In May 2023, Dan and Helen Lococo entered Ascension Hospital Southeast in Milwaukee for their first annual wellness checkup.

The couple sat together in the room for the appointment while their doctor checked their height and weight and answered a series of questions about their medical history.

When they left, they anticipated that Medicare would cover the routine appointment.

But when a billing statement arrived in their mailbox in September, the couple discovered that Dan Lococo had been charged for two additional services: an “established periodic preventive medicine exam” for $399 and an “established outpatient low MDM/ office” for $180.

Helen Lococo, who had attended an identical appointment, was not charged with any charges.

The billing discrepancy caused Dan and Helen Lococo to endure more than six months of emails, calls and sleepless nights as the couple pressed for answers from Ascension, culminating in a collection warning letter they received in the mail in December.

“This is your FINAL NOTICE,” the letter said. “Your account may be placed with a collection agency and included on your credit report if we do not receive payment immediately.”

Then, on January 23, Dan Lococo received a voicemail from Ascension informing him that all charges from the visit had been suddenly dropped, including some he never disputed. The company representative did not give any explanation.

Now, the Lococos are wondering why Ascension, one of the nation’s largest health care systems, couldn’t explain the incorrect charges.

“(An annual wellness checkup) seemed like the right thing to do,” Dan Lococo said. “But I have to say, I don’t know if I’ll ever do one again.”

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Experience working with insurance companies provides some answers.

When Dan Lococo received the initial bill, he assumed Ascension had accidentally charged him too many times. When he asked Ascension, representatives told him he had to contact his doctor, he said.

He said his doctor tried to dispute some of the charges, without success. As of late October 2023, Dan Lococo still owed more than $600 in overdue payments to Ascension.

November and December were restless months for him and Helen Lococo, who said they worked hard through documents, emails and old communications with Ascension. At night, he lay in bed mentally going over the appointment dispute and billing process.

Helen Lococo examines several medical documents she has kept after Ascension incorrectly billed her husband, Dan Lococo.

Helen Lococo examines several medical documents she has kept after Ascension incorrectly billed her husband, Dan Lococo.

Earlier in their careers, both had worked in the healthcare industry in insurance billing and financial analysis. Based on their experience, the couple decided to request their date’s insurance codes from Ascension.

Insurance codes are the set of letters and numbers that represent the healthcare treatment or service provided to a patient during a visit.

Through the codes, the Lococos confirmed that their annual wellness visit, coded G0439, was covered and not subject to copays or deductibles. According to the Centers for Medicare and Medicaid Services, an annual wellness visit includes a personalized health problem prevention plan.

Still, Ascension maintained the validity of the charges.

“Someone contacted us, left a voicemail and just said, ‘Yes, we reviewed the billing and the coding is correct,'” Dan Lococo said. “‘These are valid charges. If you have any other questions, you should contact customer service.'”

The couple said the struggle to speak to someone who could justify the additional charges became increasingly frustrating.

Further: If you have a dispute about health insurance in Wisconsin, these organizations can help you

At one point, the Lococos said they requested a meeting with a hospital representative and a patient advocate to negotiate their case. Ascension did not respond, according to Dan Lococo.

When the couple received the collection notice in December, they had not spoken to Ascension in more than a month, they said. They decided to ignore the warning.

When Dan Lococo received news in January that the charges had been suddenly dropped, he was relieved but remained frustrated by the lack of explanation.

Because Ascension also dropped its vaccination charges that it had never disputed, he suspects Ascension simply didn’t want to deal with him anymore.

“I don’t want to be that person who just (says), ‘Well, you know what? I’ll be a complete jerk and they’ll back off,'” Dan Lococo said. “That doesn’t sit well with me.”

Further: Ascension Wisconsin was criticized for understaffing and inattention. This is what new CEO Daniel Jackson plans to do.

Shortly after Journal Sentinel investigation, Ascension calls with explanation

The Public Investigator team contacted Ascension Wisconsin on February 5 for an explanation regarding the Lococos’ dropped charges.

Dan Lococo said that the next day, February 6, he received a voicemail from Ascension’s director of revenue cycle operations, Karly Wagner.

When he called her the next day, Wagner confirmed that he should never have been charged in the first place, she said.

“He went on to explain that this was an educational issue at the level of practice and customer service, and that education will be carried out to avoid future problems,” he said.

The same day, Matthew Hanselman, chief financial officer of Ascension Wisconsin, told Public Investigator that he could not comment on the Lococos situation for patient privacy reasons.

It generally attributed potential billing errors and other “reimbursement issues” to variations in insurance companies’ internal systems for processing claims.

As commercial insurance companies, Medicare and Medicaid have very different coverage and reimbursement policies, as well as different prior authorization and medical necessity requirements.

“These variations create reimbursement challenges, and payers, clinics, billing departments and other parties occasionally make errors that could affect the consumer’s balance owed,” Hanselman said.

He added that Ascension appreciates when patients ask questions about their bills.

“We thoroughly investigate those cases and work to implement solutions so that subsequent patients benefit from those learnings,” Hanselman said.

Even with the charges eliminated, Dan and Helen Lococo are concerned that other patients could fall victim to billing errors if they don’t have the free time and energy to dispute incorrect charges.

Helen and Dan Lococo were in the same room for their annual wellness exam, but Dan's bill was over $600, while Helen was not billed at all.  The couple emailed Ascension to dispute the charge for more than six months.

Helen and Dan Lococo were in the same room for their annual wellness exam, but Dan’s bill was over $600, while Helen was not billed at all. The couple emailed Ascension to dispute the charge for more than six months.

“I got the sense that the purpose of the call was to give me the impression that this was an isolated incident and to request a response indicating that I was completely satisfied with the outcome,” Dan Lococo said in an email to Public reporters. Investigator. following the call.

The couple wonders if similar incidents have happened to others.

“I can’t imagine people who have tons of bills, how they keep them in order and follow through with them,” Helen Lococo said. “This was just a bill.”

Quinn Clark is a reporter for Public Investigator. You can send an email to QClark@gannett.com. Follow her on X in @Quinn_A_Clark. Tamia Fowlkes is a reporter for Public Investigator. Contact Tamia at 414-224-2193 or tfowlkes@gannett.com. Follow her on X in @tamiafowlkes.

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This article originally appeared in the Milwaukee Journal Sentinel: Milwaukee couple spends months fighting Ascension medical bill

By Sam