The patient doesn't understand her insurance policy and the calendar year deductible. Cost-sharing insurance plans are agreed upon with the member and the insurance company (through an employer/ or self insurances) that is agreed upon with the member of the calendar year deductible for
in-network and out-network plan. She did receive a rental equipment July 20th in which she did pay the estimated copay of her insurance coverage. The *** plan covers 70%/ pt is responsible for 30% after all calendar deductibles have been met. This was explained to the patient on several phone interactions 9/22, and three times 9/25, then again on 9/She was advised that she could return the equipment. She was advised that she still will be responsible for the outstanding balances that her insurance applied towards to her deductible. Patient hung up on the staff and said she was going to file a complaint. We have attached the insurance eob's that applied everything to the member's responsibility, and the patient original agreed and signed. Documents due inform the patient if they have a deductible they would want to contact their insurance directly
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or
concerns in reference to complaint #***I understand that by choosing to accept the business response that my complaint will be closed as resolvedFor the record the company still says in their response that I requested these parts which I did notHad I requested them I would not have submitted a complaint and had they not outright refused to take them back at my request and demanded full payment again I would not have submitted a complaintAlso not sure why it takes weeks to get a refundAppreciate the help of the Revdex.com because without it I don't believe this would have ever been resolved.
Regards,
*** ***
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ***
The company hasn't tried to work with me in any way despite numerous attempts to get the issue resolved The way call with the insurance company solved nothing but the insurance company saying I'm getting the run around, and they don't understand why they just refund the money because its a lack of communication on their part They just keep stating the same thing that there is nothing they can do and I'm to pay or it will go into collections I'm not stupid I understand what is the policy regarding insurance and deductibles, if I haven't met the the deductible I'm responsible for the difference until I have met the deductible dollar amount My issue was and continues to be what Cape Medical isn't taking responsibility for their employee quoting me the wrong amount I said it was cheaper for me to return the machine and to purchase it outright online, that is no longer the case since I have paid them roughly $since July when I picked up the machine I will not be returning the machine and even if I did they will "entertain" a discount on my open balance, I don't have any open invoices, so what is there to discount?? I have lost all trust in this company in following through with anything they sayI will not be purchasing any replacement equipment through them, since it is cheaper elsewhere I will be purchasing that elsewhere
Regards,
*** ***
On November 24, 2015 we called the patient and left her a voicemail and noted her chart as follows. Called the patient left a message on her machine. apologized that she had to take time out of her work day to make calls to us to deal with this. Advised that I did in fact review her authorizations...
on file, all of which were for one nasal pillow. Advised I also had documentation from her Insurance Company that stated we are not to exceed billing for more than one nasal pillow per six months and that's why she received the same response from everyone she spoke with at CMS. Apologized for the delay in receiving her last order(looked like a B/O issue) and requested she call me back if she would like to talk about any issues. For your convenience we have included a copy of her Insurance company's regulations. Our business is in providing products and services to our patients, we Never benefit from not providing or with holding products-it compromises revenue and profitability, not to mention patient care. The issue here is with what her insurance plan will authorize. they have a "utilization management" program in place to reduce expenses and it is causing her significant issues. We understand well which Insurance companies allow which products in which quantities at which intervals. We have seen several situations, apparently this one included, where patients are given bad information by call centers at Health Insurance Companies. As stated, it is in our business and clinical interest to provide these products to our patients as frequently as their insurance allows for, in this case the complainant needs to take issue with her Insurance plan if she feels their schedule is not sufficient for her care.
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted]. Please add your rejection comments below.
[If you are rejecting the business's response please enter your rejection comments here. They keep claiming they did not lie to me. I have already forwarded the email they sent to me explaining how they send the claim to my insurance company to determine my deductible before the women came out to fit me with the machine. After I was displeased they lied again to trick me to send back the machine which they knew they would keep trying to Bill me for. They promised me on the phone that after sending back the machine I would owe nothing. I have already agreed to pay even though I feel I'm not obligated due to them being dishonest and deceitful but I require them to send me back the machine. I'm not paying them for something they still have. Send me the machine and I'll pay the balance of the $613 but I won't pay any interest. I feel this is more than a fair resolution.
Regards,
[redacted]
Tell us why here..This patient filed a complaint regarding his financial responsibility for products and services he received from our organization. He acknowledged when he received the products initially he would honor his financial responsibility, he has not. We never advise patients that they...
will not owe money, they are always directed to their insurance plan for questions. The individual had a deductible on his plan that was not met when we billed his insurer. He has demonstrated a clear pattern of not meeting his personal financial responsibility with our organization.This complaint is specious and results from someone simply not wanting to pay a bill they acknowledged they would be responsible for. Any complaints regarding the deductible or amount should be directed at his health insurance plan, who determines the amount of both.
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted].
The business is going around in circles with me. My issue is the Cape Medical representative telling me my out of pocket cost. leading me to believe it had already been run through the insurance. Even the blue cross representative said I was getting the run around and doesn't understand why they don't just credit the amount. [redacted]
We have repeatedly worked with this customer on their concerns, including a three way call with her insurance company to explain the deductible. She is free to return the machine at any time. We do not set the plan rules or deductible amounts, the plan does and we are simply following the rules of the plan she is enrolled in. The customer has repeatedly offered to return the machine and purchase a device online, if she is to do this we will entertain a discount of her open balances, understanding she will no longer have clinical coverage for her therapy or access to basic troubleshooting for the device.
The patient doesn't understand her insurance policy and the calendar year deductible. Cost-sharing insurance plans are agreed upon with the member and the insurance company (through an employer/ or self insurances) that is agreed upon with the member of the calendar year deductible for
in-network and out-network plan. She did receive a rental equipment July 20th in which she did pay the estimated copay of her insurance coverage. The *** plan covers 70%/ pt is responsible for 30% after all calendar deductibles have been met. This was explained to the patient on several phone interactions 9/22, and three times 9/25, then again on 9/She was advised that she could return the equipment. She was advised that she still will be responsible for the outstanding balances that her insurance applied towards to her deductible. Patient hung up on the staff and said she was going to file a complaint. We have attached the insurance eob's that applied everything to the member's responsibility, and the patient original agreed and signed. Documents due inform the patient if they have a deductible they would want to contact their insurance directly
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or
concerns in reference to complaint #***I understand that by choosing to accept the business response that my complaint will be closed as resolvedFor the record the company still says in their response that I requested these parts which I did notHad I requested them I would not have submitted a complaint and had they not outright refused to take them back at my request and demanded full payment again I would not have submitted a complaintAlso not sure why it takes weeks to get a refundAppreciate the help of the Revdex.com because without it I don't believe this would have ever been resolved.
Regards,
*** ***
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ***
The company hasn't tried to work with me in any way despite numerous attempts to get the issue resolved The way call with the insurance company solved nothing but the insurance company saying I'm getting the run around, and they don't understand why they just refund the money because its a lack of communication on their part They just keep stating the same thing that there is nothing they can do and I'm to pay or it will go into collections I'm not stupid I understand what is the policy regarding insurance and deductibles, if I haven't met the the deductible I'm responsible for the difference until I have met the deductible dollar amount My issue was and continues to be what Cape Medical isn't taking responsibility for their employee quoting me the wrong amount I said it was cheaper for me to return the machine and to purchase it outright online, that is no longer the case since I have paid them roughly $since July when I picked up the machine I will not be returning the machine and even if I did they will "entertain" a discount on my open balance, I don't have any open invoices, so what is there to discount?? I have lost all trust in this company in following through with anything they sayI will not be purchasing any replacement equipment through them, since it is cheaper elsewhere I will be purchasing that elsewhere
Regards,
*** ***
On November 24, 2015 we called the patient and left her a voicemail and noted her chart as follows. Called the patient left a message on her machine. apologized that she had to take time out of her work day to make calls to us to deal with this. Advised that I did in fact review her authorizations...
on file, all of which were for one nasal pillow. Advised I also had documentation from her Insurance Company that stated we are not to exceed billing for more than one nasal pillow per six months and that's why she received the same response from everyone she spoke with at CMS. Apologized for the delay in receiving her last order(looked like a B/O issue) and requested she call me back if she would like to talk about any issues. For your convenience we have included a copy of her Insurance company's regulations. Our business is in providing products and services to our patients, we Never benefit from not providing or with holding products-it compromises revenue and profitability, not to mention patient care. The issue here is with what her insurance plan will authorize. they have a "utilization management" program in place to reduce expenses and it is causing her significant issues. We understand well which Insurance companies allow which products in which quantities at which intervals. We have seen several situations, apparently this one included, where patients are given bad information by call centers at Health Insurance Companies. As stated, it is in our business and clinical interest to provide these products to our patients as frequently as their insurance allows for, in this case the complainant needs to take issue with her Insurance plan if she feels their schedule is not sufficient for her care.
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted]. Please add your rejection comments below.
[If you are rejecting the business's response please enter your rejection comments here. They keep claiming they did not lie to me. I have already forwarded the email they sent to me explaining how they send the claim to my insurance company to determine my deductible before the women came out to fit me with the machine. After I was displeased they lied again to trick me to send back the machine which they knew they would keep trying to Bill me for. They promised me on the phone that after sending back the machine I would owe nothing. I have already agreed to pay even though I feel I'm not obligated due to them being dishonest and deceitful but I require them to send me back the machine. I'm not paying them for something they still have. Send me the machine and I'll pay the balance of the $613 but I won't pay any interest. I feel this is more than a fair resolution.
Regards,
[redacted]
Tell us why here..This patient filed a complaint regarding his financial responsibility for products and services he received from our organization. He acknowledged when he received the products initially he would honor his financial responsibility, he has not. We never advise patients that they...
will not owe money, they are always directed to their insurance plan for questions. The individual had a deductible on his plan that was not met when we billed his insurer. He has demonstrated a clear pattern of not meeting his personal financial responsibility with our organization.This complaint is specious and results from someone simply not wanting to pay a bill they acknowledged they would be responsible for. Any complaints regarding the deductible or amount should be directed at his health insurance plan, who determines the amount of both.
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted].
The business is going around in circles with me. My issue is the Cape Medical representative telling me my out of pocket cost. leading me to believe it had already been run through the insurance. Even the blue cross representative said I was getting the run around and doesn't understand why they don't just credit the amount. [redacted]
Our billing team is in the process of contacting him to refund the amount and process a return of the goods he requested, but no longer wants.
We have repeatedly worked with this customer on their concerns, including a three way call with her insurance company to explain the deductible. She is free to return the machine at any time. We do not set the plan rules or deductible amounts, the plan does and we are simply following the rules of the plan she is enrolled in. The customer has repeatedly offered to return the machine and purchase a device online, if she is to do this we will entertain a discount of her open balances, understanding she will no longer have clinical coverage for her therapy or access to basic troubleshooting for the device.