Nancy Moran

Mr. W.B. Cornell, III
Collection Supervisor
Sheppard Pratt Collections
6501 North Charles Street
P.O. Box 6815
Baltimore, Maryland 21285-6815

Re: Patient Number: 30285-1

Date of Admission: September 30, 1996

Date of Discharge: approximately (?) 10/25/96

Date of First Phone Calls, Non-itemized invoices, etc. about Physician bill: Late March, 1997

Postmark of Printout Itemizing Physician Bill: 4/24/97

My letter attaching price lists and Financial Agreement: 4/28/97

Your letter defending Physician bill and attaching itemization of Hospital bill (first mention of Patient Rights Advisor): 5/2/97

Your letter admitting $155 error in Physician bill and acknowledging ("willing to accept") two $65 charges shall be deemed paid in full by payment of $100: 5/27/97

My letter responding to your 5/27/97 letter urging you to "Get it together and get it straight.": 6/3/97

Your letter responding to my 6/3/97 letter indicating the Hospital account "is being transferred to the Collection Department this month, so both of your accounts will be located in the same place: 6/13/97

Various and miscellaneous phone calls from you and Michael Healy (your assistant) that the accounts had been reworked and only (about) $783 remained: 6-7-8/97

Two letters from Assistant Attorney General Harold Frankle (copies not in my possession): July and August, 1997

Your letter discussing "price restructuring", etc., etc. and submitting a "revised itemization" reflecting alterations I had been arguing since October of the year before: 8/26/97

Your letter enclosing the 8/26/97 letter which had been waylaid by the Post Office from the new address you had used in several non-itemized invoices and which I had told you over the phone: 9/18/97

Dear Mr. Cornell:

Marking the one-year anniversary of the origin of the above sequence of mixed doctor, hospital and lab charges, this is to let you know:

1. The "credit" of $71.76 on the "Hospital" bill is due only to the fact you took my initial $130 for "Initial Evaluation" and applied it to the "Lab" bill. The "Lab" bill is still in dispute as I notified you by telephone some months ago. The $130 should rightly be applied to the "Physician" bill for which you continue to ask $255. I am hearkening back to your letter of 5/27/97 wherein, two months after your first contact, you eliminated the $155 "double charge" appended to the "Initial Evaluation" fee and wrote off the $30 "bonus charge" where a social worker was being billed out as your Ph.D. in charge. That letter was not challenged by me at the time in that my actions subsequent to the point were predicated on the involvement of the Attorney General. I do not like your strategy of bouncing around between "Physician" and "Hospital" and "Hospital" and "Lab".

2. The $130 (described in detail in my letters of 4/28/97 and 6/3/97) brings the "Physician" amount in dispute to $125. The charge for Dr. Lignos is NOT $125 as you have been pursuing since March of this year, some six months ago, but it is itemized as $85 on the price list I signed for on the day of admission (6/30/96). A photocopy of that list was an attachment to my letter of 4/28/97. (I was with Dr. Lignos for less than ten minutes and she took two outside phone calls while I was with her.) See also the attachment to this letter.

3. The "Lab" bill, as I mentioned to you, is obviously faulty for the sheer reason that: 1) not only is the "venipuncture charge" is grossly elevated and should be well under $10 (when compared to "Metpath" dba "Quest Diagnostics", not exactly novices when it comes to setting laboratory rates); AND 2) the charge "happens" to be identical for that of the "creatinine" charge. The latter factor brings to mind another concept I have chanced upon in all this cycle of paperwork. That is, "willy nilly keypunching". (You might remember I mentioned a series of stints working as a medical secretary and billing clerk in an assortment of "healthcare" settings in the Baltimore and Philadelphia areas.) (The other charges, while elevated, are not outside credulity. What is outside credulity is that you took from October 15, 1996 to May 2, 1997 to get them to me.)

4. Finally, the concept of and existence of "willy nilly keypunching" certainly has had an effect of the "Hospital" bill itemization variations that have been coming to me since somewhere around April, 1997 now going on six months. If you look closely at the "Itemization of Account" you printed 6/12/97, you will see that there is no rhyme or reason between "half" days and "whole" days even then. Your rationale and explanation of 8/26/97 remailed on 9/18/97 would therefore tend to describe all days as "$265" days and your consent to all "$175" days would certainly seem generous in comparison. Yet, there lingers in my mind how and what the effects of "willy nilly keypunching" may have been.

As for your "gracious" adjustment of the Hospital days down to the $175 I had paid all along, regardless of (retroactive?) "restructuring" and so forth, the person in the billing window, bearing official SEPH/SPPA ID (and who terminated the job at the end of the month), represented to me on at least sixteen (16) different occasions that $175 was the charge and my credit card payments of $265, $1050, $960 and $525 paid the bill in full in October of 1996. There was also the price list I was compelled to sign for. Perhaps anecdotally but coincidentally, I went to a Wal-Mart during July and charged a television for $175. The sign said $175, the bar code scanned for $175, the cash register receipt was $175 and my credit card printout said $175. Am I to expect that Wal-Mart will come after me sometime in December with a "restructured" price of $265? Certainly, the Attorney General would be happy to help me then!

While your professional staff may be the best in the nation, your billing practices tell me you are not a valid mental health care provider. This is unfortunate for all of us.

With this letter, I am also notifying the Health Care Cost Review Commission of the record in this case. It would behoove you to avoid billing situations like this in the future.

cc: Maryland Attorney General
Health Advocacy Unit
Att'n: Mr. Harold Frankle (w/enc)

Insurance Fraud Division
Maryland Insurance Administration
Att'n: Mr. Larry Morse (w/enc)