Complaint Review: the skin care clinic and coosmetic surgery center - dr michael santinelles - newport beach California

Part 1 ~ The Insurance Scam:  If I could give this con artist 0 stars I would.  I went into his office on a Groupon special as a new patient and his insurance fraud/scam that he pulled was completely unrelated to my Groupon visit but happened during that one and only visit to his office.  I waited 20 minutes in the private room before he slithered in, he talked to me for a couple of minutes and left for an additional 45 minutes before returning again to do a 3 minute procedure.  When I first arrived at the Skin Clinic, I heard him mention to a patient who was on her way out of the office that she should give her insurance card to the front desk and the receptionist would check to see if the woman's insurance would cover medical grade facials as he was quite certain they would.  Hmmm... I thought to myself... maybe I would ask him about this myself since I already knew we had phenomenal insurance, way better than most.  Well after that long wait I was extremely ticked off, but I did ask anyways... he spent less that 5 SECONDS saying "oh yeah sure, give your insurance card to the receptionist and we will see what your benefits are for medical grade facials."  He did not touch my face, examine any dermatological issues, did not look at my skin under a special light or magnifying glass, did not explain any options or procedures and showed me no products or machines that are in use there, like other dermatologists do.  HE DID NOTHING!  Well except for fraudulently charge Aetna Insurance company $250 for NOTHING!  It was a scam... I bet all the other people he has done this too can look at their EOB's and see that there is a charge that they were unaware of.  I would not have known this without checking since my flex and HRA kicked in to pay the balance that the insurance did not pick up.

Part 2 ~ The confrontation: I showed up in his Newport Beach office unannounced about 1 month later and let the receptionist know of the fraudulent charge.  She looked VERY scared!  She assured me that it was not her that did this.  They do not do anything with the insurance up front, apparently the "DOCTOR" handles all the insurance billing... REALLY??  Interesting!  Well she said he would be in shortly and since she say I was annoyed with the whole situation she tried to hurry me into a room.  Now mind you, I was not loud, my voice was low, I was not rude or obnoxious... just very matter of fact that what he just did was commit insurance fraud and he and I needed to talk to have it rectified before my husband who works for one of the nations top medical/pharmaceutical companies goes berserk on him!  She could not understand why the doctor did that.  I asked to see my chart and after some digging around she was able to locate it.  She pulled the paperwork out and showed me the type of visit he charged me for and the remarks he made regarding his evaluation THAT HE DID NOT MAKE!  Mind you we did not consult about my face or facials or anything he could do.  He had a fake paper all written up and I told her no consultation or evaluation ever happened!  She agreed and found it highly strange herself.  I told her I was fine out in the waiting room, that I was not going to be put in a room and secluded. She quickly texted him on the sly because he called right away and it was clear the conversation was hush hush and she mentioned that I was still and so were others in the waiting room.  She couldn't really speak since I was sitting there, but it was clear what was going on.  After she got off the phone she tried to offer me a room "where I could talk privately with the doctor" once he arrived!  I again declined and they quickly rushed every other person into rooms instead.  So everyone was sitting in a private room so they would not hear what the insurance scammer did.   What they did not expect was for a random man off the street to come in and inquire about services for himself--no appt.   She was very short with him and kept suggesting he schedule a private conversation with the doctor.  He said he would call and left, but then he came back in deciding to fill out paperwork in advance which clearly had the receptionist flustered as she was instructed to remove everyone from the waiting room. When the doctor arrived he flew thru the breezeway 90 miles an hour and into the back where she quickly went.  He came to speak with me after about 5 minutes.  First off, he motioned to come to the back to speak, I declined again.  He said well it would just be more private, I declined again and said I am more comfortable out here.  I then questioned him about the fraudulent charge and he tried to convince me that he had to put a procedure down to see in the insurance would cover it and the only way for him to know was to charge my insurance company for a random billing code for services he never preformed.  I let him now that I was very familiar with insurance billing and other billings as that was my job in a very large CHURCH!