Public Mediation

My Claim vs. Clear Lake Regional Med Ctr Dispute #1742782

K. B. vs. Clear Lake Regional Med Ctr
500 Medical Center Blvd, Webster, Texas, 77598, United States
Amount Involved: Other terms
    • Status: In Negotiation
      This claim has posted for public comment and negotiation. It will remain posted until resolved to the claimant's satisfaction. Suggest a resolution to help these parties reach a settlement.
       (seeking public comment)
    • Claimant Seeks: 1 non-monetary items.
    • Claim #: 1742782
    • Amount Involved: N/A
    • Filed On: Sep 24, 2013
    • Posted On: Oct 05, 2013
    • Complaint(s):
      • Commercial / Other dispute
      • Incorrectly labeling of the service and over charging for higher level than the care actually provided
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Statement of Claim
Complaints Involved (2) - View
Claimant says:
"On 4/29/2013 I called the urgent care office describing a minor skin rash that was causing quite a bit of discomfort. I was referred to the Clear Lake Regional Medical Center. After waiting at least an hour, the person at the desk recorded my symptoms, took my blood pressure, ask for my weight and height, and sent me back to the lobby to wait. After an other 30 mins, a physician looked at my arm, while we were both standing in the hallway, asked me to describe my symptoms, then told me that it was not life threatening and I could go home if I wanted to.
I explained that I was aware of that, but wanted some relief, my reason for coming in. He then sent me to the lobby again. I was then called to provide insurance information, and was sent to wait in the hallway on a chair. Some times later, a nurse explained to me in the hallway that it was most likely a food allergy and that the physician wrote a prescription. He gave me some pills, and sent me home with the prescription.
Weeks later I received a hospital bill, independent from the physician's bill, for $897.00, the balance of a $1031.00 charge after my insurance paid its portion per "their agreement with this provider". My repeated request for a bill itemization were not answered, instead I received new bills for that $897.00 amount. I asked for an audit of the bill, the answer soon came back that the charge was appropriate for the services. Upon insisting on a bill itemization, I finally received one that described among other charges for the pills, a line item coded 450-emergency room, service description Emer. dept. Level 3 $975.00
I went personally to the office that took my insurance information and asked to review record of the service provided to me that night. The person at the desk upon reviewing the record described is as a minor skin rash that should be defined as a level 1, not requiring an emergency room nor a level 3 description. She gave me the phone number for the billing department to call. I asked them to review the bill again based on my recent inquiry. They started an other audit, and sent me a form dated July 29, 2013 to fill disputing the charges. I never received a result from this second audit. Instead I got a new bill and a phone call from a collection agency, to which they submitted my case.
In addition, my Insurance company wrote in the copy of the payment statement that "the amount billed is greater than the amount allowed for this service. Based on our agreement with this provider, you will not be billed the difference". Therefore their charge were not in line with the agreement with my insurance company, and I was not informed of that in advance
Contrary to the information clearly stated on their release paper, I was never told of any co-pay, nor an estimate of any amount that would be due by myself after my insurance paid out. This is a violation of their own written policy, and I have never had a medical facility not inform me of my co-pay amount when I submitted my insurance information, unless there is none, specially the medical service to provide was already known, because the only thing left to do was write the prescription.
I feel the Clear Lake Regional Medical center did not act in good faith and in accordance to their billing policies. I need this case resolved, and my name removed from the collection agency."
...
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What Claimant Wants Hide
Non-Cash
What By When How Much
1. Payment has been satisfied by my insurance company, I want my name off the collection agency, and the bill voided Oct 09, 2013 N/A
Cash
1. Other – Pay for claim posting cost Oct 09, 2013 $7.99
Cash total : $7.99
Non-cash: 1 items
  • 0
Do you agree with the claimant’s demands?  (If you are a party to this claim, click here.)

Respondent's Counteroffer

There has been no response to this claim from Clear Lake Regional Med Ctr. This claim will remain posted until resolved
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