Initial Business Response /* (1000, 6, 2016/02/25) */
Contact Name and Title: [redacted] MD, Owner
Contact Phone: XXX-XXX-XXXX
Contact Email: [redacted]@sbcglobal.net
We initially contacted the manufacturer of Prolia to ask if under the patient's specific insurance carrier and plan, the Prolia...
injection would require a prior-authorization for coverage. We were told there was no prior-authorization required and were faxed the attached response directly from them. With that information, we proceeded to submit an order to the hospital for the shot and set up an appointment for the patient to receive it. Only when we then submitted the claim to her insurance company for coverage were we told that prior-authorization was not necessary, but the patient did not meet the requirements of her plan to be approved for coverage. We went round and round with the insurance company for months trying to convince them that the manufacturer had given us the false information. They would not be convinced to reconsider or even accept the explanation of the situation.
In the mean time the hospital sent the patient's account to their collection department because they had not received payment for nearly a year. Before sending her to collections, the hospital initially offered her a 40% discount for paying, but when they finally sent her to collections, it was for the full amount. The collection department proceeded to harassed the patient so much for payment that she finally paid the full amount to get them off her back.
To this day, we are still, striving to resolve this issue to everyone's satisfaction.
Respectfully, [redacted] MD
Initial Consumer Rebuttal /* (3000, 8, 2016/02/25) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I wish that all of this effort had been done sooner rather than much later by the physician's office. I am hoping for some sort of resolution.
Initial Business Response /* (1000, 6, 2016/02/25) */
Contact Name and Title: [redacted] MD, Owner
Contact Phone: XXX-XXX-XXXX
Contact Email: [redacted]@sbcglobal.net
We initially contacted the manufacturer of Prolia to ask if under the patient's specific insurance carrier and plan, the Prolia...
injection would require a prior-authorization for coverage. We were told there was no prior-authorization required and were faxed the attached response directly from them. With that information, we proceeded to submit an order to the hospital for the shot and set up an appointment for the patient to receive it. Only when we then submitted the claim to her insurance company for coverage were we told that prior-authorization was not necessary, but the patient did not meet the requirements of her plan to be approved for coverage. We went round and round with the insurance company for months trying to convince them that the manufacturer had given us the false information. They would not be convinced to reconsider or even accept the explanation of the situation.
In the mean time the hospital sent the patient's account to their collection department because they had not received payment for nearly a year. Before sending her to collections, the hospital initially offered her a 40% discount for paying, but when they finally sent her to collections, it was for the full amount. The collection department proceeded to harassed the patient so much for payment that she finally paid the full amount to get them off her back.
To this day, we are still, striving to resolve this issue to everyone's satisfaction.
Respectfully, [redacted] MD
Initial Consumer Rebuttal /* (3000, 8, 2016/02/25) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I wish that all of this effort had been done sooner rather than much later by the physician's office. I am hoping for some sort of resolution.