benefits, therefore a contractual adjustment is not applicable.
  
  

  Customer response

  03/20/2023

  Complaint: ********

  
  

  I am rejecting this response because:

  
  

  It makes absolutely no sense that the ER physician can update their coding, but the hospital continuously refuses to. I submitted the updated EOB that was sent to my insurance company from EMS, and subsequently my insurance covered the physicians charge. I have spoken with ******** at EMS who has spoken with somebody at Kettering health Network, and she also does not understand why this can't be updated. Additionally, I am not satisfied that the person who contacted me from Kettering Health Network was the initial person I had a complaint with! I want to speak with a supervisor. Again, going around in circles over a very simple coding issue is ridiculous.

  
  

  Sincerely,

  
  

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

  

  Business response

  03/28/2023

  Per further review and auditing with the coding department,  there is documentation in passing about the nausea and vomiting, but only as a secondary issue.  Primary exam, treatment, and documentation all indicate the patient’s dental issue as the primary reason for the visit.  
  
  Per the False Claims Act,  we cannot code this account in a manner that doesn’t match the documented medical records to generate payment from her insurance.   
  
  The patient is welcome to reach out to our Medical Records department to request an amendment to her chart.   That number is ************   option 3.     Per HIPAA law, the patient is allowed to make amendments to her own record at any time.
  
  

   

   

   

   

   

  
  

• Initial Complaint

  01/03/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I got approved for an MRI finally! I had to jump through a million hoops since june to get this approved. So a scheduling Lady named **** calls me and leaves a vm on or about friday the 23rd dec. It was late in the day when I heard the vm and just before my holiday celebration for saturday. I was busy in the kitchen. So I call this week and keep calling. Only to find out she isn't in the office. She's out for a whole other week. There is a note saying no one else is allowed to schedule my MRI!!and no one can tell me if anyone is temporarily filling her position while she is gone! That is incompetent work on behalf of kettering network. All I want to do is get on the schedule so I know my appointment ahead of time. I have many health appts every week. Its very important to get the date and time. I will resend everything from kettering and go to ***** if this isn't corrected asap. A grievance will be filed. To hold my information hostage and not allow me to schedule with **** ******** hospital is absurd!!

  

  Business response

  01/11/2023

  January 11, 2023
  
  
  ******* ********
  *** ******** ****
  *********, **
  
  Dear Ms. ********:
  
  I hope this letter finds you well.  Your Complaint with the Better Business Bureau (BBB) was received, and an investigation begun on January 3, 2022.  At Kettering Health Network, we are committed to provide high quality healthcare services to our community and it is always our goal to serve you safely and effectively with respect, integrity, teamwork, and excellence.  Therefore, our responsibility is to assure you, your concerns have been investigated and appropriate actions have taken place.
  
  Your care concerns were shared with and reviewed by the Director of the Radiology Department, the Manager of the Radiology Department, the Manager of Scheduling Services, as well as the Manager of the Patient Relations Department.  These individuals are the most appropriate to review this matter and take any warranted follow up actions.  Our investigation into your concerns was completed on January 10, 2022.
  
  I understand that you were approved for an MRI after you had to work very hard to get your insurance to approve the testing.  Our investigation found that our staff member had reached out on 12/19, 12/22 and 12/26 and left a message. When you returned our call, you were told that the person who needed to schedule your MRI was out of the office for a week and no one else could provide you the assistance you needed to schedule this MRI.   We found that a note had been placed on your chart not to schedule/reschedule/or cancel the MRI but send your call to the original scheduler.  So, when you called the team referred you back to this scheduler.  Because this happened it inhibited your ability to get this test scheduled in a timely manner.  We very much appreciate that you have brought this issue to our attention.  We are currently looking at our current process and possible changes we can make to avoid this occurrence for other patients in the future.  After finishing our review, I did note that you were able to be scheduled for the MRI on January 6, 2022.  Again, please except our apologies as this should not have occurred.
  
  I truly hope the above information is beneficial to you.  On behalf of the KHN, please accept our most sincere apologies if we have failed to meet your care expectations and for any stress and anxiety you may have experienced.   We appreciate you bringing your concerns to our attention and allowing us the opportunity to address and improve upon the quality of care and treatment we provide to our patients. This completes the investigation and follow-up process.  I truly hope your recovery is going well and wish you God’s blessing of improved health for the future.
  
  Should you have any further needs or concerns, please do not hesitate to contact me at 513-867-3399.
  
  Sincerely,
  
  
  ******** ****** RN, BSN-CCM, MHA
  Manger of the Patient Relations Department
  Kettering Health Hamilton
  
  
  
  
  
  
  
  
  

• Initial Complaint

  06/23/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  The basis of my complaint is that Kettering Hospital sent a very large bill still being processed by insurance to a collection company. There was a lot of errors on the insurance providers side which caused the claim to be rejected. I got it straightened out and had both the hospital and insurance in the office with each other to get it fixed. The original service date was October 4, 2021 and received the bill unexpectedly by January 2022. As I had already met my premiums a 7k plus bill was a shock. By 5-2-22 I had received my final conversation with Kettering extended office and assured them that **** ***** **** ****** was in talks to pay them. They did on 5-5-22. So my issue is on 6-21-22 I received a letter dated 6-14-22 that the debt was sent to ***** *********, a debt collection company. I have also learned that there are additional 8k charges that may incur the same issue all over again. **** is in talks with them again for this next issue but they already have said that the account cannot be put on hold for me. After many years of dealing with the exact same medical issue this one year suddenly is such a problem. ****** **** did cause it but Kettering purposely and maliciously made it worse and tried blaming me. My main goal is to make sure they don’t damage my credit and to maybe have them take a hard look at their billing practices and communication with insurance providers. I’m not sure what to upload so I can send what you ladies and gentlemen need as needed.

  

  Business response

  06/28/2022

  Patient’s insurance processed the original claim on 12/13/21 and applied a large deductible.  The patient disputed his balance with his insurance, but patient didn’t stay in communication with Provider regarding status of his appeal/dispute. The account aged out and was sent to collections due to length of time insurance took to reprocess claim. 
  
  Insurance reprocessed the claim on 6/21/22 and paid 100% of the allowed amount.  The corrected explanation of benefits now shows zero patient responsibility.   The account has been corrected and at a zero balance.  The account has been recalled from collections. 
  
  A call was made to the patient and voicemail was left providing action taken on account.  We apologize for any inconvenience this may have caused and we thank you for letting Kettering Health investigate you billing concern.
  
  
  

  Customer response

  06/28/2022

  
  Complaint: ********
  
  I am rejecting this response because: While It is true that the balance has been resolved, the explanation behind it is not factual, the dates only show the literal newest dates Abe not the actual dates, and completely disregard my attempts to talk to them and the fact that my insurance was in contact with them. Kettering last call to me was 5-2-22 and I talked with the extended office they called themselves . On 5-5-22 They were paid according to insurance.

  My insurance kept dropping the ball big time and I had to call them many many times, hours on the phone each time. So too be told that I did not keep up on my insurance? Insulting to say the least. I will be calling the number they gave me in the voicemail as well but they clearly don’t understand what they did. The state themselves that my insurance took too long for them so they decided in essence to come after me. Only now do they have any care or will to look into things. I’m sure I’ll be here again when the next pending bill they have now posted as in progress suddenly is an issue as well. 

  
  Sincerely,
  
  ******* ********

• Initial Complaint

  11/17/2021

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  On 22 Jan 21, I received a estimate liability for my medical procedure of $257 (see attached document). On 15 Feb 21, 2 days before my procedure this amount went up to $834. I was told by the billing office this cost could go up some but it would not be a significant amount more. At that time, I agreed to going through with the procedure. (I do not have supporting documents, this was phone conversations) In Nov 21, I finally received the bill for $1441.58. This is almost double what I was told 2 days before my procedure. And 5x the initial estimate liability I was quoted. I understand this is provided at as a "estimate", however billing at double the estimate is completely misleading and deceitful. I am requesting that Kettering Medical bring this to a resolution that is more in line with the estimate I was provided.

  

  Business response

  12/06/2021

  Business Response /* (1000, 5, 2021/11/18) */ Thank you for the referral from Ms. *******. As this is billing related, an interdisciplinary approach will be taken to conduct the investigation, please allow additional time for a thorough review. Consumer Response /* (3000, 7, 2021/11/20) */ (The consumer indicated he/she DID NOT accept the response from the business.) I understand the company is requesting additional time for review, please provide the date a response will be provided. Business Response /* (4000, 9, 2021/11/23) */ Reviews are typically completed within 30 days. A letter has been sent to your address with additional information. The review is in progress. Thank you.

• Initial Complaint

  10/04/2021

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Resolved

  More info

  I have a primary and secondary insurance company. Kettering has not billed my secondary insurance, therefore I have medical bills that are listed as pending. I have called multiple times to try and get this closed out without success. I am even willing to just pay the co-pays and submit a claim myself to the secondary insurance, since I've done it before with other medical bills. If I was allowed to do this, the bill would be closed out and I would already have been reimbursed by the secondary insurance. Its unbelievable that I want to get a bill paid and am even willing to do the work myself, and yet I still have these bills hanging over my head. Please just bill me!

  

  Business response

  10/07/2021

  Business Response /* (1000, 5, 2021/10/05) */ I spoke with consumer and obtained secondary insurance information. Accounts are being updated and billed to appropriate plan. Consumer Response /* (2000, 7, 2021/10/06) */ (The consumer indicated he/she ACCEPTED the response from the business.) Customer service called and stated that I was being given a higher priority. They accepted copies of my secondary insurance information and asked for a chance to bill them again instead of billing me and having me submit a claim to the secondary insurance. I agreed that I would give Kettering another chance. If it does not work out then the next step is to bill me and I'll file a claim. At least it appears things are moving again.

*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. ↩