Vita Care of Southwest Virginia

Review: I was misrepresented on the cost of my infusion therapy.They stated that my insurance would not cover any of the cost of my 6 weeks of infusion therapy. My prescription plan would and in fact covered the medication part of the therapy, which I paid for up front and they filed the claim for the medication and received payment for even though they had full payment from me for all the cost of the infusion therapy.Desired Settlement: I desire to be reimbursement for the total amount of the medication that they received from my prescription plan. I need to be reimbursed for the excessive supplies that I have on hand. I advised them that I did not need any more supplies weeks into my infusion therapy and they continued to send supplies anyways.

Business

Response:

RE Case: [redacted] This letter is in response to the comploint filed with the Better Business Bureou on

08/12/2014.

We do not feel we owe reimbursement to the patient. The amount the patient paid

out of pocket was for the per diem charges for our services, as explained in detail

below. We did explain this thoroughly with the patient upon admission and again on

the phone call we received on 08/12/2014.

When we originally received the referral from [redacted] I contacted the

patient directly on 06/17/2014 and discussed pricing and payment options for

[redacted] service. The patient stated they would rather have the antibiotics in a

Skilled Nursing Facility - where their insurance would pay for the services, than to pay

out of pocket to have the antibiotics at home. Then on 06/19/2014 the patient

contacted me and stated they would like to receive the antibiotics at home and

agreed to pay out of pocket. When receiving your first dose at [redacted] Medical Center

on 06/20/2014 - the nurse in The lnfusion Center reviewed the patient's need for two

antibiotics - [redacted] and [redacted]. I gave the patient it additional cost for

receiving two antibiotics - and the patient agreed to pay the out of pocket amount

quoted. The patient also agreed to contact our pharmacy after receiving first dosing

and arriving home, so we could make our delivery that evening. We prepared the

medication that day during our normal operating hours, so when the patient

contacted our pharmacy, we could make a prompt delivery. When the patient

contacted our pharmacy late that evening the patient informed us that another

pharmacy had delivered the medication to their home, even after the patient made

the verbal agreement to receive the services from us. The patient also stated they

were going to use the other pharmacy's medication instead of receiving our delivery.

On Monday 06/23/2014 we spoke with the patient again and the patient requested to

switch to our services and be reimbursed for the days the patient used the other

pharmacy's medication (a total of 3 days). On behalf of the patient, we contacted

Pikevílle [redacted] Community Home Health, and [redacted] Pharmacy and

informed them the patient would be receiving all medications and pharmacy services

from our pharmacy, starling 06/24/2014.

Most commercial insurances pay a daily rate for our services between $100 and $215.

For this patient the first antibiotic charge was $45.00/day for the per diem and the

second antibiotic charge was $22,50/day for the per diem, total of $67.50/day for the

per diem. As a courtesy, we discounted services an additional 15% when the patient

agreed to pay the balance in full. The patient did pay by Credit Card on 06/20/2014 in

the amount $2409.75, for a total of 42 days. Because the home health agency sent the

antibiotic order to another infusion pharmacy and the patient received 3 days of

medication and pharmacy services from [redacted] pharmacy, we issued a

reimbursement check in the amount of $172.12 on 06/23/2014. The amount paid in full

by the patient is for our per diem service (mixing of medication, monitoring and dosing

medication by our pharmacist, delivery/shipping of medication, supplies and

equipment for administration of antibiotics). This amount was for a total of 39 days for

those services for the two antibiotics dispensed and delivered/shipped to the patient

on a weekly basis.

Upon admission to our services, the signed an admission agreement. As a standard

procedure, when this admission agreement is signed, we give a copy to all our patients.

Our delivery driver gave this patient a copy on 06.24,2014, with Patient Copy written in

highlighter at the top of the page. I am enclosing a copy of this admission agreement

for your records. Under Section l: Acceptance of Services and Agreement to Pay, the

third section to initial is that the patient has been informed of their estimate of the

portion of charges for which they are responsible to pay: $2237.63 for 39 days antibiotics

(and our records do reflect this was paid in full by credit card - as stated above).

l am also enclosing a copy of the Advance Beneficiary Notice of Noncoverage (ABN).

This is a form issued by Medicare that gives an explanation of why Medicare does not

pay for the supplies and equipment and what the patient's estimated cost will be. The

patient also signed this form on 06.24.2014.

I have enclosed our records from billing the patient's Medicare Part D plan ([redacted]).

The patient should have also received an explanation of benefits from [redacted] with this

information, [redacted] did pay a total of $452.80 for vials of medication. Since the patient

paid the per diem cost up front, in full, we discounted your supply cost in an amount

equal to the copay responsibilities as a courtesy. The copays would have been an

additional $79.90. If the patient did not have a Port D plan for us to bill the vials of

medication, this patient would have incurred an even higher out of pocket cost, than

the $2237.63 paid in full.

We also have record of speaking with the patient on a weekly basis, but have no

record of the patient requesting we send fewer supplies. we dispense supplies based

on what each patient should be using to be in compliance with their therapy. Supplies

are sent as part of the daily per diem - there is no separate additional charge, as we

do not line item bill. Once supplies are dispensed to a patient's home, we cannot take

those back into our pharmacy, per federal regulations.

I hope this letter has addressed your concerns. Please do not hesitate to contact me

with any additional questions.

Sincerely,

[redacted]. LPN

Patient Care Coordinator