California Advanced Imaging Medical Associates (CAAI on EOBs)
These folks do MRI readings. They are based out of Novato CA, which is about 180 miles north of the Monterey Bay area where the services were rendered.
HOW MANY OF YOU COULD HAVE TRACKED ALL THIS BILLING AND PICKED UP ON ALL THE ERRORS, OMISSIONS AND ISSUES? WHAT PERCENT OF OUR POPULATION COULD TRACK THIS STUFF? REMEMBER, THIS IS ONLY 1 OF 11 VENDORS I'LL NEED TO TRACK AND PAY THIS YEAR.
And yes, it ends in some super sketchy billing from a very large group of radiologists that cover the entire bay area, and I'm not the only person that's noticed the exact same issues. Some online reviews say the exact same things, and this has been going on for years...
EOB List
Below is a nifty google sheet I built to try to keep up with all this billing. In total, CAAI . They made seven different billing submissions to Blue Shield. They only got five approved. This is odd. We'll look into what happened later. They likely should have gotten paid something for all seven...
Some general items to note:
- They typically billed within a week of service and Blue Shield turned around the EOB within a few days or a week. Very timely on both parts (and this is relevant when you see the bills presented to me months later...)
- They are billing 176 for a reading and they are being allowed 81 per read. That means the most they can accept for payment between the Insurance company reimbursement and my payment is $81 per read (because they are controlled as an "in network" provider).
Errors, Omissions and Problems
There are 7 EOBs documented for a total of 8 billed items. (EOB received 1/28 had two line items on it). There seems to be billing issues or anomalies with 5 of the 8 billed items (if not all 8 if you include allocation to copays for something that should have been allocated to deductibles)
- Blue Shield seems to have fubarred something on the EOBs. They were inconsistent with the reimbursements. They made partial payments for services on 1/21 and 1/22 but not partials on all the others. Or it's an odd situation where they pickup some of the cost for a second item for a given day?? It's odd. I don't care about this because my I knew my out of pocket max would be reached this year and I was getting credit for everything I was paying. If that was not the case I would have called Blue Shield to ask about these anomalies.
- The Radiology group double billed for an MRI on 1/22. They billed for three that day even though only two were done. This could have been an honest accident or not. Given they are using generic codes on EOBs which seemingly do not specify body part, not sure how Blue Shield knew it wasn't a third MRI.
- The Radiology group was declined for payment for 2/4 DOS. That seems like a a billing submission error. They should have been paid for that. It does not appear they have rebilled Blue Shield for that denial yet.
Below is all this in more detail... and do skim or read it. You'll want to come up to speed before you get to the nefarious billing stuff at the bottom and the YELP reviews -- which support the idea this has been going on for years...
DOS - 1/21/2019 (right ankle and right shoulder, 2 reads done for 2 mris)
On 1/21/2019 I had two MRI's done. One of my right ankle and one of my right shoulder. This bills below are not for the imaging itself. These are for the read of the imaging. The images are transferred digitally that day to a Radiologists office who looks at them and writes up a summary.
Below is the EOB (Explanation of Benefits) I received from Blue Shield. This summarizes the billing submission for that day and the adjustments made by Blue Shield since these providers are in network and contractually obligated to only collect what is allowed by Blue Shield.
- Billing NON Transparency -- For starters, look at red #2 and #3. #2 is next to number 7322126. On some EOB's that is a CPT code specifying what procedure was done. On this EOB and all of these, this is NOT a CPT code. #3 states, "Diagnosis and treatment codes billed on this claim and their meanings can be requested by contacting customer service." Thus, as a consumer I have absolutely no way to look up a code and verify they are being reimbursed for something that makes sense. For all I know they are getting reimbursed for a set of crutches or a knee brace.
- Irrelevant Billed Amount used to present a fictional network savings amount -- Medical Offices are known to bill silly and irrelevant amounts for services that they know are going to get adjusted down or discounted down. Red #10 and 11 below show a billed amount of $176. They could have made that $500 if they wanted to. It's an irrelevant number. Yet red #9 uses that irrelevant number less the amount they allowed (80.78) to give the patient the impression they saved the insured 95.22. This is all silly puddy math for confusion and illusion.
Service was provided on 1/21/2019 (1). A bill was recieved at Blue Shield on 1/24/2019 (7) and this EOB was turned around 1 day later (8). So the billing submission and disposition of this was all very fast and efficient.
The provider had a fictional list price of $176 (10) and they were allowed $80.78 (4) for the service. This should have been allocated to my $2500 deductible. Instead they allocated it as a co-payment. It seems there really is no deductible on this policy just an out of pocket max even though that is not how it was presented...
I owe 80.78 for this service.
The second bill for that day was billed on the same day but not dis-positioned for four days vs the one above. When dis positioned, they were allowed the same amount, BUT this time Insurance paid 61.56 and the only made me pay 19.22 of it. This doesn't make much sense, but given the next one is the same, it appears Blue Shield picks up some of the bill for the reads if two images are done the same day....
DOS - 1/22/2019 (right hip and left hip, 2 reads done for 2 mris)
The following day, on 1/22/2019 I had two more MRIs done. One for my right hip and one for my left hip.
The billing here was done on a single EOB vs the separate ones above. The allowed amounts were the same and the odd situation where Blue Shield picks up part of the payment for the second one done on a single day is here too, so it doesn't appear that was a mistake the day prior.
The same billing NON-transparency issue exists here as well as the "network savings" farce.
DOS - 1/22/2019, (right or left hip, a duplicate bill that was declined)
For some reason, someone tried to submit another bill for the same day. I'm not sure how Blue Shield knew it was a duplicate and not for a third MRI.
With the non-transparent codes, it's impossible to know.
DOS - 2/4/2019 (right scapula, what should have been valid billing was declined)
On 2/4/2019 I had an MRI done of my right scapula. What seemingly should have been billed for the same amount of the others was billed for slightly less, and the bill was declined by Blue Shield. That note with a star is really for CAIA not me and it basically says they billed wrong and they need to rebill to get credit for the work. They seemingly did not rebill, thus they did not get paid for this read.
DOS - 5/9/2019 (left elbow)
You are getting the hang of this now.
This all looks typical and normal .
List price billed was 176, allowed amount was 80.78 and that was passed on to me as a Copay required.
DOS - 5/9/2019 (left shoulder)
A carbon copy of the one prior and normal looking.
List price billed was 176, allowed amount was 80.78 and that was passed on to me as a Copay required.
Now onto the Billing from the Provider...
This provider read 7 MRIs. As of now, they are only allowed to collect for 6. They should have rebilled for the one that was fubarred but they seemingly did not do that. Although it says they had to submit within 45 days, they actually should have up to 12 months to bill properly.
Amount due from me:
- 1/21/2019 - $101 (81+20)
- 1/22/2019 - $101
- 2/4/2019 - $0 (bad billing)
- 5/9/2019 - $81
- 5/15/2019 - $81
Total due: $364
Now, wait til you see this...
First Bill, Dated 6/18/2019 asks for $162 for DOS 5/9 and 5/15 with a weird note on it......
The first bill from this clan arrives.
1) It is for the most recent two reads. In that sense, these are billed timely an all prior are lost somewhere.
2) There is a note that says: "You may however continue to receive a statement in our old format, which you should not ignore"
Foreshadowing: The pay to address on this is different. It would "seem" they may have switched billing companies and did not transfer over all outstanding bills....
Technically, there is nothing wrong with this bill. I should pay it.
Second Bill, Dated 6/24/2019 asks for $404.78.. or is it 80.78...!?!
Just days later, this shows up in the mail. This must be that "old format" referenced above, right?
What's the "Acct Balance" on this? $404.78
Odd, right?
Look at the adjustment date for the 1/21 service. That was adjusted by -95.22 on 6/21. But we know from the EOB that EOB were processed for TWO bills on 1/21 on 1/25 and 1/28 respectively.
Hey, wait?! Where is the second line item for 1/21? It's missing?
And they have the 1/22 bill on there for a single item when that should be for two, and they have the 2/4 on there, but that one got declined for bad billing?!
Now let's look at all the RED items on this page...
Balance: 404.78
Message: "Your insurance has applied a portion fo your bill to your co-payment. Please remit payment. "
Well this is an entire bowl of f-cked up spaghetti now isn't it?! Notice, under the line items it says "Current Patient Responsibility $80.78", which is in fact correct based on what they have here, but how many people might just pay the amounts in RED? In total, I only owe these folks $364 and they have accurately billed me for $162 on their "new bill" which means I only will owe $202 if and when this spaghetti gets fixed.
Question: Do you think they really switched billing companies, or do you think this may be a ploy they use when they get folks with multiple amounts to overbill? Who knows...
I decided the easiest thing for me to do was to do nothing for a month to see if anything got cleaned up in subsequent bills.
Third Bill, Dated 7/19/2019 asks for $162)
The third bill looks like the first bill. It's accurate for the last two DOS's.
Nothing to see here...
Fourth Bill, Dated 7/23/2019 asks for $404.78.. or is it 80.78...!?! )
This gets more interesting now.
The Account Balance and Amount due still show 404.78, BUT the message in the red box is different!
"The current patient responsibility is your responsibility. Payment is due. Mastercard and Visa Accepted. "
That means someone looked at this and changed it from last time. Yet, they have not added any appropriate line items, they have not made any more adjustments and they have not removed the irrelevant line item they did not get any allowance for...
Okay. Time to look into these folks a little more...
This bill implies a J. Crain is responsible for the work. That isn't ringing a bell. I recall seeing names on my reports and I don't recall that being one of them...
Well I'll be, she did do one of the seven. She did the one that was billed wrong and got turned down by Blue Shield totally for bad billing.
I know, let's call them and play a game. Let's play dumb about the total due and see what they say?!
I called 415-883-1218. HUMMMmmmm...
- They take calls M-F 8-3:30.
- They are closed every other friday
- They don't have a voicemail box?!
What the heck!? Those are banker's hours, and no voicemail? Who are these people?!
CA Advanced Imaging ...
Wow. This is a big outfit. How can a big outfit have such bad billing? Their only job is to read images and bill...
Looks like I'm dealing with the group known as "National Orthopedic Imaging Associates"
I googled around and found their website: http://www.orthoimaging.com/physicians/
Something isn't sitting well with me. These folks are a big group and part of a bigger group. All they do is image and bill and this billing is late an atrocious. By accident or intention? The best way to futz with people on billing is to look incompetent... I don't usually pay much attent to YELP, but I found these interesting...
These are from a different location..but same parent company and they seem to sharing a billing department...
Well. That was unsettling.... let's look at another location...
Jana Crain is seemingly in the Navato office, but pretty sure that's here in the pics on yelp for the Atherton location. Just a marketing photo...
Nothing like having to deal with an imaging cartel who seemingly runs billing scams. AND THIS is what most Americans are clueless about. This is just one of 11 vendors I'll have to deal with this year... and the number may go up. I can already tell you that two others overbilled or tried to over bill by $3350 on a $150 service and $20,000 on a 6500 service.....
8/4/2019
I'm going to play with these folks for a while. SShhhh... Keep it a secret. We don't want them getting tipped off...
I'll let you know how this plays out...
My check was cashed on 8/19...
Fifth Bill - 8/8/2019
They sent out a bill before my check got to them. Thus, the first item for 1/21 was still on there and the second item on the bill, the line item for 1/22 has also now been adjusted...
Per the Balance I owe them, 309.56. Per the little note that is much smaller, my current patient responsibility is $161.56. My actual patient responsibility is $80.78 because I had a check in the mail to them for the first line item that has now been cashed...
Here's a letter I included with my check for $80.78....
