Spectrum CEO: More transparency needed in billing

Target 8

GRAND RAPIDS, Mich. (WOOD) — In an email to a complaining patient, the CEO of Spectrum Health acknowledged there needs to be more transparency regarding how patients are billed for doctor visits.

“We agree with you that a more transparent process is necessary,” Spectrum Health CEO Tina Freese Decker wrote (PDF) in response to a complaint. “I have shared your suggestion (for additional transparency) with our Spectrum Health Medical Group leadership so that we can apply this suggestion into our workflow.”

Freese Decker copied Spectrum Health’s director of patient care on her response.  

The patient who sent the email to the CEO — and shared the response with Target 8 — had been charged $142 for a second appointment because she briefly discussed two minor issues with her doctor during her annual exam.

“She didn’t do any additional treatment, testing or prescribe me anything. There was no follow up scheduled. There was no indication that this was anything other than a typical conversation one might have with their new doctor,” wrote the patient, who had visited a doctor at the Spectrum Health Medical Group on Lake Drive at E. Paris Avenue.

A month later, the patient received her bill. The annual wellness visit was covered by insurance, but there was a second charge for the same day that was not covered.

“When I called billing, I was informed that once you have a conversation about something that’s not considered preventative, you are billed for an additional consultation,” the patient wrote in her complaint (PDF) to Spectrum. 

“This experience made me feel deceived. It made me feel like I need to be skeptical of my doctor. I can’t answer questions she asks me without first inquiring how much this will cost. I can’t tell her about my health issues because I’ll be penalized for it,” added the patient, who didn’t want to be identified for this report.

Target 8 reached out to Spectrum Health Thursday, asking what progress had been made addressing the billing issue since the CEO sent the email to the patient on Feb. 2.

A Spectrum spokesperson said the system has formed a group to examine the issue:

“Spectrum Health strives to be partners with its patients in providing the care they need to achieve optimal health and wellness. We are required by law to follow established guidelines for all visits. A group within our health system has been formed to evaluate the issue and look at best practices of other health systems across the country. We want to find a solution that alleviates this concern for patients and at the same time ensures we are compliant with billing and coding regulations. We realize the billing process can be confusing and are committed to transparency with our patients,” a Thursday statement read.

Spectrum is not the only health system facing criticism for billing practices related to annual checkups. Target 8 reported another woman’s experience with a Mercy Health physician earlier this week.

Additionally, a single mother from a small town in Kent County, who Target 8 is identifying only as Lindsey, previously reached out to Target 8 regarding a bill she got after a wellness visit with a physician at Spectrum medical building in Grand Rapids. While she waited for the appointment, Lindsey filled out the standard questionnaire, checking a box to indicate she had periodic leg cramps.

“(The doctor) looked at the form and she said, ‘Oh, I see you checked yes to leg cramps. Tell me more about it,’” Lindsey recalled.

Lindsey said the doctor showed her some stretches, told her to drink more water and checked her magnesium and iron levels in addition to the routine blood tests that were already scheduled for her annual physical.

“I get the bill… and I was charged for two office visits,” Lindsey said in an interview with Target 8 Thursday. “I called the doctor’s office right away and I said, ‘This can’t be right. Is this a mistake?’”

But it wasn’t a mistake.

Krista Davis, an insurance broker with The Gremel Group in Rockford, explained that any discussions that fall outside the scope of preventive care can be billed differently.

“If you’re going in for preventive services, know that there is a scope of services that’s considered preventive with zero cost, but if you go in and have a complaint or a scenario diagnosed, then it changes… to another category of care,” Davis said.

Target 8 reached out to Medliminal, a national company that specializes in medical cost containment and works to eliminate errors in hospital billing, among other services. Jeanne Woodward, vice president of Medliminal’s consumer division, explained that physicians can bill for an extra visit if the services rendered go “significantly above and beyond” a routine annual checkup.

“(The additional services provided) have to be significant, distinct, and easily identifiable,” said Woodward.

Representatives from Medliminal pointed out that doctors report patients arriving at annual checkups with long lists of questions that require significant resources, causing delays that impact the rest of the day’s appointments.     

“I can see it from both sides,” said Woodward, referring to doctors and patients.

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