Alpha Sleep Diagnostic Centers, LLC

[A default letter is provided here which indicates your acceptance of MediationIf you wish, you may update it before sending it.] Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] ,and find that Mediation is necessary Regards, [redacted]

First, to the Revdex.com; This is the second time I have responded to this complaint I am having trouble with your website RE: complaint The equipment the patient was supplied with is rented by his insurance company We received an initial three month rental authorization to bill We did and all went well The next month we requested an authorization and it was denied and the insurance company wanted face to face chart notes from his physician stating that the patient needed the equipment and that he would use it The patient was advised to go see his physician to get the proper documentation and then we would request an authorization and send a bill We never received the documentation needed to request an authorization The patients insurance company will reject any claim sent without an authorization and proper documentation The patients doctor did send us the chart notes as we requested, but they were not enough to obtain an authorization They had to specifically talk about sleep apnea and CPAP The patient was advised of this The patient called the insurance company and a rep told him it was a covered benefit and would be paid for That is true as long as they receive the proper documentation and give an authorization number We could not get the authorization because the patient did not want to go back to see his doctor and pay for another appointment Understandable, but the hew healthcare system and rules set for the by insurance companies are specific and they will not budge Without the face to face, no authorization, therefore the bill drops to the patient I must abide by the insurance company rules for claim submission and they give mo no leewayThank you, ***

Thank you for allowing me to respond I have read the chart notes and talked with the billing department [redacted] ( [redacted] initially authorized a three month rental to ensure the patient would be compliant and use the machine The billing department submitted an authorization request to purchase the machine at the end of the authorized period as the patient compliance was good The Authorization was denied; [redacted] asked for the physician chart notes Billing submitted the physician chart notes and was again denied because the chart notes did not discuss sleep apnea or CPAP machine usage The billing department informed the patient that he would need to see his physician within days and discus (and document in the file) sleep and CPAP [redacted] will not give us an authorization and will deny all claims until the proper chart notes are submitted [redacted] deemed the cpap machine to be medically unnecessary due to no documentation in the physician chart The billing department requested notes again from the physician They sent them to us but there was still no documentation of a discussion on cpap or sleep apne Once again our authorization request was denied Billing ask the patient to see his physician within days and then an appeal would need to be sent, including the physician notes, to [redacted] by the patient/physician and the patient is responsible for the rental charge at this time The billing department then started sending the patient the bills for the cpap [redacted] denied the payment of the cpap due to not having face to face notes from the physician that specifically stated they talked about cpap and or sleep apnea and there was no appeal sent to *** We are bound by the insurance companies procedures regarding authorization/billing and they make the final determination of payment, not us The billing department continued to send the patient statements and finally sent the patient to collection.We did follow the insurance company policy and ultimately they did deny payment making the patient responsible for the outstanding balance

First, to the Revdex.com; This is the second time I have responded to this complaint.  I am having trouble with your website.  RE: complaint The equipment the patient was supplied with is rented by his insurance company.  We received an initial three month rental authorization to bill.  We did and all went well.  The next month we requested an authorization and it was denied and the insurance company wanted face to face chart notes from his physician stating that the patient needed the equipment and that he would use it.  The patient was advised to go see his physician to get the proper documentation and then we would request an authorization and send a bill.  We never received the documentation needed to request an authorization.  The patients insurance company will reject any claim sent without an authorization and proper documentation.  The patients doctor did send us the chart notes as we requested, but they were not enough to obtain an authorization.  They had to specifically talk about sleep apnea and CPAP.  The patient was advised of this.  The patient called the insurance company and a rep told him it was a covered benefit and would be paid for.  That is true as long as they receive the proper documentation and give an authorization number.  We could not get the authorization because the patient did not want to go back to see his doctor and pay for another appointment.  Understandable, but the hew healthcare system and rules set for the by insurance companies are specific and they will not budge.  Without the face to face, no authorization, therefore the bill drops to the patient.  I must abide by the insurance company rules for claim submission and they give mo no leeway. Thank you, [redacted]

[A default letter is provided here which indicates your acceptance of Mediation. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID .[redacted], , and find that Mediation is necessary.
Regards,
[redacted]

Thank you for allowing me to respond.  I have read the chart notes and talked with the billing department.  [redacted] initially authorized a three month rental to ensure the patient would be compliant and use the machine.    The billing department submitted an...

authorization request to purchase the machine at the end of the authorized period as the patient compliance was good.  The Authorization was denied; [redacted] asked for the physician chart notes.  Billing submitted the physician chart notes and was again denied because the chart notes did not discuss sleep apnea or CPAP machine usage.  The billing department informed the patient that he would need to see his physician within 30 days and discus (and document in the file) sleep and CPAP.  [redacted] will not give us an authorization and will deny all claims until the proper chart notes are submitted.  [redacted] deemed the cpap machine to be medically unnecessary due to no documentation in the physician chart.  The billing department requested notes again from the physician.  They sent them to us but there was still no documentation of a discussion on cpap or sleep apne.  Once again our authorization request was denied.  Billing ask the patient to see his physician within 30 days and then an appeal would need to be sent, including the physician notes, to [redacted] by the patient/physician  and the patient is responsible for the rental charge at this time.  The billing department then started sending the patient the bills for the cpap.  [redacted] denied the payment of the cpap due to not having face to face notes from the physician that specifically stated they talked about cpap and or sleep apnea and there was no appeal sent to [redacted].  We are bound by the insurance companies procedures regarding authorization/billing and they make the final determination of payment, not us.  The billing department continued to send the patient statements and finally sent the patient to collection.We did follow the insurance company policy and ultimately they did deny payment making the patient responsible for the outstanding balance.