Cedar Sinai Medical Center

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Unethical Billing Practices
Posted by on
LOS ANGELES, CALIFORNIA -- I am sure many consumers have at one time or another experienced bad customer service. Well, at csmc they have excelled in being the worst!!

when you visit a doctor any csmc medical facility
you are charged for 1. Physician fee 2. Csmc facility fee (I.E exam room) 3. Leasing of all equipment used (I.E ultrasound mach etc.)

Seems fair, of course we can all agree that if you are provided a service that service should be paid for and what ever equipment used should also be as well.

Problem 1: a routine visit to a physican in an exam room when it isn't necessary for the physician to touch you (literally) **maybe** billed as an operating room procedure.
Yes this has happened to me.
The reason for stating "maybe" is because csmc bills certain procedure codes depending on the insurance company you have.

I.E. When I had blue cross Illinois the same visit was billed as an office visit.
Now that my insurance has changed to an excellent reimbursement plan they bill the same type of visit as an operating room.

Problem 2: they double bill insurance companies
and patients.(Proof available)

situation#1 saw doctor x on 06/19/06
insurance is based upon a fiscal yr
06/19/05 through 06/18/06
insurance carriers changed from one
company to another
csmc billed blue cross-il for dos 6/19/06
then billed united health care for dos 6/19/06
then they billed me 2 facility copays.

Make no mistake I did not have dual insurance which they were aware of because I provided this info to csmc.

Of course both insurance companies are launching an investigation into their billing activities

to make matters worse
when csmc sent me a bill I paid it!!!
Now csmc has sent me to collections for an unpaid bill
of course I have proof of payment.
Yes,I have contacted the billing dept, supervisors,anyone who would listen. Everyone says it is not their department
and shruggs their shoulders

moral of the story

please be diligent in selecting your doctors
make certain you know which hospital affiliation he/she is with.
If the doctor is in a medical facility or hospital ask questions!!!!About billing
do not assume that your insurance will protect you. Ultimately you are responsible for all incurred fees. Whether they are justified or not

if you live in Los Angeles
avoid Cedar Sinai Medical Center
they may have excellent doctors no question but that is not where the problem lies.
The doctors save lives not the facility(csmc)
most of csmc doctors have private offices. When available use the md's private offices.

What good does it do to have a doctor save your life only to have a facility murder you with the aggravation of endless unethical billing. Which by this time no one at csmc cares anymore

ps: this problem only occurs with the csmc facility billing department ,they are experts at inflating bills to the better paying insurance companies to offset the loss they have for non-paying patients or underpaying insurance companies

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User Replies:
spiderman2 on 03/03/2007:
Your complaint should be addressed to the insurance commission in your state.
Noneill on 03/03/2007:
The billing code is based on time spent with the patient, new/returning pt, complexity of the visit. What the description states means little. And you are correct, if the doctor is seeing you in a facilty that he does not own, that facility can charge for the space use. There is nothing unusual about that. The billing 2 insurances as primary for 1 visit is in error. Errors happen. It is possible that you were covered by 2 plans as primary plans, but if that is the case, there would be an overpayment that should be reimbursed to you. They cannot post duplicate charges for duplicate insurance. And you do not owe 2 copays. If anything, as I said, they owe you.

Insurances have provisions for the event of an insured having double coverage. Most likely in your case, the insurance that you had first during the period of change will act as the primary. The newer insurance will act as secondary. Depending on the rules in place by the second insurance they may pay as if you had no other coverage which would result in you getting the difference. Or they may have a rule in place that states no insured beneficiary will profit from having insurance so they will only pay for the portion of the bill that was your responsibility - the copay, deductible or balance of the bill. That second version is the most common.

What you need to do is find out from your employer if in fact you were covered by both insurances at the same time. If you were, then have your human resource dept get the insurances to determine which one will act as primary. Then you will need to find out from the one acting as secondary how they should have paid the claim and have them make the necessary corrections to CSMC. Be patient, none of this will done quickly.
Nohandle on 03/03/2007:
Heed Noneill's advice, she's knowledgeable in this field. If you have further questions, I'm certain she can help.
HSmith on 03/27/2012:
My husband and I are currently dealing with a cedar Sinai medical billing error on their side that went to collections. By the way, we paid cash for the procedure, and should never been billed nor should have this on our credit. The only reason we found out was due to a credit check. No returns phone calls from their side...until we had a lawyer call. Some movement took place, but still trying to clear another billing error, and once again...no return phone calls. I hope their prepared for a legal fight.
Frustrated w/ Cedars Sinai on 12/17/2012:
I am going through the same horrible experience. I was always a cash patient at one of their facilities. I paid in person at their office each time after meeting the doctor. They then send a facility bill which I've already paid. And then they send it to collections. I have my receipt which expressly notes I paid for physician AND facility. Now, if only someone would listen. >_<
Deeza on 04/03/2013:
Cedars sent us a lovely thank you card and then we got the bill which was $25,000. Great doctors BUT inflate the bills. I have just finished paying off a broken arm (they billed $65,000!) Now, I'm fighting back. I want to know EXACTLY the cost of everything so that I can dispute the bill. I have insurance but have to pay 30%.
larry on 05/30/2013:
I came in for a physical to a Cedars Sinai doctor. I asked them to send my labs to a specific laboratory they work with. My insurance pays 100% for physicals and related labs if done in a contracted lab. They billed me for physical and a sick visit at the same time. They did my labs inhouse whether by mistake or to make more money and I received a bill for almost 1000. Never saw my labs, never followed up on anything. They are crooks and I will never go there again.
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