Collett, Jared R

October 4, 2016 Revdex.com1010 E. Missouri AvenuePhoenix, AZ 85014Conciliation & Engagement Dept. Subject:  ID# [redacted]To Whom It May ConcernThank you for bringing this to our attention. Let me bring out the history so there is a clearer picture of this situation....

This child was treated for a vascular anomaly. He required custom compression garments and the mom was advised that as they would fit snuggly, the child would need to be re-measured at least every 3 months to allow for either  growth of the child or reduction in the lymphatic retention. Bio-Concepts designs and manufactures custom compression garments. On November 21, 2014, Bio-Concepts received the first order for this child from the ordering facility. Insurance information was provided and the mom was contacted. She had a Blue Cross/Blue Shield policy (BC/BS) that we are not contracted with. Understand, BC/BS has a national policy that they will not pay to providers that are not contracted. They will pay to the family, if they pay. Because of this, it is our policy to be paid upfront and file a courtesy claim for the policy holder.  We would work on a prior authorization, if needed, but she would need to pay upfront. The mom was furious and refused to consider this. She demanded professional courtesy, as a physician, and insisted she would have the insurance pay to Bio-Concepts.  Bio-Concepts worked with her BC/BS insurance and they provided an “Out of Network Exception” for the garments [2 sets]. The order shipped within 10 days of receiving the authorization.  No returns or complaints at this time came from the mom or the therapist. A claim was filed the day the order shipped, December 22, 2014. In March, 2015, Bio-Concepts received an order to make 2 new sets of custom compression garments for the child with new measurements. However, we had still not been paid for the original 2 sets. We contacted the mom and advised these would be out of pocket and she still owed for the original 2 garments. She again balked and insisted her insurance would cover.  She eventually got a case manager to work with for her child. It was through the case manager that we finally got the BC/BS claims department to tell us that they in fact had paid the claim – to the mom. She had not sent payment on to Bio-Concepts. We left several messages and were finally paid April 15, 2015. The case manager also helped to obtain another prior authorization. The new sets were provided and a claim was filed. This time the insurance sent an EOB stating that in spite of the prior authorization, it was not a covered benefit and therefore, the patient’s responsibility. Mom eventually got her insurance to pay to her in May 2015. However, she didn’t pay to Bio-Concepts until August 19, 2015.In August 2016 another 2 sets were ordered with new measurements and the same argument ensued. Mom refused to pay up front. A prior authorization was obtained and the garments were provided. Mom was unhappy with the length of the sleeve even though it match matched the length of the previous garments. The garments were shortened 1 inch to accommodate the mother. Mom received payment from the insurance and again Bio-Concepts had to prove she received payment and we were not paid until November 2015.In March, 2016 Bio-Concepts received an order for 2 new sets and mom was sternly advised she would need to pay for them up front. It was not acceptable that we should have to work so hard to be paid for a service. It was her insurance and it is now her fight with them. As a medical practitioner and a policy holder, she has more weight with her insurance to pay promptly and to the vendor, than we do. She relented and paid. The garments were provided March 29, 2016. A claim was filed and mom has been reimbursed from her insurance. It paid to her April 14, 2016, Check# [redacted] in full.Our warranty period is 30 days from day of receipt by the patient. It covers alterations or replacement   resulting from defects in workmanship, materials or design. Mom returned these garments to Bio-Concepts in mid-may (out of warranty) for no charge alteration. Bio-concepts, wanting to keep peace, allowed the alteration per the therapist’s instructions for changes. All was done and shipped May 25, 2016. On June 17, 2016 Bio-Concepts received the garments back from the mom demanding a refund, stating they didn’t fit. She refused to take the garments to the therapist to have them evaluated.We do not believe that Bio-Concepts is at fault for any errors with the final garments. Mom is most difficult to deal with and only values her own opinion. Further, she has already been reimbursed for the garments.I hope this sheds some other light on this.Sincerely,Lari-Ann C. R[redacted]Corporate Secretary