INDEPENDENCE, Ohio — Frustrated and overwhelmed seems to be the pattern of feelings for Cleveland Clinic patients after they leave their annual exam appointments only to find they've been charged hundreds of dollars for what they claim was a simple, short conversation.
Back in July, I told you about Katie Valenti.
She's a lifelong Cleveland Clinic patient who told me she'd been charged $253 after her most recent annual exam for a medical concern she brought up to her doctor.
RELATED: Cleveland Clinic charges woman $250 for bringing up health concern
After that story, my inbox was flooded with dozens of emails from Cleveland Clinic patients who claimed to have found themselves in a similar situation.
Janelle Madzia was one of them.
She said she and her husband were doing research on what to do after getting a pricey medical bill when they came across our article.
"There isn't anything justifying this billing," Madzia wrote in her email.
Madzia told me on Thursday that she had an appointment with a Cleveland Clinic OBGYN in late July.
The appointment was like any other, she said.
"At the end she (her OBGYN) had asked if I had any other concerns because she saw that I had an appointment coming up. She had initiated the conversation and I said, 'Yeah, I have this coming up.' She took a look at two of the meds I was on and she's like, 'Oh, you know, keep your appointment, but let's try this.' She made a quick change and that was it. I didn't think anything of it," Madzia said.
Madzia estimates the conversation was no more than three minutes.
She was later charged $469, and her bill listed the reason as her being a "low complexity patient."
"I have no idea what that even means. It wasn't until my insurance company sent me my estimated benefits that actually said, well, here's your diagnostic code, which then set me off for another spiral of what is this? Because I don't have a diagnosis. I don't have anything in my medical history. I don't have anything in my MyChart," Madzia said.
Madzia has been a patient with the Cleveland Clinic since 2011, and she said she has never had an issue like this come up.
When Madzia called customer service to have her charge reevaluated, she was told both the charge and diagnostic code were accurate.
"They coded it off of one sentence," she claims. "I'm very frustrated. I'm confused."
I reached out to the Cleveland Clinic about Madzia's situation.
A representative said:
"If a patient has a well visit with no new issues mentioned, it's billed as just a well visit. If a patient does have issues that need to be addressed, they will be billed separately in order for insurance to cover both the annual exam and the additional medical concern that was addressed - depending on the patient's coverage.
We inform patients of this possibility when they schedule, and it's included in their appointment reminder. I've attached a screenshot of an example for you. We do not track complaints specific to this issue, but this type of billing is not unique to our health system and is dependent on the patient's insurance coverage.
As we accept a large variety of insurance plans - each with different copays, deductibles, etc. - it is important for patients to understand their plan's coverage and potential financial responsibility. Our financial advocates are available to help patients with an estimate of charges before they receive care and also review their account to ensure the billing reflects the services they received."
Below is a screenshot of the appointment reminder that the Cleveland Clinic sends to OBGYN patients that includes a notice of potential additional charges.
However, Madzia said she never received the appointment reminder that would've cautioned her about discussing additional medical concerns with her physician.
I went back to the Cleveland Clinic with Madzia's claim, to which a representative admitted Madzia did not receive the reminder.
For gyn-related visits, that additional reminder message only began in August, according to the Cleveland Clinic, which was after Madzia's visit.
"But yet, according to the clinic, I'm still liable for this because I brought up a concern which I didn't even know I wasn't allowed to bring up concerns because I didn't get that notification that came in several weeks after," Madzia said.
Following the conversation I had with the Cleveland Clinic, Madzia said an ombudsman called her.
"They pretty much said, 'Well, yeah, we screwed up. You didn't get that notification, but we'll offer you 35% off for your $469,'" Madzia told me. "I'm disappointed that this is the practice of the Cleveland Clinic because this isn't the Cleveland Clinic I knew when I started going there."
Madzia claims the ombudsman also explained an option that the clinic could go through her previous annual exams and tack on that same charge since she admitted to having previous medical concerns outside the scope of her exam.
She's now deciding whether to accept the 35% discount, which means she'd still have to pay $300, or appeal the charge.
While trying to make that decision, she hopes her story acts as a tale of caution for other Cleveland Clinic patients.
"At the end of the day, I can afford this bill. We're okay financially. $460, that's gonna be two weeks of groceries, right? But there are other people that are on fixed incomes or seniors like my parents. There's people that I know [who] can't afford this," Madzia said. "Take a look at your mail, read your estimate statements, ask questions, challenge the Cleveland Clinic. If we don't all start challenging the Cleveland Clinic with this practice, they're gonna continue to take advantage of people."
If you have any billing concerns, please email me at Kaylee.Olivas@WEWS.com.
