August 2, 2003

Patient Accounts Billing

Phelps Memorial Hospital

701 North Broadway

Sleepy Hollow, NY 10591

Attention: Matt Knaus

Dear Patient Accounts Billing,

Subject: BILLING DISPUTE PromptCare 6/9/2003

This letter documents a billing and service complaint against the PromptCare center at Phelps Memorial Hospital, and Dr. Nigro as a representative thereof. This summer (2003) I was employed by IBM Research in Hawthorne NY, as a Research Intern. On 8 June 2003 I visited Long Island and was bitten by a deer tick. I discovered the tick on the morning of 9 June 2003, a maximum of sixteen hours after the bite was initiated. I promptly removed the tick on my own.

The tick bite concerned me for two reasons: (1) I was unable to remove the tick in one piece, so I thought it possible that I might still have a piece of the tick under my skin; and (2) my research on the Internet informed me of the possibility of acquiring lyme disease. My visit to the PromptCare center assuaged neither of these concerns, yet left me with a very large bill for the service provided.

Being from Pennsylvania, I did not have a doctor in New York, so I looked for relatively quick service at a low price. Price is a large concern to me, because my only health insurance is a mandatory student health insurance package from The MEGA Life and Health Ins. Co. that is not intended for daily usage, and therefore, has a very high deductible ($1000).

The PromptCare center at Phelps Memorial Hospital promises rates “typically substantially lower than the emergency room”, and claims that the service is intended for “abrasions, contusions, etc.”, i.e., non-emergencies. Twice, before and after providing my billing information to PromptCare during my visit on 9 June 2003, I inquired about the fee for the PromptCare service; both times my requests were answered in a way which led me to believe that the service would be relatively inexpensive (when compared with an emergency room visit) and were dismissed as something “that the billing department” handles.

I made certain that I was not being admitted to the emergency room (I explicitly asked the nurse who provided the initial evaluation) during my visit on 9 June 2003.

I waited for approximately two and a half hours before being seen by Dr. Nigro at PromptCare. Dr. Nigro spent less than five minutes with me. He visually inspected the bite and said that I had done a “good job” of removing the tick. I showed him the tick, which I had preserved in a bottle of isopropyl alcohol, pointing out that the tick was in three pieces instead of one—indicating that perhaps, therefore, I had not done such a good job. He claimed that this fact did not represent a problem, and that the hospital did not wish to attempt to remove any piece of the tick from under my skin (or even to check whether such a piece existed). He did not prescribe any preventive antibiotics, but said that I should watch for symptoms, which he orally listed, and get a lyme-test in approximately six weeks.

For this visual exam of approximately five minutes, I received two bills that total $430: one from Phelps Memorial Hospital for $333, and one from Dr. Nigro for $97. Based on a discussion I had on 25 July 2003 with a representative at The MEGA Life and Health Ins. Co., this charge is in the range of a typical emergency room visit. Indeed, the insurance claim that was sent by Phelps to MEGA Life even lists the charge as Emergency Room service.

Upon receiving the bills, on 25 July 2003 I contacted Dr. Nigro’s billing agency at 800-666-2455, Phelps Memorial Hospital, and The MEGA Life and Health Ins. Co.

At approximately 3:00 pm, I contacted Phelps, where I first spoke with a Mr. Bill Lane. After listening to the situation, Mr. Lane stated that he thought that he would be able perhaps to lower the bill from $333 to $240—if I were willing to pay the entire bill in a single payment. He said that he would need approval for this rate reduction, but felt that it would probably go through, given the circumstances. I informed Mr. Lane that 25 July was my final day at IBM, so my phone number would no longer be valid; therefore, I arranged to call him back on Monday, 28 July 2003.

After talking with Mr. Lane, I spoke with The MEGA Life and Health Ins. Co., where a representative confirmed that the bill I had received looked like an emergency room bill, instead of a “prompt care” bill. Therefore, still concerned that the bills were for emergency room service instead of PromptCare, I called the PromptCare center in an attempt to determine the typical rates for PromptCare service.

At PromptCare, I was referred to Maria in the ER, who informed me that it is hospital policy to not give out PromptCare rate information over the phone, because they “don’t want people to be deterred from coming in for service” (but that this should not be a large concern, because they have “a variety of payment options”). She stated that PromptCare is less expensive than the ER, but would not state by what amount. I told her that I had already come in for service, and just wanted to verify the rate I was charged. She transferred me to Denise in Patient’s Accounts Billing.

I explained my situation, once again, to Denise. Denise took my phone number, and said that she would attempt to have someone “pull my file” before the end of the day, to verify whether the charges were correct. She said that she would try to have someone call me by the end of the day.

At approximately 3:30 pm, I had not received a phone call from Phelps, so I called patient accounts billing again. Bill Lane answered the phone. He informed me that his “boss” had just walked by and declined my request for a reevaluation of the bill. I requested that Mr. Lane put me on the line with his supervisor; he refused. I requested that Mr. Lane give me his supervisor’s phone number; he refused. However, he did give me his supervisor’s name (Matt Knaus), at my request, and said that he would try to have Mr. Knaus call me.

By 4:25 pm, I had received no phone calls from Phelps, so I called Bill Lane again. We had an extended (approximately ten minute) conversation, in which Mr. Lane repeatedly refused to give me Mr. Knaus’s phone number. Mr. Lane made many verbal attempts to deter me from following up my complaint, but promised, at my request, to send an itemized explanation of my charges to Pittsburgh.

At 4:35 pm, I contacted the Phelps switchboard and asked to be connected to Mr. Knaus, which I was. I explained the circumstances of my visit, and Mr. Knaus promised to have the bill reevaluated, and suggested that I might expect some reprieve, based on my limited use of the facilities. Mr. Knaus said he would attempt to contact me by Monday, 28 June 2003 on my cellular phone.

By 4:30 pm on Monday, I had not heard from Mr. Knaus, so I tried to call him at his “direct” line (which he had given me). A woman, to whom I explained that I was going overseas and would be unavailable for a number of weeks beginning Tuesday, answered the phone. She claimed that Mr. Knaus “was behind closed doors”, but that he would call me back if possible. By Tuesday afternoon at 2 pm, Mr Knaus had not contacted me.

If this matter cannot be resolved so that the charges are brought to a non-emergency-room visit level, I will, upon my arrival in the United States near the end of August, pursue this matter with IBM by recommending, based on my own experience, that they strongly discourage their interns (most of whom are in a similar situation to myself: no local doctor, near Phelps Hospital, concerned about cost) from visiting Phelps when looking for reasonably priced service. I will also find it necessary to detail this situation to Carnegie Mellon University, which sends a large number of interns to IBM each year. Finally, I will pursue the matter with Elliot Spitzer (Attorney General of New York), the New York State Department of Health, and any other avenues that may arise.

Sincerely,

Michael Merideth

Carnegie Mellon University

cc:  Mary C. Montgomery, The MEGA Life and Health Ins. Co.

      Dr. Nigro, Phelps Memorial Hospital Emergency Physician

      Lara Braca, IBM Research