Initial Business Response / [redacted] (1000, 12, 2015/10/15) */ Response: To whom it may concern, Because we care, our goal at Alick's Home Medical is to serve and take care of each of our customers like we would our own parentsWe strive to always provide the best service possible, but also understand that sometimes we may fall shortThank you for the opportunity to address this customer's concerns as stated in case # XXXXXXXX, and to quickly resolve this matter for our account # XXXXXX While every effort is made to provide our customers with the most accurate information regarding their insurance benefits, it should also be noted that the individual is still responsible for knowing and understanding the benefits, limitations, and authorization requirements of their own insurance policyTo help our customers recognize this point, each customer is required at the time of delivery to sign an assignment of benefits form that acknowledges their financial responsibility for any and all services receivedAny information provided to the customer at the time of service is only our best estimation, and is not a guarantee of benefits or payment from their insuranceDue to the way in which insurance claims are processed, final billing for any customer cannot be determined until a finalized explanation of benefits (EOB) has been issued by the insurance payerIt is impossible for us to quote any exact benefit amount prior to claim processing, and we do not make it our policy to make any such quoteWhile our representatives make a good faith effort to explain a customer's expected insurance responsibilities and benefits, we find that many customers still may not fully understand, thereby resulting in confusion or frustration During our initial verification of this customer's [redacted] benefits on 08/08/14, we were advised by plan CSR Kay (call reference # XXXXXXXXXXXXXX) that HCPCS codes Eand Ewere a covered benefit on the member's policy with no pre-certification requirementThe member's benefits were stated as 80% coverage of the allowed amount with a 20% co-insurance responsibility for the member after the $deductible was metThe deductible accumulations at the time of our call showed $had been met, but standard disclaimer recordings advised that final benefits and payment amounts are determined at the time of claim processing since totals are subject to changeBased on this information, we collected the estimated remaining $deductible amount at the time of service When the claims for date of service (DOS) 08/12/were submitted to his insurance for processing, the member's plan applied a total of $toward deductible for the first month of CPAP rental, the sale of the heated humidifier, and the sale of all other associated suppliesThis member's policy covers CPAP as a monthly rental on a rent to purchase basisEquipment rental is billed/paid per month, and is never pro-ratedRental claims for DOS 9/12/and 10/12/were also applied toward deductible at the allowed amount of $for each monthA total of $was billed to the customer in accordance with his policyAn EOB for each DOS would have been issued directly to the customer from his insurance plan confirming this deductible responsibility This customer has had an outstanding balance on his account since the initial deductible amounts were posted to his private pay balance on 9/24/Other than the $collected at the time of delivery for the estimated deductible, no payment has ever been receivedThe remaining $deductible balance, which has been posted to his private pay account since 11/12/14, has been clearly defined by his insurance as the member's responsibilityAny dispute regarding benefit amounts is strictly between the member and their insurance planProviders are bound by contract to assign member responsibility amounts to the customer as indicated on the payer's EOB After the member's Anthem BC/BS policy terminated on 10/31/14, our monthly CPAP rental claim for DOS 11/12/was denied as member responsibility due to lack of active coverageSince no other insurance information had been provided, billing for the $monthly CPAP rental was posted to the customer's private pay balance on 12/24/By that time, the customer had returned the CPAP on 11/24/14, stating it was not working for himThe customer signed a release of liability for discontinuation of therapy without the authorization of the ordering physician A new insurance card for a Physicians Health Plan (PHP) policy was scanned into our medical records imaging system on 01/08/This policy was effective from 11/01/until 01/31/15, and we were an in network provider with a month timely filing limitUnfortunately, this member's plan required a prior authorization for HCPCS Ewhich could not be obtained since the customer did not provide the new insurance information prior to the rental DOSIt appears that the customer may not have thoroughly investigated how his ongoing CPAP rental would be affected by his new insurance plan As a courtesy, however, we have attempted to obtain a retro authorization for 11/12/Efrom PHPUnfortunately, our request was denied by PHP siting late notification of servicesWe confirmed with the PHP representative that any post service request, regardless of when it was submitted, would have been denied for the same reasonSince the customer's new insurance information was not provided to our office prior to the 11/12/rental date, there was no way we could have obtained an approval for this serviceConsequently, the $11/12/CPAP rental charge has remained as the customer's responsibility At this time, our records indicate that the customer's outstanding balance of $is accurateThe customer's account has not yet been turned over for outside collections, and nothing has been reported to any credit agencyWhile the customer has indicated having multiple conversations with our billing department, the only noted interaction with our private pay accounts representative was on 05/08/The representative's note indicated that the customer had left a voice message requesting a return call after being transferred from a conversation in which a CSR had advised him of his balance dueThe private pay representative returned his call, but had to leave a message requesting he call us back to discuss his questionsHIPAA restrictions do not allow us to leave detailed information on a customer's voice mailThe customer continued to receive letters regarding his delinquent account balance, but there were no further responses from the customer noted on his account Offer: Thank you again for the opportunity to address this customer's concernsWhile our investigation does show that this customer's remaining $balance is valid as previously described, we can clearly see that his expectations were not metTherefore, in an effort to find a mutually agreeable outcome and reestablish goodwill, we would gladly accept the discounted amount of $as final payment in fullWe have taken into consideration that the customer has returned the CPAP machine, and this reduced amount represents our costs associated with the CPAP related supplies provided to him during the initial equipment setupWe hope that this solution will be satisfactory Initial Consumer Rebuttal / [redacted] (3000, 14, 2015/10/20) */ (The consumer indicated he/she DID NOT accept the response from the business.) I do not accept this because the original bill was for no more than $and now you want to charge me over double thatI would settle for $not a cent moreDoes the person responding to this even look into the history or just throw out a numberAlso don't leave me a voice mail if your department doesn't work regular hours and can not be flexible on timeOther regular people work the same hours and can't make now work related phone calls during workI work till pm and have told your people that and if you can't make notes on people's accounts stating that then you need a new systemYou will remove my name from the debt collector that you have sent my info too and you will retract anything posted negative on my creditIt is also not my fault that you do not file claims on insurance in a timely manner and then turn around and expect people to fork over money because of incompetence
Initial Business Response /* (1000, 5, 2016/06/21) */
Contact Name and Title: *** S***, President
Contact Phone: XXX XXX-XXXX ext ***
Contact Email: ***@alicks.com
I understand fully the consumer's complaint and am sorry that they have had this experienceI have forwarded this
complaint on to the Rehab Group that is responsible to finish this remoldI am sorry that the first mold did not work out
I have requested that my Rehab Group follow up with *** and the family every week until this process is completedUnfortunately, even I personally received a message that *** did call and I attempted to return his call at least once if not twice and got voice mail
I encourage this consumer to keep me in the loop if my rehab group does not meet his needs from this point forwardMy email is ***@alicks.com and is the best way to reach me
I appreciate the consumer's frustration and will look forward to hearing a positive outcome from this point
Initial Business Response /* (1000, 14, 2015/07/15) */
Thank you for bringing this issue to our attention. We appreciate the opportunity to clarify what has happened. But first, we would like to apologize for any frustrations the customer may have experienced. We want to say that we are...
extremely sorry to hear that this customer is unhappy with the service that he received from our company. I do know that several of our associates have wanted to assist this customer and have found it difficult to do so. Our goal, however, is to make sure the needs of our customers are met with quality compassionate care. We further, will work with this customer to get to resolve whatever issues remain.
We spoke with those employees who have had contact with the customer. Although we can not confirm that his phone calls were not returned (as alleged in his complaint), we are very sorry to hear that this happened and apologize for the disappointment it may have caused. When the client notified the staff of this issue, all the employees said they apologized as well to the client for the inconvenience and made sure to meet the client's needs at the time they met with him. One of our Registered Respiratory Therapists met with the client on June 3, 2015. She was handed a script for a chin strap and Nuance or Airfit P10 pillow mask. The client then had some questions regarding the overnight test and how it would work if he was wearing a pillow mask. The Therapist explained the pulse oximeter test to the customer and then explained the differences between the masks. Since the customer had just received a mask with headgear in March, the therapist explained that there would not be coverage for the headgear since it was considered overutilization by his insurance company which only allows a headgear every 6 months. Therefore, the headgear was to be billed to the customer. The customer said he understood the charge. After the customer explained that he had tried calling several times to tell us the mask was unsatisfactory to him, Alick's wrote off the charge for the headgear even though we could not resell the same. The customer did complain about air leaking and blowing into his eyes at this time, but did not bring his original full face mask back to be looked at to see if the Therapists could help him with that issue. Since the customer switched to a nasal pillow mask at that time and assuming that it had worked for him, that would have resolved the issue of air leaking into his eyes. On June 4, 2015 another Registered Respiratory Therapist reviewed a download for the customer and noticed several things on the download that he felt could significantly help the customer with the use of the CPAP. The Therapist called the customer to talk with him about the information and offered to assist the customer. Unfortunately, the customer was not receptive to any questions or suggestions saying instead that it was "too little too late." As the therapist tried to discuss the matter further, the customer hung up on the Therapist.
The therapist then reached out to the doctor to let him know that Alicks Respiratory department would be happy to work with the customer to help him tolerate the CPAP or even switch to BiPAP if that is what the physician preferred. There continue to be avenues to resolve the issues and help the customer should he be amenable to that. Our healthcare professionals would be delighted to work with this customer to achieve a positive outcome.
If, on the other hand, the customer continues to not wish to work with our Healthcare team, we can refund the $50 he paid for an extended warranty on the CPAP device after that unit has been returned. A more appropriate solution would seem to be to work together to achieve a better outcome than what we have been able to do thus far.
We all stand ready to do so without any hesitation. For the past shortfalls, again we extend a sincere apology. Hopefully we can reach a better outcome going forward.
Initial Consumer Rebuttal /* (3000, 16, 2015/07/15) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I had to have an appointment in order to return the mask, the one returned phone call was when I was away from home, the other two unanswered, so could not return the mask. No one apologized for anything, until the manager heard of it. Actually, that's what set me off in the store, the original respiratory therapist saw me to fit me for the second one, did not even show that she was aware that she'd sold me the original mask, nor that I tried to contact her the three times. simply sighing and shrugging her shoulders....If that's an apology, that would be the first time, I'd ever heard it expressed that way. By that time, I'd had enough, turned them over to the Indiana State's Attorney, which has a case pending. I refused to work with them, had the doctor change the prescription over to Memorial Home Care. but now run into issues with getting a new heater hose, the insurance will not pay because I do not have 30 consecutive days using the machine. I only had the nasal mask for a week prior to tonsil surgery, so was unable to use the mask post surgery, was supposed to resume using it, once cleared by the surgeon but the hose has holes in it. The manager also uttered something under her breath as I turned my back to walk out, again, this must be standard for all Alick's employees. I feel the respiratory therapist calling later that week was to cover their butts, plain and simple. I notified the sleep specialist and her staff that I would not do business with Alick's, that I was switching everything over to Memorial, and they were aware of the situation including a new prescription to have Memorial take over general supplies for the C-PAP. They did not return the calls to Alick's for that reason. I am also on Alick's robo-calls, which had also better stop.
I contacted the manufacturer, resellers both are aware of the problem.
Initial Business Response /* (1000, 5, 2017/11/20) */
I thank this caregiver for alerting our management of the issues with his father's equipment. At this time, we have not been able to identify what the issue with the consumer's equipment is; however, we have offered to switch the unit out again...
and evaluate all aspects or its charging and function. The first time that we retrieved the unit, our quality team could not duplicate the described problem.
Having said that, we take the consumer's experience with equipment provided through Alick's very seriously. To try to remedy this situation, Alick's has offered to replace the unit with a new unit and to also provide additional backup portability should there be any further issue. We at Alick's look forward to providing ongoing excellent care now and in the future to this gentleman.
Initial Consumer Rebuttal /* (2000, 7, 2017/11/21) */
(The consumer indicated he/she ACCEPTED the response from the business.)
I accept the solution that has been agreed add-on. But I would like to add that for a life dependant medical device I should not have had to go to the lengths that I did in order to get this resolved.
Initial Business Response /* (1000, 5, 2018/01/19) */
Contact Name and Title: [redacted], President
Contact Phone: XXX XXX-XXXX, 213
Contact Email: [redacted]@alicks.com
First, I am so sorry that we did not resolve this issue more expeditiously, particularly while you were present in the...
store. Having said that, I appreciate working through this matter with you and believe that the issue is now resolved to your satisfaction. I agree that we needed to better communicate the particular balances and how your payment, first thought to be for one invoice, was being applied (without your knowledge) to other open items. As always, communication of issues normally resolves them in an efficient manner.
Should there be any further issues either in this regard or any other, please do not hesitate to contact me or any of our other management team.
Initial Consumer Rebuttal /* (2000, 8, 2018/01/20) */
(The consumer indicated he/she ACCEPTED the response from the business.)
Even before the owner received the complaint from the Revdex.com, he contacted me and began working with me to make things right. He even gave me his direct office number so I didn't have to deal with calling through the switchboard. He agreed that the consumers online billing portal does need upgrading especially since on my end there was no mention to a credit to my account. Given the effort put forth by the owner to resolve this matter, I am willing to give them a second chance and continue utilizing them as my provider.
Initial Business Response /* (1000, 12, 2015/10/15) */
Response:
To whom it may concern,
Because we care, our goal at Alick's Home Medical is to serve and take care of each of our customers like we would our own parents. We strive to always provide the best service possible, but also...
understand that sometimes we may fall short. Thank you for the opportunity to address this customer's concerns as stated in case # XXXXXXXX, and to quickly resolve this matter for our account # XXXXXX.
While every effort is made to provide our customers with the most accurate information regarding their insurance benefits, it should also be noted that the individual is still responsible for knowing and understanding the benefits, limitations, and authorization requirements of their own insurance policy. To help our customers recognize this point, each customer is required at the time of delivery to sign an assignment of benefits form that acknowledges their financial responsibility for any and all services received. Any information provided to the customer at the time of service is only our best estimation, and is not a guarantee of benefits or payment from their insurance. Due to the way in which insurance claims are processed, final billing for any customer cannot be determined until a finalized explanation of benefits (EOB) has been issued by the insurance payer. It is impossible for us to quote any exact benefit amount prior to claim processing, and we do not make it our policy to make any such quote. While our representatives make a good faith effort to explain a customer's expected insurance responsibilities and benefits, we find that many customers still may not fully understand, thereby resulting in confusion or frustration.
During our initial verification of this customer's [redacted] benefits on 08/08/14, we were advised by plan CSR Kay (call reference # XXXXXXXXXXXXXX) that HCPCS codes E0601 and E0562 were a covered benefit on the member's policy with no pre-certification requirement. The member's benefits were stated as 80% coverage of the allowed amount with a 20% co-insurance responsibility for the member after the $500.00 deductible was met. The deductible accumulations at the time of our call showed $300 had been met, but standard disclaimer recordings advised that final benefits and payment amounts are determined at the time of claim processing since totals are subject to change. Based on this information, we collected the estimated remaining $200.00 deductible amount at the time of service.
When the claims for date of service (DOS) 08/12/14 were submitted to his insurance for processing, the member's plan applied a total of $360.28 toward deductible for the first month of CPAP rental, the sale of the heated humidifier, and the sale of all other associated supplies. This member's policy covers CPAP as a monthly rental on a rent to purchase basis. Equipment rental is billed/paid per month, and is never pro-rated. Rental claims for DOS 9/12/14 and 10/12/14 were also applied toward deductible at the allowed amount of $45.80 for each month. A total of $451.88 was billed to the customer in accordance with his policy. An EOB for each DOS would have been issued directly to the customer from his insurance plan confirming this deductible responsibility.
This customer has had an outstanding balance on his account since the initial deductible amounts were posted to his private pay balance on 9/24/14. Other than the $200.00 collected at the time of delivery for the estimated deductible, no payment has ever been received. The remaining $251.88 deductible balance, which has been posted to his private pay account since 11/12/14, has been clearly defined by his insurance as the member's responsibility. Any dispute regarding benefit amounts is strictly between the member and their insurance plan. Providers are bound by contract to assign member responsibility amounts to the customer as indicated on the payer's EOB.
After the member's Anthem BC/BS policy terminated on 10/31/14, our monthly CPAP rental claim for DOS 11/12/14 was denied as member responsibility due to lack of active coverage. Since no other insurance information had been provided, billing for the $125.00 monthly CPAP rental was posted to the customer's private pay balance on 12/24/14. By that time, the customer had returned the CPAP on 11/24/14, stating it was not working for him. The customer signed a release of liability for discontinuation of therapy without the authorization of the ordering physician.
A new insurance card for a Physicians Health Plan (PHP) policy was scanned into our medical records imaging system on 01/08/15. This policy was effective from 11/01/14 until 01/31/15, and we were an in network provider with a 12 month timely filing limit. Unfortunately, this member's plan required a prior authorization for HCPCS E0601 which could not be obtained since the customer did not provide the new insurance information prior to the rental DOS. It appears that the customer may not have thoroughly investigated how his ongoing CPAP rental would be affected by his new insurance plan.
As a courtesy, however, we have attempted to obtain a retro authorization for 11/12/14 E0601 from PHP. Unfortunately, our request was denied by PHP siting late notification of services. We confirmed with the PHP representative that any post service request, regardless of when it was submitted, would have been denied for the same reason. Since the customer's new insurance information was not provided to our office prior to the 11/12/14 rental date, there was no way we could have obtained an approval for this service. Consequently, the $125.00 11/12/14 CPAP rental charge has remained as the customer's responsibility.
At this time, our records indicate that the customer's outstanding balance of $376.88 is accurate. The customer's account has not yet been turned over for outside collections, and nothing has been reported to any credit agency. While the customer has indicated having multiple conversations with our billing department, the only noted interaction with our private pay accounts representative was on 05/08/2015. The representative's note indicated that the customer had left a voice message requesting a return call after being transferred from a conversation in which a CSR had advised him of his balance due. The private pay representative returned his call, but had to leave a message requesting he call us back to discuss his questions. HIPAA restrictions do not allow us to leave detailed information on a customer's voice mail. The customer continued to receive letters regarding his delinquent account balance, but there were no further responses from the customer noted on his account.
Offer:
Thank you again for the opportunity to address this customer's concerns. While our investigation does show that this customer's remaining $376.88 balance is valid as previously described, we can clearly see that his expectations were not met. Therefore, in an effort to find a mutually agreeable outcome and reestablish goodwill, we would gladly accept the discounted amount of $160.28 as final payment in full. We have taken into consideration that the customer has returned the CPAP machine, and this reduced amount represents our costs associated with the CPAP related supplies provided to him during the initial equipment setup. We hope that this solution will be satisfactory.
Initial Consumer Rebuttal /* (3000, 14, 2015/10/20) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I do not accept this because the original bill was for no more than $75 and now you want to charge me over double that. I would settle for $35 not a cent more. Does the person responding to this even look into the history or just throw out a number. Also don't leave me a voice mail if your department doesn't work regular hours and can not be flexible on time. Other regular people work the same hours and can't make now work related phone calls during work. I work till 5 pm and have told your people that and if you can't make notes on people's accounts stating that then you need a new system. You will remove my name from the debt collector that you have sent my info too and you will retract anything posted negative on my credit. It is also not my fault that you do not file claims on insurance in a timely manner and then turn around and expect people to fork over money because of incompetence.
Initial Business Response / [redacted] (1000, 12, 2015/10/15) */ Response: To whom it may concern, Because we care, our goal at Alick's Home Medical is to serve and take care of each of our customers like we would our own parentsWe strive to always provide the best service possible, but also understand that sometimes we may fall shortThank you for the opportunity to address this customer's concerns as stated in case # XXXXXXXX, and to quickly resolve this matter for our account # XXXXXX While every effort is made to provide our customers with the most accurate information regarding their insurance benefits, it should also be noted that the individual is still responsible for knowing and understanding the benefits, limitations, and authorization requirements of their own insurance policyTo help our customers recognize this point, each customer is required at the time of delivery to sign an assignment of benefits form that acknowledges their financial responsibility for any and all services receivedAny information provided to the customer at the time of service is only our best estimation, and is not a guarantee of benefits or payment from their insuranceDue to the way in which insurance claims are processed, final billing for any customer cannot be determined until a finalized explanation of benefits (EOB) has been issued by the insurance payerIt is impossible for us to quote any exact benefit amount prior to claim processing, and we do not make it our policy to make any such quoteWhile our representatives make a good faith effort to explain a customer's expected insurance responsibilities and benefits, we find that many customers still may not fully understand, thereby resulting in confusion or frustration During our initial verification of this customer's [redacted] benefits on 08/08/14, we were advised by plan CSR Kay (call reference # XXXXXXXXXXXXXX) that HCPCS codes Eand Ewere a covered benefit on the member's policy with no pre-certification requirementThe member's benefits were stated as 80% coverage of the allowed amount with a 20% co-insurance responsibility for the member after the $deductible was metThe deductible accumulations at the time of our call showed $had been met, but standard disclaimer recordings advised that final benefits and payment amounts are determined at the time of claim processing since totals are subject to changeBased on this information, we collected the estimated remaining $deductible amount at the time of service When the claims for date of service (DOS) 08/12/were submitted to his insurance for processing, the member's plan applied a total of $toward deductible for the first month of CPAP rental, the sale of the heated humidifier, and the sale of all other associated suppliesThis member's policy covers CPAP as a monthly rental on a rent to purchase basisEquipment rental is billed/paid per month, and is never pro-ratedRental claims for DOS 9/12/and 10/12/were also applied toward deductible at the allowed amount of $for each monthA total of $was billed to the customer in accordance with his policyAn EOB for each DOS would have been issued directly to the customer from his insurance plan confirming this deductible responsibility This customer has had an outstanding balance on his account since the initial deductible amounts were posted to his private pay balance on 9/24/Other than the $collected at the time of delivery for the estimated deductible, no payment has ever been receivedThe remaining $deductible balance, which has been posted to his private pay account since 11/12/14, has been clearly defined by his insurance as the member's responsibilityAny dispute regarding benefit amounts is strictly between the member and their insurance planProviders are bound by contract to assign member responsibility amounts to the customer as indicated on the payer's EOB After the member's Anthem BC/BS policy terminated on 10/31/14, our monthly CPAP rental claim for DOS 11/12/was denied as member responsibility due to lack of active coverageSince no other insurance information had been provided, billing for the $monthly CPAP rental was posted to the customer's private pay balance on 12/24/By that time, the customer had returned the CPAP on 11/24/14, stating it was not working for himThe customer signed a release of liability for discontinuation of therapy without the authorization of the ordering physician A new insurance card for a Physicians Health Plan (PHP) policy was scanned into our medical records imaging system on 01/08/This policy was effective from 11/01/until 01/31/15, and we were an in network provider with a month timely filing limitUnfortunately, this member's plan required a prior authorization for HCPCS Ewhich could not be obtained since the customer did not provide the new insurance information prior to the rental DOSIt appears that the customer may not have thoroughly investigated how his ongoing CPAP rental would be affected by his new insurance plan As a courtesy, however, we have attempted to obtain a retro authorization for 11/12/Efrom PHPUnfortunately, our request was denied by PHP siting late notification of servicesWe confirmed with the PHP representative that any post service request, regardless of when it was submitted, would have been denied for the same reasonSince the customer's new insurance information was not provided to our office prior to the 11/12/rental date, there was no way we could have obtained an approval for this serviceConsequently, the $11/12/CPAP rental charge has remained as the customer's responsibility At this time, our records indicate that the customer's outstanding balance of $is accurateThe customer's account has not yet been turned over for outside collections, and nothing has been reported to any credit agencyWhile the customer has indicated having multiple conversations with our billing department, the only noted interaction with our private pay accounts representative was on 05/08/The representative's note indicated that the customer had left a voice message requesting a return call after being transferred from a conversation in which a CSR had advised him of his balance dueThe private pay representative returned his call, but had to leave a message requesting he call us back to discuss his questionsHIPAA restrictions do not allow us to leave detailed information on a customer's voice mailThe customer continued to receive letters regarding his delinquent account balance, but there were no further responses from the customer noted on his account Offer: Thank you again for the opportunity to address this customer's concernsWhile our investigation does show that this customer's remaining $balance is valid as previously described, we can clearly see that his expectations were not metTherefore, in an effort to find a mutually agreeable outcome and reestablish goodwill, we would gladly accept the discounted amount of $as final payment in fullWe have taken into consideration that the customer has returned the CPAP machine, and this reduced amount represents our costs associated with the CPAP related supplies provided to him during the initial equipment setupWe hope that this solution will be satisfactory Initial Consumer Rebuttal / [redacted] (3000, 14, 2015/10/20) */ (The consumer indicated he/she DID NOT accept the response from the business.) I do not accept this because the original bill was for no more than $and now you want to charge me over double thatI would settle for $not a cent moreDoes the person responding to this even look into the history or just throw out a numberAlso don't leave me a voice mail if your department doesn't work regular hours and can not be flexible on timeOther regular people work the same hours and can't make now work related phone calls during workI work till pm and have told your people that and if you can't make notes on people's accounts stating that then you need a new systemYou will remove my name from the debt collector that you have sent my info too and you will retract anything posted negative on my creditIt is also not my fault that you do not file claims on insurance in a timely manner and then turn around and expect people to fork over money because of incompetence
Initial Business Response /* (1000, 5, 2016/06/21) */
Contact Name and Title: *** S***, President
Contact Phone: XXX XXX-XXXX ext ***
Contact Email: ***@alicks.com
I understand fully the consumer's complaint and am sorry that they have had this experienceI have forwarded this
complaint on to the Rehab Group that is responsible to finish this remoldI am sorry that the first mold did not work out
I have requested that my Rehab Group follow up with *** and the family every week until this process is completedUnfortunately, even I personally received a message that *** did call and I attempted to return his call at least once if not twice and got voice mail
I encourage this consumer to keep me in the loop if my rehab group does not meet his needs from this point forwardMy email is ***@alicks.com and is the best way to reach me
I appreciate the consumer's frustration and will look forward to hearing a positive outcome from this point
Initial Business Response /* (1000, 14, 2015/07/15) */
Thank you for bringing this issue to our attention. We appreciate the opportunity to clarify what has happened. But first, we would like to apologize for any frustrations the customer may have experienced. We want to say that we are...
extremely sorry to hear that this customer is unhappy with the service that he received from our company. I do know that several of our associates have wanted to assist this customer and have found it difficult to do so. Our goal, however, is to make sure the needs of our customers are met with quality compassionate care. We further, will work with this customer to get to resolve whatever issues remain.
We spoke with those employees who have had contact with the customer. Although we can not confirm that his phone calls were not returned (as alleged in his complaint), we are very sorry to hear that this happened and apologize for the disappointment it may have caused. When the client notified the staff of this issue, all the employees said they apologized as well to the client for the inconvenience and made sure to meet the client's needs at the time they met with him. One of our Registered Respiratory Therapists met with the client on June 3, 2015. She was handed a script for a chin strap and Nuance or Airfit P10 pillow mask. The client then had some questions regarding the overnight test and how it would work if he was wearing a pillow mask. The Therapist explained the pulse oximeter test to the customer and then explained the differences between the masks. Since the customer had just received a mask with headgear in March, the therapist explained that there would not be coverage for the headgear since it was considered overutilization by his insurance company which only allows a headgear every 6 months. Therefore, the headgear was to be billed to the customer. The customer said he understood the charge. After the customer explained that he had tried calling several times to tell us the mask was unsatisfactory to him, Alick's wrote off the charge for the headgear even though we could not resell the same. The customer did complain about air leaking and blowing into his eyes at this time, but did not bring his original full face mask back to be looked at to see if the Therapists could help him with that issue. Since the customer switched to a nasal pillow mask at that time and assuming that it had worked for him, that would have resolved the issue of air leaking into his eyes. On June 4, 2015 another Registered Respiratory Therapist reviewed a download for the customer and noticed several things on the download that he felt could significantly help the customer with the use of the CPAP. The Therapist called the customer to talk with him about the information and offered to assist the customer. Unfortunately, the customer was not receptive to any questions or suggestions saying instead that it was "too little too late." As the therapist tried to discuss the matter further, the customer hung up on the Therapist.
The therapist then reached out to the doctor to let him know that Alicks Respiratory department would be happy to work with the customer to help him tolerate the CPAP or even switch to BiPAP if that is what the physician preferred. There continue to be avenues to resolve the issues and help the customer should he be amenable to that. Our healthcare professionals would be delighted to work with this customer to achieve a positive outcome.
If, on the other hand, the customer continues to not wish to work with our Healthcare team, we can refund the $50 he paid for an extended warranty on the CPAP device after that unit has been returned. A more appropriate solution would seem to be to work together to achieve a better outcome than what we have been able to do thus far.
We all stand ready to do so without any hesitation. For the past shortfalls, again we extend a sincere apology. Hopefully we can reach a better outcome going forward.
Initial Consumer Rebuttal /* (3000, 16, 2015/07/15) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I had to have an appointment in order to return the mask, the one returned phone call was when I was away from home, the other two unanswered, so could not return the mask. No one apologized for anything, until the manager heard of it. Actually, that's what set me off in the store, the original respiratory therapist saw me to fit me for the second one, did not even show that she was aware that she'd sold me the original mask, nor that I tried to contact her the three times. simply sighing and shrugging her shoulders....If that's an apology, that would be the first time, I'd ever heard it expressed that way. By that time, I'd had enough, turned them over to the Indiana State's Attorney, which has a case pending. I refused to work with them, had the doctor change the prescription over to Memorial Home Care. but now run into issues with getting a new heater hose, the insurance will not pay because I do not have 30 consecutive days using the machine. I only had the nasal mask for a week prior to tonsil surgery, so was unable to use the mask post surgery, was supposed to resume using it, once cleared by the surgeon but the hose has holes in it. The manager also uttered something under her breath as I turned my back to walk out, again, this must be standard for all Alick's employees. I feel the respiratory therapist calling later that week was to cover their butts, plain and simple. I notified the sleep specialist and her staff that I would not do business with Alick's, that I was switching everything over to Memorial, and they were aware of the situation including a new prescription to have Memorial take over general supplies for the C-PAP. They did not return the calls to Alick's for that reason. I am also on Alick's robo-calls, which had also better stop.
I contacted the manufacturer, resellers both are aware of the problem.
Initial Business Response /* (1000, 5, 2017/11/20) */
I thank this caregiver for alerting our management of the issues with his father's equipment. At this time, we have not been able to identify what the issue with the consumer's equipment is; however, we have offered to switch the unit out again...
and evaluate all aspects or its charging and function. The first time that we retrieved the unit, our quality team could not duplicate the described problem.
Having said that, we take the consumer's experience with equipment provided through Alick's very seriously. To try to remedy this situation, Alick's has offered to replace the unit with a new unit and to also provide additional backup portability should there be any further issue. We at Alick's look forward to providing ongoing excellent care now and in the future to this gentleman.
Initial Consumer Rebuttal /* (2000, 7, 2017/11/21) */
(The consumer indicated he/she ACCEPTED the response from the business.)
I accept the solution that has been agreed add-on. But I would like to add that for a life dependant medical device I should not have had to go to the lengths that I did in order to get this resolved.
Initial Business Response /* (1000, 5, 2018/01/19) */
Contact Name and Title: [redacted], President
Contact Phone: XXX XXX-XXXX, 213
Contact Email: [redacted]@alicks.com
First, I am so sorry that we did not resolve this issue more expeditiously, particularly while you were present in the...
store. Having said that, I appreciate working through this matter with you and believe that the issue is now resolved to your satisfaction. I agree that we needed to better communicate the particular balances and how your payment, first thought to be for one invoice, was being applied (without your knowledge) to other open items. As always, communication of issues normally resolves them in an efficient manner.
Should there be any further issues either in this regard or any other, please do not hesitate to contact me or any of our other management team.
Initial Consumer Rebuttal /* (2000, 8, 2018/01/20) */
(The consumer indicated he/she ACCEPTED the response from the business.)
Even before the owner received the complaint from the Revdex.com, he contacted me and began working with me to make things right. He even gave me his direct office number so I didn't have to deal with calling through the switchboard. He agreed that the consumers online billing portal does need upgrading especially since on my end there was no mention to a credit to my account. Given the effort put forth by the owner to resolve this matter, I am willing to give them a second chance and continue utilizing them as my provider.
Initial Business Response /* (1000, 12, 2015/10/15) */
Response:
To whom it may concern,
Because we care, our goal at Alick's Home Medical is to serve and take care of each of our customers like we would our own parents. We strive to always provide the best service possible, but also...
understand that sometimes we may fall short. Thank you for the opportunity to address this customer's concerns as stated in case # XXXXXXXX, and to quickly resolve this matter for our account # XXXXXX.
While every effort is made to provide our customers with the most accurate information regarding their insurance benefits, it should also be noted that the individual is still responsible for knowing and understanding the benefits, limitations, and authorization requirements of their own insurance policy. To help our customers recognize this point, each customer is required at the time of delivery to sign an assignment of benefits form that acknowledges their financial responsibility for any and all services received. Any information provided to the customer at the time of service is only our best estimation, and is not a guarantee of benefits or payment from their insurance. Due to the way in which insurance claims are processed, final billing for any customer cannot be determined until a finalized explanation of benefits (EOB) has been issued by the insurance payer. It is impossible for us to quote any exact benefit amount prior to claim processing, and we do not make it our policy to make any such quote. While our representatives make a good faith effort to explain a customer's expected insurance responsibilities and benefits, we find that many customers still may not fully understand, thereby resulting in confusion or frustration.
During our initial verification of this customer's [redacted] benefits on 08/08/14, we were advised by plan CSR Kay (call reference # XXXXXXXXXXXXXX) that HCPCS codes E0601 and E0562 were a covered benefit on the member's policy with no pre-certification requirement. The member's benefits were stated as 80% coverage of the allowed amount with a 20% co-insurance responsibility for the member after the $500.00 deductible was met. The deductible accumulations at the time of our call showed $300 had been met, but standard disclaimer recordings advised that final benefits and payment amounts are determined at the time of claim processing since totals are subject to change. Based on this information, we collected the estimated remaining $200.00 deductible amount at the time of service.
When the claims for date of service (DOS) 08/12/14 were submitted to his insurance for processing, the member's plan applied a total of $360.28 toward deductible for the first month of CPAP rental, the sale of the heated humidifier, and the sale of all other associated supplies. This member's policy covers CPAP as a monthly rental on a rent to purchase basis. Equipment rental is billed/paid per month, and is never pro-rated. Rental claims for DOS 9/12/14 and 10/12/14 were also applied toward deductible at the allowed amount of $45.80 for each month. A total of $451.88 was billed to the customer in accordance with his policy. An EOB for each DOS would have been issued directly to the customer from his insurance plan confirming this deductible responsibility.
This customer has had an outstanding balance on his account since the initial deductible amounts were posted to his private pay balance on 9/24/14. Other than the $200.00 collected at the time of delivery for the estimated deductible, no payment has ever been received. The remaining $251.88 deductible balance, which has been posted to his private pay account since 11/12/14, has been clearly defined by his insurance as the member's responsibility. Any dispute regarding benefit amounts is strictly between the member and their insurance plan. Providers are bound by contract to assign member responsibility amounts to the customer as indicated on the payer's EOB.
After the member's Anthem BC/BS policy terminated on 10/31/14, our monthly CPAP rental claim for DOS 11/12/14 was denied as member responsibility due to lack of active coverage. Since no other insurance information had been provided, billing for the $125.00 monthly CPAP rental was posted to the customer's private pay balance on 12/24/14. By that time, the customer had returned the CPAP on 11/24/14, stating it was not working for him. The customer signed a release of liability for discontinuation of therapy without the authorization of the ordering physician.
A new insurance card for a Physicians Health Plan (PHP) policy was scanned into our medical records imaging system on 01/08/15. This policy was effective from 11/01/14 until 01/31/15, and we were an in network provider with a 12 month timely filing limit. Unfortunately, this member's plan required a prior authorization for HCPCS E0601 which could not be obtained since the customer did not provide the new insurance information prior to the rental DOS. It appears that the customer may not have thoroughly investigated how his ongoing CPAP rental would be affected by his new insurance plan.
As a courtesy, however, we have attempted to obtain a retro authorization for 11/12/14 E0601 from PHP. Unfortunately, our request was denied by PHP siting late notification of services. We confirmed with the PHP representative that any post service request, regardless of when it was submitted, would have been denied for the same reason. Since the customer's new insurance information was not provided to our office prior to the 11/12/14 rental date, there was no way we could have obtained an approval for this service. Consequently, the $125.00 11/12/14 CPAP rental charge has remained as the customer's responsibility.
At this time, our records indicate that the customer's outstanding balance of $376.88 is accurate. The customer's account has not yet been turned over for outside collections, and nothing has been reported to any credit agency. While the customer has indicated having multiple conversations with our billing department, the only noted interaction with our private pay accounts representative was on 05/08/2015. The representative's note indicated that the customer had left a voice message requesting a return call after being transferred from a conversation in which a CSR had advised him of his balance due. The private pay representative returned his call, but had to leave a message requesting he call us back to discuss his questions. HIPAA restrictions do not allow us to leave detailed information on a customer's voice mail. The customer continued to receive letters regarding his delinquent account balance, but there were no further responses from the customer noted on his account.
Offer:
Thank you again for the opportunity to address this customer's concerns. While our investigation does show that this customer's remaining $376.88 balance is valid as previously described, we can clearly see that his expectations were not met. Therefore, in an effort to find a mutually agreeable outcome and reestablish goodwill, we would gladly accept the discounted amount of $160.28 as final payment in full. We have taken into consideration that the customer has returned the CPAP machine, and this reduced amount represents our costs associated with the CPAP related supplies provided to him during the initial equipment setup. We hope that this solution will be satisfactory.
Initial Consumer Rebuttal /* (3000, 14, 2015/10/20) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I do not accept this because the original bill was for no more than $75 and now you want to charge me over double that. I would settle for $35 not a cent more. Does the person responding to this even look into the history or just throw out a number. Also don't leave me a voice mail if your department doesn't work regular hours and can not be flexible on time. Other regular people work the same hours and can't make now work related phone calls during work. I work till 5 pm and have told your people that and if you can't make notes on people's accounts stating that then you need a new system. You will remove my name from the debt collector that you have sent my info too and you will retract anything posted negative on my credit. It is also not my fault that you do not file claims on insurance in a timely manner and then turn around and expect people to fork over money because of incompetence.