ComplaintsforLovelace Health System

• Initial Complaint

  07/03/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My son had an ear tube removal surgery for both ears on June 6, 2023, at the Lovelace hospital located in Roswell N.M. The procedure itself and the medical staff did an excellent job and have no complaints at all from them. My complaint is that prior to the surgery I had been called to discuss the cost of the procedure and was informed that it would be $2783.46 for the procedure that I would have to pay out of pocket for. I asked for an itemized receipt to see what I would be charged for but they could not give me one. I was told that cost was to cover my $750.00 insurance deductible as well as the medical procedure itself. I specifically asked them if that was the total amount that I would have to pay and they said yes. I also called two other times to make sure and was told the same exact amount would be charged with what my insurance was going to cover and the deductible. I agreed to that amount. On the day of the surgery, I paid the $2783.46 and again was told that was the full amount. On July 2, 2023, I received a bill from Lovelace for $870.16. I called billing and a manager about it. They informed me that I had paid the amount for Lovelace on the day of the surgery, but the full total cost was really $2903.62 with the additional $120.16 for the added medical procedure which makes sense. My complaint is that Lovelace did not include my Deductible in the total cost when I paid the bill or called. Instead, they forgot to mention or didn't include it in the cost. So after they realized they had to pay the deductible they then were short on the actual bill. So they sent me the bill to cover it. They should have totaled the full procedure as well as the deductible and made me pay that on the day of the surgery. Also on my receipt it says the price could change depending on further tests or anything insurance wouldn't cover but not leaving out the deductible that needed to be accounted for and added to the total amount.

  Business response

  07/21/2023

  There is a signed Financial consent form signed that states "I understand I am financially responsible for deductibles, coinsurance, and all services not covered by insurance benefits and/or entitlements. 

  We will not adjusting this balance.

   

  Customer response

  07/24/2023

  Complaint: ********
  
  I am rejecting this response because Lovelace does not want to take responsibility for their incompetence and their inability to add basic math to inform the patient of the Actual full amount and break it down for patients. Lovelace can't even supply patients with a basic itemization of the charges because they want to Suprise patients with charges like this that should of been paid first like the deductible. The deductible should have been paid first that's common practice; it is not my fault Lovelace failed to do their job. If I would have had the itemization like I asked for I would have done their job for them.
  
  
  
  Regards,
  
  ***** ****** 

   

  [To assist us in bringing this matter to a close, the consumer must give a reason why they are rejecting the response. If the consumer does not provide a reason the complaint will be closed Answered]

  Business response

  07/27/2023

  We have reviewed your explanation of benefits which left a patient responsibility of $3,653.62. The amount estimated and collected was $2, 783.46. The remaining balance is $870.16, the amount billed. Estimates are not always 100% accurate, we apologize for this inconvenience. $870.16 is patient liabiliy based on insurance payments and adjustments and what they left as patient responsibility. 

  Customer response

  07/31/2023

  Complaint: ********
  
  I am rejecting this response because they do not want to take responsibility for not giving me the accurate price for the procedure by lying to me about the total price which should have included my deductible in the total but instead lied to me saying that it was included only to find out later it wasn't. The question is Why wasn't I charged the total amount of $3,600.00 on the day of the surgery instead of the $2700.00? I understand estimates are not accurate but lying to the patient about the deductible being included is not right. Estimates should not include blatantly leaving out the foreseen cost of a deductible which is known before billing that's why they run it to see what is covered or not. Thats like leaving out the cost of Anesthesia or the procedure itself only to bill the patient later because they forgot. 

  
  
  
  Regards,
  
  ***** ****** 

   

  [To assist us in bringing this matter to a close, the consumer must give a reason why they are rejecting the response. If the consumer does not provide a reason the complaint will be closed Answered]

• Initial Complaint

  12/16/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I went through a procedure with the Lovelace Pain Clinic on 1/11/2022. The procedure went as expected. In February/March 2022 I was being billed for $6,432.30. This was disputed between Lovelace and I and the balance was wiped from my account. I am again being billed for $6,432.30 starting October 2022 of this year. I took the correct steps by first visiting my primary doctor at the *** ****** ****** ****** ******. I went to Physical Therapy for a continued period of time (Aug 4th - Oct 13th 2021 ), that paperwork was again provided November 21st 2022. I went back to my primary Doctor again before being referred to the Lovelace Pain Clinic (Nov 22, 2021). My visits with Lovelace started I believe Dec 28 or 31, 2021, according to the **** claims. Prior to the provider scheduling my procedure on Jan 1, 2022 I was advised no pre auth was needed. Also prior to the procedure in between Lovelace visits further documentation was not requested by the provider nor did I sign a waiver. I'd also like to note that due to me being billed so late in the year again, the appeal process time window with **** has already expired. The issue lies with Lovelace however I am still being billed for this issue. If the doctor/hospital did not follow the correct procedures I should not be charged for their lack of oversight. I have been attempting to get in contact with them everyday for almost a month now I have have no clear answer. I am either told it is "under review" or leadership in charge is "busy." Meanwhile I am stuck with the bill and continue to receive billing statements.

  Business response

  02/24/2023

  
  This account has been adjusted. Please reach out if you have further questions. Thank you.
  
   
  **** ****** ******
  
  Manager, Customer Svc Operations

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