cho698

12-30-2021

Services Used: Outpatient

Beware of Huron Gastroenterology and of Dr. Mark J. Velarde.

I am being billed almost $3000 for a colonoscopy and Esophagogastroduodenoscopy which I was entitled to have done at no charge under the affordable care act. Surprisingly, the problem is not the insurance company refusing to pay but the Huron Gastroenterology’s negligence in documenting the record, communicating with me as a patient and failure to work with the insurance company to have the bill paid.

In 2015 I had a colonoscopy with a recommendation that I get another one after 3 years. It was on my list of things to do when I went to visit Dr. Mark J. Velarde of Huron Gastroenterology. I went to Dr. Velarde for digestive issues. During my visit Dr. Velarde asked about cancer history in my family. I told him that almost all of my immediate family had died of cancer including my mother, father, grandmother, great grandmother and 2 closest cousins. I essentially have no family left thanks to cancer. Dr. Velarde then said I should get a colonoscopy to “make sure” and while doing that we should do a Esophagogastroduodenoscopy. Dr. Velarde did not say this colonoscopy was a cancer screening preventative procedure it seemed to be implied because of the context of the conversation.

After the procedure I found out that Dr. Velarde ordered a diagnostic colonoscopy and Esophagogastroduodenoscopy which was performed on October 1, 2021. He never informed me that it was a diagnostic procedure. I never asked or requested a diagnostic procedure. I spoke with Kim in his office in billing. She told me that if Dr. Velarde documented our conversation then it would be possible to change the coding to preventative. Kim, in a later conversation, said after talking with Dr. Velarde that Dr. Velarde failed to document our conversation and that it would be improper to adjust and correct the record. Kim then said Dr. Velarde asked that she should get a copy of my previous colonoscopy and use the recommendation to resubmit the claim back to the insurance company. I gave Kim my previous doctor information and she told me she would get a copy of the previous record and call me back later that day. I also told Kim that I had spoken to my insurance company that they said they are willing to pay the bill as they have paid ones just like this before but they need the doctor to code the procedure correctly as preventative and that it might be helpful to have the doctors office call and talk to them as they could guide them as how to code it correctly. After a week of not hearing back from Kim I called and left a few messages eventually talking with her supervisor, Traci. Traci, told me that they will not be getting or submitting my previous colonoscopy records or would they be resubmitting my bill back to the insurance company. Traci said that I needed to get these records and contest this with my insurance company myself. I had previously called Traci about this matter and left messages so I asked her why she, Kim, the rest of her office do not return phone calls or do what they say they are going to do. Traci said they do not have the time to return phone calls or do what they say they will do as they get to many phone calls.

I appealed to the insurance company and it was denied with a message asking the doctor’s office call them so they could help them with coding so the bill could be paid I appealed again with the insurance company and again lost. I called Traci again and gave her this number.

My issues here are:
1. I was entitled under law to a free cancer screening colonoscopy and Esophagogastroduodenoscopy.
2. Dr. Velarde implied to me that this was a cancer screening colonoscopy and Esophagogastroduodenoscopy.
3. Dr. Velarde failed to properly document our conversation which could have been used by their office to change the billing code.
4. Dr. Velarde never informed me that he was ordering a diagnostic procedure.
5. Dr. Velarde never looked out for my interests or well being in this matter rather he only looked out for his own financial well being by ordering money making procedure tests with no consideration as to how it might impact me financially.
6. If Dr. Velarde had informed me that he was requesting a diagnostic procedure I would have without hesitation said no and asked my family doctor for the same procedure but as a cancer screening procedure.
7. Dr. Velarde’s office to my knowledge has never once contacted the insurance company and tried to work with them on this matter despite two requests form the insurance company.
8. Dr. Velarde’s office does not return phone calls, do what they say they intend to do or act in any way like a professional office.
9. I am being billed for almost $3000 by Dr. Velarde’s office because of his offices gross neglect and incompetence for a procedure that I was entitled to have done free by law.

• Date Visited 12-2021
• Overall Satisfaction
• Explanation of diagnosis and Treatment Plan
• Trust in Provider
• Procedural Skills