Complaint Review: Summit Medical Group

My family uses doctors for our 2 year old daughter along with other SMG affiliated Doctors in Essex County NJ.  We have been going for routine preventative visits (covered at 100%) by my Insurace carrier (Cigna) and we have had several discussions about other health issues (our pediatrician looked inside my daughters ear for possible infection) during a recentvisit and as a result were billed for those questions and ear check (triggered a Diagnostic Code and a Consult Code). Basically I have never encountered such a la carte pricing for services (along with other charges that are balanced billed to our family's plan deductible) without being told these discusssions were charges or would trigger a charge on a routine, covered preventative visit.

I don't think it's too much to ask questions regarding my 2 year old daughter's health and worry about the TOPIC or Concern.  Now, whether you believe that our Pediatrician should enter a Diagnotic code for a 5 second ear check during shots/prevenative than you be the judge.  Suffice it to say, the billing horrors just started when we went back for the shots that were not given (ear infection detection) on the second (covered 100% shots) visit!

Now my wife and I are forced to be careful what we discuss with our SMG Pediatricians in fear looks like in practice to extremely aggressive ( I would use the word rapacious for it apears systemic within SMG) The question is how complicit are the SMG Dr.'s in this practice?

On another recent occason I was going to have a colonoscopy consult done (covered at 100%) and was charged 600.00 worth of "Consultative Surgical Fees" for I had asked about the  "Possible" removal (possible in that I wanted to know what the out of pocket cost would be) of said wart removal.  I was told not too worry that  this was would fall under the Preventative category (or most likely).  Well it wasn't or isn't! and I  never imagining that my questions were triggering Diagnostic Codes for Billing!!  I was never told hwo much I was harged and still awaiting the final bill which I have no doubt wil be in the thousands of dollars given the first office (covered visit) resulted in my owing 650.00 dollars of out of pocket costs for a discussion!!

There is obviously a pattern her at SMG and I would be interested in knowing about other similiar experiences for perhaps further media outreach in the state of NJ and beyond.  I work in Health and Hospital System and this lack of (which is deliberate because I called the billing department three times prior to my coverred colonoscopy for a cost of the wart removal..not one word) transparency fits across my three family (wife's experience with her Dr's coming in next posting) SMG Dr. Patient experinces which are just awful and bordering on fraud (perhaps)?  I would like to epxlore the billing deception with my carrier (Cigna) and if any other Healthcare Billing/Insurance/State experts have an opinion on how to put an end to this kind of practice  I would welcome the feedback.

This is what happens when Dr.s fold thier practices into large Physician Health Pratice Groups like SMG and the sheer size and availability give them the arrogrance to bill this way.  It's corrupting and my research has begun in order to find Dr.s that don't pratice this way and actually may serve as a cautionary tale that will help bring doctors back  into their own practices that bill transparently and dont' hinder or non-communicate patients looking for transparency.  If anyone knows of such a Dr's Group in Northern NJ I would welcome the infol

Caveat Emptor SMG.  Sean O. Essex Fells NJ