One of the largest medical practices in Connecticut is under investigation by the state attorney general’s office for its billing practices after two patients were thrown out for creating a fuss over being charged additional office visit fees as part of their routine physicals.
Two West Hartford residents were told by Dr. Kent Stahl, CEO of Hartford Medical Group, which serves 50,000 patients, that they were no longer welcome in the practice.
In one case, he told Darlene Susco, the owner of a marketing firm, that he would allow her back only if she withdrew her written complaint to Attorney General Richard Blumenthal.
The issue – which the two complainants believe involves many more patients and possibly many more medical groups and doctors – is about what is covered when patients have an annual physical, which are often fully covered by insurance, and what services patients and insurance companies can be charged extra for. Their position is that the physical should include an update on all medical issues, and any necessary prescriptions.
Dr. Stahl insists his billing practices are proper and legal, and said he believes the attorney general’s office will agree with him. “In general, both situations involve simultaneous charges for preventative services (exams) and disease evaluation and management services,” Dr.
Stahl wrote me. He also said he has not waived fees for anyone who complained.
However, that does not appear to be the case, as the attorney general’s office provided me a statement saying that Blumenthal is investigating based on the two complaints from the West Hartford residents as well as from a third patient served by the practice, which has offices in West Hartford, East Hartford, Glastonbury, Avon, Windsor, Wethersfield, Manchester and Enfield.
“My office has received complaints about Hartford Medical Group alleging excessive and unjustified billing for medical services,” the attorney general said in a written statement. “In some cases, consumers received bills for what they believed were routine physicals covered by insurance. The allegations concern potentially unjustified charges added to consumer bills for services that should have been included in the physical or were never provided.”
The most serious issue involves Don Reder, a professional mediator and arbitrator, who contacted me last year after he received a $90 bill for an office visit from the Hartford Medical Group, on top of what his insurance carrier paid for his annual physical.
Reder said he was rejected by the practice last year after he began questioning why he and his insurance carrier were being charged twice for the same visit.
While Dr. Stahl and John L. Fundock, chief operating officer of the Hartford Medical Group, said they can’t discuss specifics of Reder’s medical issues, they insist he was billed properly because he had brought up additional issues beyond his basic physical during the examination.
They also accused Reder of being belligerent and “nasty” in his complaints to staff and said Reder falsely claimed that he was an attorney. They also said Reder initially refused to pay his bill. It was for these reasons he was told to get another doctor, they said.
“I informed him quite clearly that he crossed the line in the content and tone of the conversations with me and my assistant, and that as a result of that he would be discharged from the practice,” Fundock wrote me in an email. “Even though, as he stated, he is a highly paid arbitration lawyer, at $200 per hour plus, we do not tolerate verbal abuse.”
Reder, who is not an attorney, denies ever telling them that he was and said his complaints were made in the tone that any consumer would use questioning what they felt was an improper bill.
For Reder, with homes in West Hartford and in Florida, the fight is not about the $90 bill, which he said he paid. He has been conducting his own investigation into his bills as well as the practice. He said he knows of others who have also been charged twice, and that some of them succeeded in having the second charge removed.
He said that he learned from his insurance carrier that he or his insurance company had been billed twice for the past four or five physicals, once for the actual physical and once for treatment of cluster headaches, which Reder said he has not had for several years.
“The record of the physical is inconsistent with the HMG billing and, despite not having them (cluster headaches) since 2004, they have been billing a separate charge for the management of these for years,”
Reder wrote me.
Susco said that prior to last year, the charge to her insurance company for her physical included standard wellness care, but starting last year Hartford Medical broke this part out and charged her $125.21 in a separate bill, while reducing the cost charged to her insurer for the annual physical.
“This works out great for Hartford Medical Group because they’ve found a way around accepting assigned payments for standard wellness care, and it makes no difference at all to Anthem, because they’re only paying the assigned amount no matter what the bill is,” she wrote to Blumenthal. “But my 100 percent-covered standard wellness care is now costing me $125.21 – before any standard blood tests are performed.”
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