Colorado Center for Reproductive Medicine

CCRM had not received any inquiries from the patient prior to receiving the letter from the Colorado Revdex.comUpon receipt of the letter, a representative from CCRM’s Patient Financial Services department reached out to the patient by phone on January 4, to discuss the complaint to the Revdex.com: The representative explained to the patient that her insurance company had told CCRM that the authorization for her services had been denied, this was shortly before the patient payment due dateThis denial triggered a call and payment reminder to the patient for the total amount due without insurance coverageIt is CCRM’s policy that payments are due five days prior to the start of stimulation medication, the denial by the insurance company was received very close to that payment due dateIt was later found that only one code of the many sent for the prior authorization had been denied and the others were all approvedUnfortunately this one code denial wasn’t specified to CCRM by the insurance company, instead, we were simply told the authorization was denied I let the patient know that we would be refunding her the amounts that insurance approved authorizationWe also let the patient know that CCRM has put in place a double-check for any patient who’s prior authorization is denied when the patient has clear benefit coverageWe will make sure to clarify if the entire authorization is being denied or only specific codesPlease let us know if you have any questions or need additional detailThank you,Rebecca

April 6, 2018 Attn: Revdex.com [email protected] Revdex.com Complaint ID *** Due to the specific nature of the patient’s ongoing feedback, CCRM is working directly with the patient to address her questions and concerns.Thank you,*** RHONDA
***, RNExecutive Director

CCRM had not received any inquiries from the patient prior to receiving the letter from the Colorado Revdex.com. Upon receipt of the letter, a representative from CCRM’s Patient Financial Services department reached out to the patient by phone on January 4, 2018 to discuss...

the complaint to the Revdex.com: The representative explained to the patient that her insurance company had told CCRM that the authorization for her services had been denied, this was shortly before the patient  payment due date. This denial triggered a call and payment reminder to the patient for the total amount due without insurance coverage. It is CCRM’s policy that payments are due five days prior to the start of stimulation medication, the denial by the insurance company was received very close to that payment due date. It was later found that only one code of the many sent for the prior authorization had been denied and the others were all approved. Unfortunately this one code denial wasn’t specified to CCRM by the insurance company, instead, we were simply told the authorization was denied.  I let the patient know that we would be refunding her the amounts that insurance approved authorization. We also let the patient know that CCRM has put in place a double-check for any patient who’s prior authorization is denied when the patient has clear benefit coverage. We will make sure to clarify if the entire authorization is being denied or only specific codes. Please let us know if you have any questions or need additional detail. Thank you,Rebecca