ComplaintsforUW Health

• Initial Complaint

  02/10/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On July 5th 2021 I received an emergency appendectomy at UW Health TAC hospital. The **** was processed through my insurance I was only to pay my co insurance per my insurer Aetna. I recently received an additional **** from UW Health stating that I owe an additional $2200 in denied insurance claims. When I contacted UW Health they stated that that Aetna is not following their contract with UW Health and bundling billing. Because of this UW Health has decided to charge the patients instead of fixing the issue with Aetna. I was specifically told that **************** at UW Health decided to start charging patients for Aetnas inability to follow the contract. UW Health never informed me that this was going to start happening. Why should the patient have to pay for contract issues between the insurance and the hospital? They are putting their issues on the patient without letting the patients know they are going to start being charged. I was never notified of this change in billing practices by UWHealth.

  Business response

  02/14/2022

  Good morning ****,
  
  Thank you for your inquiry.
  
  The Aetna Bundling issue goes back to 2019.  When the issue was reported, it was brought to Aetnas attention immediately.  UW Health has provided Aetna with many spreadsheets listing all the accounts effected and after roughly a year of Aetna not responding to the issue, Aetna was advised that their members would be billed. 
  
  UW Healths Management created a letter that would be sent to patients with Aetna advising them of this issue.  **************** was sent a letter on 11/16/2021 which details the issue and what she can do to have it resolved.  As patients call into our **************************** we are also advising them that they can set up a payment arrangement, apply for community care, and/or reach out to the Insurance Commissioner to put in a formal complaint.  
  
  Currently Aetna has reported that a ticket has been created to have this issue fixed and accounts reprocessed but that was reported months ago and there is still no resolution.Billing the patient was the last thing UW wanted to resort to, but after many failed attempts to make Aetna realize how big of an impact this was having, it was the only choice. 
  
  Thank you,
  
  **************
  UW Health

  Customer response

  02/15/2022

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to **mplaint ID ********, and have determined that this does not resolve my **mplaint.  For your reference, details of the offer I reviewed appear below.
  
  I do not accept the fact that the issue between Aetna and UW Health should fall on the patient.  If UW Health has issues with Aetna then it should not be an in network provider for Aetna.  As of right now they are not acting as an in network provider if I am having to pay more than my ** insurance and ** pay deems necessary.  I was not made aware of the questionable billing practices until after my procedure was **mplete.  Why are they not alerting patients before any procedures of possible extra billing? I believe they are hiding this from those insured by Aetna until after procedures have been **mplete in order to get more money.  Had I been aware of the issues between UW Health and Aetna before hand I would have gone to a different hospital.  UW Health seems to be intentionally hiding this information to keep patients **ming to their clinics and hospitals only to blindside them afterwards with extra billing. 
  
  Regards,
  
  *************************

  Business response

  02/15/2022

  We are sorry you feel this way but UW Health as exhausted it's efforts to resolve this on your behalf. As stated in the letter sent to you, we recommend you take the following steps:
  ? Call your payor at the number listed on the back of your insurance card to discuss the payors
  processing of this claim and ask that they pay for the bundled charge.
  ? Call your ************************* if you have an employer sponsored health plan. Explain
  that because UW Health and Aetnas contract does not permit charge bundling, you have been
  billed for the balance. Your ************************* can speak to their account manager at
  Aetna to inquire about getting your claim reprocessed.
  ? If neither of those are successful, you can also reach out to the *************** Commissioner
  office to ask for guidance in getting Aetna to process your claim appropriately.
  

• Initial Complaint

  12/21/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  UW Health has a very confusing billing process geared towards overcharging patients. ** has different entities ** Hospital and ** Clinic. Even the name of the facility may have Clinic in it but legally it may come under ** hospital ownership and if that's the case then the patient would get a huge **** of hospital facility charges separately.I went to University Station Eye Clinic - Ophthalmology and got an invoice of close to $600 for a regular annual eye exam. It contained both hospital and physician charges. This is a ridiculously high charge for just an annual eye exam. While scheduling my eye exam or checking in at the clinic reception, I was never told that this facility comes under the ** Hospital entity and not under the ** Clinic entity. Both entities have the same name and for consumers, there is no way to determine whether the facility would be considered as a clinic or a hospital.** should make it transparent to customers to help identify whether the facility is considered a clinic or hospital so they can plan their expenses accordingly.

  Business response

  12/28/2021

  Complaint Submission Date: 12/21/2021
  ID: ********
  Customer Information:
  ***********************
  
  Good afternoon,
  
  We received your inquiry regarding the Facility Fee at our UW Hospital and Clinics-Hospital locations, more specifically the University Station Eye Clinic.
  
  The Patients charges were as follows:
  UW Hospital and Clinics- University Station Eye Clinic- Facility Fee $200.00
  Balance of $134.00 is applied to deductible
  ** Physicians- Refraction $70.00
  ** Physicians-****************, OD $298.00
  Both are still pending insurance and we do not know what will be applied to the patients out of pocket.
  
  Patient had been seen earlier this year in the same clinic and was charged the same facility fee, however at that time the facility fee was $190.00. Each July our fees are reviewed and determined if there will be a price increase. At that time the price was increased from $190.00 to $200.00. The patient had a different insurance at that time and the insurance paid the Facility Fee in full and patient paid $81.51 for the Provider charges.
  
  In November the patient was sent an appointment reminder via MyChart that states there will be a Facility Fee for the November visit as well as when the patient came in for his appointment on 11/9/2021 he was offered the ** Hospital Notice of Hospital ********** Services that informs patients that they will receive two separate bills for their services.
  
  Here are two references that can be helpful in determining when UW Health care will have two bills (Facility fee and Physician).
  UW Health locations owned by ** Hospital. These locations will have a Facility fee
  American Family Children's Hospital Clinics (**** Highland Ave.)
  Digestive Health Center (750 University Row)
  East Clinic (*************** Dr.)
  Hand and Upper Extremity Rehabilitation Clinic (************.)
  Kidney Clinic (*********************.)
  Lymphedema and Venous Edema Clinic (********* St.)
  Oakwood Geriatrics Clinic (*********************.)
  Pain Management Clinic (***************.)
  Rehabilitation Clinic (**** University Ave.)
  Research Park Clinic (**************.)
  ****************** Clinic Physical Therapy (*****************.)
  University Hospital (****************.)
  University Station Clinic (**** University Ave.)
  ***************************** Center (****************.)
  ** Health at The American Center (**** East Park Blvd.)
  ******* Center (*****************.)
  West Clinic (451 Junction Rd.)
  Women's Pelvic Wellness (202 S. Park St)
  Yahara Clinic Orthopedic Physical Therapy (**** East Broadway)
  Note:  This is not an all-inclusive list and there may be some exceptions
  Example some care at ******* may have a UW Health Facility fee as the clinical space may be rented
  How to look up an individual Provider to determine if your visit location will have a Facility fee and a Physician ****:
  
  Online at:  UWHealth.org   
  Click on:  Find a Doctor (top left)
  Go to:  Magnifying glass | search by provider name (enter name and enter)
  Click on:  Provider name hyperlink
  Click on:  Practice locations
  Select the location you are scheduled at (click on blue down arrow)
  Click on the blue box    
  If the location has a blue icon listed:
  The location will have 2 bills
  The location is Out-Patient Hospital and is owned by University Wisconsin Hospital
  Most Health Plans apply Out-Patient Hospital benefits and are subject to deductible
  
  In the future, if you have a concern about the cost of a service please do not hesitate to contact us for a Price Estimate. There are several ways to create your own estimate by either MyChart or our website www.uwhealth.org/billing-insurance or you can contact our ******************** at ************.
  
  Currently, I am not able to offer an adjustment to the balance. However, we do offer Financial Assistance that the patient can apply for to see if a reduction can be made through that program. If the patient is interested,he can apply right through MyChart.
  
  Please let me know if you have any further questions.
  
  *****
  UW Health Customer Service
  
  
  

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