Title: Transferred Care Mid Pregnancy
I'm sharing this not just in the hope that the office will take steps to improve transparency in billing, respect for patient communication requests, and accuracy in documentation---- but also so that YOU, the patient, can be more informed about what your rights are. Just because many offices do XYZ, doesn't mean it's right or even legal. They get away with it because no one speaks up. Start speaking up. & if you're already a patient please reach out to your insurance company and get a copy of what you've been billed for. It's my personal opinion that this office "upcodes".
Upcoding is a type of medical billing fraud or abuse where a healthcare provider submits a claim to insurance using a billing code for a more expensive or additional service or procedure, that is not what actually was performed, in an effort to maximize profits.
My Story:
I reached out to the office via email with concerns. I had hoped for written clarity for documentation purposes on several serious issues, but despite multiple requests, I was met with repeated voicemails and no effort to provide me with the formal written communication I requested.
For the purpose of accountability, I've referred my concerns to my insurance company, the New Hampshire Attorney General's Consumer Protection Bureau, the New Hampshire Board of Nursing/Medicine, and recently I also included the Department of Health regarding HIPAA concerns (Under HIPAA, patients have a legal right to request and receive communications in their preferred manner, and covered entities, like this provider's office, must accommodate those requests. They didn't. Instead they just repeatedly called and left voicemails. I actually found this really disrespectful when I specifically asked for a written response).
Anyways. Here are the core issues that led me to transfer my care:
1. Billing Practices:
First of all, they force you to sign up for autopay and put a card on file despite having in-network insurance, in my case. If you don't, you won't get care. I wasn't told this until I was sitting there about to walk into my much-needed appointment for my pregnancy!
Additionally, patients have a right to receive an itemized bill BEFORE being charged. This office's practice of charging the card on file without providing an itemized statement in advance when requested is out of step with both state and federal consumer protection standards.
I was told I could "call the office" to check if a balance was due -- an unrealistic expectation because they will charge your card immediately, leaving no time to check in. They do not warn you, they do not tell you when to expect to be charged or how much you'll be charged-- so good luck if you're a family on a budget!
I was also told it was my responsibility to determine what would be covered by insurance. However, not sure how I can do that when I'm told X is being performed yet they bill me for X & Y. One example of this is a "vascular duplex scan," which I was never told about nor given the option to consent to- I was there to check if my baby had a heartbeat. I did not need a vascular duplex scan (Google it- it's very complex and has nothing to do with checking fetal viability at 7 weeks pregnant.)
2. Inaccurate Medical Documentation:
A note in my chart inaccurately states I reported vaginal bleeding. I never reported any bleeding during this pregnancy. This is a serious issue, especially as an Rh-negative patient -- had I reported bleeding, standard of care would have required an Rhogam injection, which was never offered. The documentation error calls into question either the provider's accuracy or adherence to standard of care. (My personal theory is that it was falsified in order to justify billing for a vascular duplex scan they never performed.)
3. Improper Billing of CPT Code 93976:
The office billed for a limited vascular duplex scan (CPT 93976), but this was never performed, I never consented to such a study, nor did anyone go over any "results" with me and there are none in my medical record. According to medical coding guidelines, billing this code requires specific diagnostic criteria that were not met or documented in my chart. There was no spectral Doppler used, no vascular interpretation (waveforms, velocity measurements), and the scan was transvaginal only which is not at all consistent with how this study is typically conducted. This charge feels inappropriate and unsupported by my medical record.
While I've chosen to transfer my care, I want to note that my decision is not a reflection on the care I received from Dr. Dulac, RN Anmarija, or Erin Hebert -- all of whom I truly appreciated and enjoyed meeting. read more
