Wheelchair Professionals LLC

Initial Business Response /* (1000, 5, 2015/09/11) */
Member Name: *** ***
Complaint receipt date: 9/2/
BB case #: XXXXXXX
Insurance: UHC Commercial
State: FL
Complaint by Ms***: My physician ordered a power wheelchair/scooter for meThis company was chosen to fill the
orderOnce I mentioned that I may be losing insurance soon they suspended my order without informing meI should mention that this was after I was told by them not to call back rather they would call me insteadThey made no attempt at other arrangements, and I would have not have known my order was not being processed had I not eventually called, despite their advice, to check up on things
Summary of Issue: This case began in early AugustWCP was sent the referral from *** a medical supply company that does not supply customized or power equipmentMs***’s coverage was due to expire at the end of the monthThe only medical documentation that Ms*** has was a prescriptionIn order to get a POV/Scooter approved by her insurance company would be to have a mobility exam completed with her doctor and an evaluation done by a physical therapistMs*** would have needed to have those appointments completed before WCP could request an authorization for a POV
The local provider from our network explained to Ms*** that there would not be enough time before her insurance termed to get the necessary medical documentationThere was no reason to proceed unless Ms*** was wanting to purchase a POV out of pocketPlease see the timeline of events below
The time line of events:
08/03/Client has RX and will have it fax ASAPMs*** called an a case was started
08/03/The RX was received and sent to the local provider so they could set up an evaluationDuring this recorded call the representative did not tell Ms*** not to call backWCP told her the local provider would be calling her
08/05/WCP followed up with *** to ensure they received the referral
08/06/WCP received information about the new contact person at ***WCP was told that someone would be scheduling with MS*** the next dayMs *** called in to check statusWCP told her that *** would be calling her soonWe have the call recordedThe representative did not tell Ms*** not to call
08/11/Client called for statusShe stated that she had not been contacted by ***The provider was trying to callShe stated she did not receive a callWCP verified the phone numberWCP explained that *** will have to schedule as we do not have access to their scheduleAgain WCP did not tell her not to call
08/12/Client called stating that she will not have insurance after todayWCP informed the member that we cannot provide this type of equipment in one dayTHE MEMBER SAID YOU MIGHT AS WELL CANCEL THISShe then stated she did not want to cancel when wanted to get this doneWCP informed her that this could not be completed in one dayShe asked for the number to the provider and WCP gave it to her
08/12/The client called back to say that *** did not have the referralWCP confirmed that they did
08/12/*** spoke with Ms***She thought she would have a new scooter immediatelyWCP had informed her that this particular equipment cannot be provided in a day when it has to be authorized by insuranceShe stated she was losing her insurance that day*** they wouldn’t be able to obtain the required med docs and receive authorization within one day
08/17/WCP followed up on the order
08/28/Client called for statusWCP explained that the *** told her that this could not be completed before her insurance termedClient stated that nobody said anything to her about canceling the order
WCP apologizedThe information that we have is that *** informed her that they would not have enough time to get the needed medical documentation
Response:
WCP and the all of its network providers specialize in custom mobility equipmentWhen filling a doctor’s order for equipment certain pre-service requirements must be met this often includes a face to face exam with chart notes and a physical therapy evaluationSeating evaluations must be completed by Assistive Technology ProfessionalsThese ATPs have tight schedulesWe schedule evaluations at the first possible openingWe do also screen for customers that may not qualify to have a power mobility device according to insurance guidelinesWCP only had a prescription for Ms***This is not enough information to proceed for screening or prior authorization requestAt no time during the course of these calls did anyone at numotion or WCP tell Ms*** not to callIt was Ms*** that called to say her insurance was terming in one day on 8/She did not say she may be losing coverageShe stated she was losing her insurance the next dayOn that day the necessary evaluations had not been completedWe did not have the information to submit this request to the insurance*** did explain this to Ms***With no medical documentation and no insurance coverage Ms*** could only proceed as a private payWe deeply apologize if that is what she wanted to doShe did tell WCP she wanted this completed in one dayShe did not mention continuing the order to for private payWhat she wanted WCP and *** to do could not be done using her insurance to pay