Quinn ClarkTamia Fowlkes
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In May 2023, Dan and Helen Lococo entered Ascension Hospital Southeast in Milwaukee for their first-ever annual wellness checkup.
The couple sat in the room together for the appointment as their doctor checked their height and weight and ticked through a series of questions about their medical history.
When they left, they anticipated Medicare would cover the routine appointment.
But when a billing statement landed in their mailbox in September, the couple found that Dan Lococo had been charged for two additional services — an "established patient periodic preventive medicine examination" for $399 and an "office/outpatient established low MDM" for $180.
Helen Lococo, who had sat through an identical appointment, was not charged at all.
The billing discrepancy caused Dan and Helen Lococo over six months of emails, calls and sleepless nights while the couple pushed for answers from Ascension, culminating in a collections warning letter they received in the mail in December.
"This is your FINAL NOTICE," the letter read. "Your account may be placed with a collection agency and reported on your credit report if we do not receive payment immediately."
Then, on Jan. 23, Dan Lococo received a voicemail from Ascension letting him know all charges from the visit had been suddenly dropped, including some that he never disputed. The company's representative didn't give an explanation.
Now, the Lococos are asking why Ascension, one of the country's largest health care systems, was unable to 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 that I'll ever do one again."
Experience working with insurance companies provides some answers
When Dan Lococo got 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 attempted to dispute some of the charges, without success. By the end of October 2023, Dan Lococo still maintained over $600 in overdue payments to Ascension.
November and December were restless months for him and Helen Lococo, who said they toiled over documents, emails and old communications with Ascension. At night, she lay in bed replaying the appointment and billing dispute process in her head.
Early in their careers, both had worked in the health care industry on insurance billing and financial analysis. Based on their experience, the couple decided to request their appointment's insurance codes from Ascension.
Insurance codes are the set of letters and numbers representing the health care treatment or service given 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 and deductibles. According to the Centers for Medicare and Medicaid Services, an annual wellness visit includes a personalized health issue prevention plan.
Still, Ascension maintained the validity of the charges.
"Somebody did contact us back, left a voicemail and simply said, 'Yes, we looked at the billing, and the coding is all correct,'" Dan Lococo said. "'These are valid charges. If you have any other questions, you have to contact customer service.'"
The couple said the struggle to speak with someone who could justify the extra charges became increasingly frustrating.
More:If you're having a health insurance dispute in Wisconsin, these organizations may be able to help
At one point, the Lococos said they requested a meeting with a representative from the hospital and a patient advocate to negotiate their case. Ascension did not respond, according to Dan Lococo.
By the time the couple received the collections notice in December, they had not spoken to Ascension in more than a month, they said. They decided to ignore the notice.
When Dan Lococo received the news in January that the charges had suddenly been dropped, he felt relieved, but remained frustrated with the lack of explanation.
Because Ascension also dropped his vaccination charges that he had never disputed, he suspects Ascension simply didn't want to deal with him anymore.
"I don't want to be that person that just (says), 'Well, you know what, I'll just be a complete jerk, and they'll back down,'" Dan Lococo said. "That doesn't sit well with me."
Shortly after Journal Sentinel inquiry, Ascension calls with explanation
The Public Investigator team contacted Ascension Wisconsin on Feb. 5 for an explanation of the Lococos' dropped charges.
Dan Lococo said the following day — Feb. 6 — he received a voicemail from Ascension's director of revenue cycle operations, Karly Wagner.
When he called her back the next day, Wagner confirmed that he never should have been charged in the first place, he said.
"She went on to explain that this was an educational issue at the practice and customer service level, and that education will take place to avoid future problems," he said.
The same day, Matthew Hanselman, Ascension Wisconsin's chief financial officer, told Public Investigator that he could not comment on the Lococos' situation for patient privacy reasons.
In general, he attributed potential errors in billing and other "reimbursement challenges" to variations in insurance companies' internal systems for processing claims.
As commercial insurance companies, Medicare and Medicaid have widely varying reimbursement and coverage 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 mistakes which could impact the consumer’s balance due," said Hanselman.
He added that Ascension appreciates when patients ask questions about their bills.
"We thoroughly investigate those instances and work to put solutions in place, so subsequent patients benefit from those learnings," Hanselman said.
Even with their charges removed, Dan and Helen Lococo worry that other patients might fall victim to billing mistakes if they lack the free time and energy to dispute incorrect charges.
"I got the sense that the goal of the call was to provide me with the impression that this was an isolated incident and to solicit a response indicating that I was completely satisfied with the outcome," Dan Lococo said in an email to Public Investigator reporters 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 that straight and go through at all," Helen Lococo said. "This was just one bill."
Quinn Clark is a Public Investigator reporter. She can be emailed at QClark@gannett.com. Follow her on X at @Quinn_A_Clark. Tamia Fowlkes is a Public Investigator reporter. Reach Tamia at 414-224-2193 or tfowlkes@gannett.com. Follow her on X at @tamiafowlkes.
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Government corruption. Corporate wrongdoing. Consumer complaints. Medical scams. Public Investigator is a new initiative of the Milwaukee Journal Sentinel and its sister newsrooms across Wisconsin. Our team wants to hear your tips, chase the leads and uncover the truth. We'll investigate anywhere in Wisconsin. Send your tips to watchdog@journalsentinel.com or call 414-319-9061. You can also submit tips at jsonline.com/tips
Ascension is notorious for failing patients regularly. I'm an Aurora client. They are no better. I have been lied to by their doctors numerous times. When called on their lies, the doctors drop you as a patient. At this point, I've gone through numerous doctors. Thirty years ago, when I first went to Aurora, things were quite different. However, all of my doctors from that time have retired and the "new breed" are absolute crap. There is an MD there that will kill someone, if she hasn't already. Completely incompetent. She had Aurora send me a threatening certified letter. Of course, a patient has no chance against one of their MDs. They will gladly take your money but they suffer criticism very poorly. I wish we had a Froedtert in this area.
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