Community Surgical Supply of Toms River, Inc.

Complaint: ***
I am rejecting this response because:
The only thing that is true that I found out from my insurance not the provider is my coverage dictates what I pay. I requested my supply be shipped but as of today still has not been shipped I was made to understand the $covered the monthly fees and after three months the CPAP would be mineMy insurance explained there is a month rental fee for $and then the CPAP will be mineClearly the supplier will say anything to get the machine rented and collect their fee. I am willing to settles this with the monies already paid and the payments my insurance will pay over the ten month period.
Regards,
*** ***

The patient received his initial unit with us 2/01/2012.  Under the patient's insurance policy, [redacted], the unit is covered for 5 years from the initial date of delivery in the event of damage, malfunction, etc.  The unit itself rents for 10 total months.  From there, it enters...

maintenance and service.  The equivalent of 1 rental month is billed to the insurance once every 6 months.  In the event of problems, CSS is required to exchange or replace the unit.  Once the 5 years has passed from the original delivery date, the imachine is no longer covered by the insurance maintenance and service agreement, and no further exchanges or replacements will be honored.  At that point, pending an updated prescription and documented support that there is a continued need for treatment, the patient is eligible to receive a new unit, which would be covered under the insurance plan just like the first unit, starting with a 10 month rental plan and then entering into the maintenance and service agreement.  This process will continue every 5 years as long as the patient requires continued treatment and continues to see his doctor to prove medical necessity.  The patient received an exchange to the original unit 4/2016.  He indicated he wasn't happy with the unit and it was exchanged again 11/2016.  The patient is again asking for an exchange as of 3/10/17.  We explained to the patient that his machine is now out of warranty (again the initial unit was provided 2/01/2012) and has exceeded 5 years since original delivery and therefore we would need a new prescription and updated medical chart notes in order to provide a brand new unit.  He spoke with two supervisors in our department on 3/10/17.  The patient indicated that he was refusing to see his doctor for an updated prescription.  We advised wouldn't be able to provide a new unit without it, and the new unit would be billed to his insurance.  We are unfortunately unable to provide any new equipment without proper medical documentation at this point.

Response:All efforts are made to advise patient's of their financial responsibility prior to the delivery of their equipment, however, it is important that patient's educate themselves in regards to the insurance carriers they elect, and the benefits that cover them. [redacted] first attempted...

schedule delivery of his unit at the end of June. His benefits were explained to him and we advised that his initial set up supplies and first month rental would be a $99.35, which would need to be paid cash on delivery. [redacted] was aware that this was not a purchased item, but a rental. On 6/30/16 [redacted] elected to cancel his order as he indicated he wouldn't be able to pay his financial responsibility going forward. On 7/01/16 [redacted] contacted us again and indicated that he would be contacting his insurance directly to see if they would purchase this item for him outright instead of renting. On 7/07/16, [redacted] called back and rescheduled his delivery for 7/16/16. He paid his initial payment of $99.35 and signed all agreement paperwork indicating that this was a rental item and that he would be financially responsible for all charges under his insurance benefit plan that he is not covered for. Per the insurance contract [redacted] elected with his carrier, he only has 70% coverage. Unfortunately the decision to purchase or rent this equipment is dictated by his insurance carrier's guidelines, not the provider. We are required to provide this equipment to the patient as a rental item for a maximum benefit of 10 total rental months under [redacted] benefit plan.

Thank you for reaching out to us regarding [redacted] billing concerns. The invoices he referenced in the complaint are actually insurance deductible charges for the rental of his CPAP machine. There are no open invoices or patient responsibility associated with a delivery of CPAP...

supplies.  After reviewing the file, I am willing to adjust the deductible charges since there was a change of insurance during the rental cycle which caused these invoices to be applied toward his deductible. I hope [redacted] finds this resolution satisfactory. Best Regards, Tina Tina P[redacted]Director of Reimbursement Community Surgical Supply[redacted]
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