A Billing Nightmare Wrapped in a Pediatric Clinic

I want to preface this by saying that Dr. Paul Cortez is a good pediatrician. He is personable, fantastic with the kids, and provides reasonable clinical care.

However, a routine well-child exam should be a stress-free milestone, not a traumatic, anxiety-inducing financial burden for the parents. His medical expertise is completely overshadowed by outright shady and predatory billing practices. Given how systemic and recurring these issues are year after year, I am absolutely sure the doctor is partly to blame and actively in on the strategy.

The same billing nightmare happened to us last year. We had to formally dispute the charges, and between the endless runarounds, ignored messages, and frustrating back-and-forth between the pediatric office, the billing department, and our insurance, it cost us three full months of our time just to get a basic checkup covered correctly. The predatory and surprise billing culture at this practice is deeply ingrained. If you dare ask even a single extra question about your child’s development during a physical, this office will immediately unbundle the visit and slap you with a steep diagnostic charges to insurance.

During our most recent well-child visit, we brought our sons in expecting standard, fully covered preventative care. Instead, we were again hit with surprise bills weeks later because the clinic purposefully unbundled routine pure-tone hearing screens and submitted them as standalone diagnostic tests under their respective CPT codes. By deliberately failing to attach the standard ACA-mandated preventative modifier, our insurance system was forced to kick the charges straight to our family deductible.

When you try to resolve these obvious “clerical errors,” the front desk completely washes their hands of the issue and punts you to the John Muir central billing department. That department operates like a black hole of unreturned voicemails and hour-long hold times. When I finally cornered a billing representative, she aggressively tried to claim a standard pediatric hearing check is a “diagnostic” test. It wasn’t until I physically conferenced in an Aetna representative on a three-way call and had to yell just to be heard over her pushback that they finally backed down.

A doctor’s office should be a trustworthy partner in your child’s health, not a bureaucratic adversary that uses defensive coding to nickel and dime families. Save yourself the immense administrative nightmare and find a pediatric practice that actually knows how to bill preventative care accurately and honestly.

Dr.Cortez is so helpful and really cares about his patients. He’s been my sons pediatrician for over a year. He addresses all my concerns and has a lot of patience with my little guy.

Dr Cortez has to be one of the best pediatricians on the planet. Time after time we are blown away by his demeanor, compassion, and patience with anxious parents! He is wonderful and the facility and staff are nice too.