Coram Healthcare Corporation of Massachusetts

Coram is unable to provide the patient's financial responsibility for claims that the insurance provider has not yet processedWe called the customer again to review the detailed bills and were advised that they did want any further calls on the subjectPatient has been provided direct manager points of contact in the pastIf the customer wants to speak to the manager’s manager, we can certainly arrange thatWe would like to resolve this issue but need to be able to discuss with the customer

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 belowThe above response does not answer my complaint I did try and cooperate with Coram up until I felt Bullied by their tactics First I do not recall ever speaking to someone in Aug The 1st time I spoke to anyone at Coram for the serial I told them no problem I gave them the number the very next day and they told me it was the wrong number off the back of the pump They then called me every day that week including calls on Friday while I was at work I am sorry but Coram/CVS does not get to call some one times in a week because they waited to the last minute to complete their inventory check list On top of calls in week they had a gentleman outside of their organization call me from a cell phone Sunday evening while I was out The gentleman barely spoke English and he informed me he was on his way to my house to read the digit serial number He wanted to know who was home when I told him I was out This is what has me so upset at this organization They do not have a right to harass people at work and the weekend because of their check list The number would have been provide long ago if they were not so over the top crazyI did provide a number which turned out wrong, I did confirm I have the same pump they sent me and told them I will get the number for them They still called each day because their internal check list is more important than treating people decentlyThe callers even gave me the first or numbers of the digit serial number They have the number in front of them and I am confirming I have the same pump they sent me and they threaten me with cutting off my medicine unless I cooperateCooperating is fine but call me over and over in the same week, sending someone to my home and treating me with no medicine is wrong I have sent questions directly to CVS about their policies with no response as of yet I will provide what ever is needed but will not and should not be bullied or threatened by anyone because of their inventory policy Try calling or emailing someone and giving them more than a day before harassing them Contact on a Sunday afternoon to go come to my house will never be acceptable to me nor should it for this CARING organizationOne of my main issues is who CVS shared my info with without permissionThe reverse search showed this as a cell phone in lower NE PhillyCoram does not have a location in this area Regards, [redacted] ***

The patient was prescribed [redacted] formula and 7-syringes The patients insurance, ***, does not cover [redacted] formulaThe patient chose to be self-pay for the formula and the supplies The patient was incorrectly set up to bill the [redacted] formula and supplies (per diem charge) to the insurance This was corrected and the patient was notified of this action The denied claim balances were transferred to the patient's account to bill the patient for payment The patient account balance was adjusted off on 2/12/and a void claim request was sent to [redacted] on 2/15/ An overpayment was identified on the patient's account and a refund request for patient overpayment on formula and supplies has been initiated for $ This was determined from the patient paying their invoice prior to the adjustments being taken on their account Training is being conducted with intake for correct setup of patient accounts and audits will be conducted going forward on accounts with insurance denials for the formula not being a covered expense The account currently has a zero balance

Our research has shown that this is not a Coram Infusion patient If more information can be provided as to the [redacted] Retail Store in question, we will certainly work to connect the parties together

We sent her the detail twice and our pharmacy and billing office have talked to her several timesThe detail only consists of line itemsDrug cost, Per diem, and Nursing visitThe per diem includes all the items listed belowBilling all of these charges together is a widely accepted industry standard and most insurance companies are billed using this methodologyThe patient agreed to the cost at the initiation of therapyRegards, *** Pursuant to the [redacted] Per Diem code descriptions, the following items and services are included in the Per Diem rates: (i) Administrative Services· Coordination of benefits with other insurers· Verification of insurance eligibility and extent of coverage· Obtaining certificates of medical necessity and other required documentation· Obtaining prior authorizations· Patient financial services, billing and account collection activities· Licensure and regulatory compliance· Maintenance and storage of medical and reimbursement records· Inventory and facility maintenance· Patient education materials (ii) Pharmacy Professional Services (a) Dispensing· Medication profile sand drug utilization review· Monitoring for potential drug interactions· Sterile procedures including intravenous admixtures, clean room upkeep, vertical and horizontal laminar flow hood certification, and all other biomedical procedures necessary for a safe environment· Compounding of medications· Patient counseling as required under OBRA (b) Clinical Monitoring· Development and implementation of pharmaceutical care plans· Pharmacokinetic dosing· Review and interpretation of patient test results· Recommending dosage or medication changes based on clinical findings· Ongoing pharmacy patient assessment and clinical monitoring· Other professional and cognitive services as needed to clinically manage patient's pharmacy care (c) Pharmacy Professional Services· Comprehensive knowledge of vascular access systems· Continuing education to professional pharmacy staff· Removal, storage and disposal of infectious waste· Maintaining accreditation requirements· Maintaining insurance requirements (e.gliability), including compliance with all state and federal regulations related to minimum insurance coverage (iii) Care Coordination· Patient admission, including communication with other medical professionals, patient assessment, and opening of the medical record· Patient/caregiver education, including providing training and patient education materials· Clinical coordination of infusion services care with physicians, nurses, patients, patient’s family, other providers, caregivers and case managers· Patient discharge services, including communication with other medical professionals and closing of the medical record· Clinical staff availability hours/day, days/week for questions and/or problems· Development and monitoring of nursing care plans· Coordination, education, training and management of field nursing staff (or sub-contracted agencies)· Delivery of medication, supplies and equipment to patient’s home or designated alternate site (iv) Supplies and Equipment· DME (durable pumps, poles and accessories) for drug and nutrition administration· Equipment maintenance and repair (excluding patient-owned equipment)· Short peripheral vascular access devices· Needles, gauze, non-implanted sterile tubing, catheters, dressing kits and other necessary supplies for the safe and effective administration of infusion, specialty drug and nutrition therapies

The last bill the patient received was sent in errorThe patient's outstanding balance is zero dollars

The patient's insurance company agrees with the balance dueThey paid in January and the member submitted a copy of his balance and [redacted] reconsidered the chargeThey came back with the same result in July and we began billing the member againThe patient has not provided Coram with PAP details or secondary insurance

Our billing center talked to the patient and resolved this issueThere were some charges that the patient was not made aware of upfront and those will be adjusted

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 The last PDF sent from the billing person, [redacted] , included this:1/30-902/6-902/13-353.922/20-884.802/15-902/17-265.44This is the last "detailed" bill received via email This is insufficient detail and is not responding to patient's questionsAbout charges.I do not know what is involved in the above charges dated 2/13, 2/20, and 2/ What is included? Delivery of supplies? IV antibiotics? I am still asking for a break down of those charges I know the dollars is for nurse visit but do not know what the other charges include Why don't you list every day of service an d the charge of what service for that day? And yet a final bill has not been sent [redacted] did sentA separate bill for March 1, so that can be sent to Medical Assistance Regards, [redacted]

We have left the patient voice messages and an email in order to connect and resolve this complaintOnce we are able to reach the patient and work out a resolution, we will post an update

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] . As per Coram's response I would like to arrange to speak with the manager's manager and will accept a phone conversation from said person.Regards, [redacted] ***

The patient received service beginning June 06, She received Total Parenteral Nutrition Therapy and Nursing Her coverage was [redacted] through June 30, The patient received retroactive coverage for [redacted] , effective May, Coram was notified of this change on July 1, Coram is not a Certified Home Health Agency and therefore cannot provide nursing for [redacted] recipientsThe Nursing services were transferred to a certified provider.The open balances on the patient’s account are for TPN therapy and Nursing for dates of service in June The co-pays that we billed directly to the patient for TPN therapy and Nursing services will be adjusted off her responsibility due to verification of [redacted] coverage for these dates services billed to her

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 # ***Please add your rejection comments below.
I am rejecting Coram's response I have no idea what the final bill isAnd I DO NOT have an itemized billTo make sure the figures are correct I have a bill outlining dollars for the nurse visit then a bill for What does that entailI am asking Coram to itemize For example, on January The nurse came outAdmitted drew blood and administered IV med Break down the cost of that visit DO NOT lump services under one price I have the contract with prices outlined and I am trying to figure out how they got the totals And what is the final bill? And why was I sent to collection agency when I have NO idea what the billIs? The last nurse visit on March should not be included I let Coram know that medical assistance started March and I would bill that insurance So again please break down the bill starting January throug February EVERY DaY
Regards,
*** ***

Detailed bills have been provided in the usual course of business and again upon request and explained to the patient’s Power of Attorney. These bills provide line-item detail of the charges by way of *** codes. These codes are used by the health care industry to describe services provided. This is customary and industry-standard detail for claims and the associated chargesPatient signed a financial agreement with Coram and Coram has been responsive to patient’s questions about the charges. Coram maintains that it has provided sufficient detail for patient to act consistently with her obligations regarding the services provided to her

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 # ***
I will not be satisfied until I am promised that I will not have to pay this billFirst step was to contact my copay assist to dispute with them, I have not heard back from them so this issue has not been resolvedRejecting Solution
Regards,
*** ***

Revdex.com:
On 11/9/and 11/10/I had received voicemail messages from Coram in addition to
an email, all within a hour period which has been less than week ago I have already responded to her email explaining that I had been in and out of the hospital the last days due to procedures and a surgery, both requiring anesthesia and have been focused on recovering physically As soon as I was able to access my email this morning, I replied to their email with an explanation and informing them that I would be sending them a follow up email with the information they requested I understand their lack of compassion and understanding, but I had not known weeks prior to their first attempt to reach out that I would be having to undergo these procedures and surgery the last week and a half Their tone of demeanor has increased my stress in a time that my body needs to work on recovery I will be getting the information to them shortly, but I would appreciate no further verbal harassment on their end Thank you
Regards,
*** ***

We reached out to the patient and provided detailed information regarding his charges. Coram was not aware that the patient had a copay assistance programWe provided the patient with the documentation needed to submit charges to the copay assistance program

The contract with this insurance company specifies that we bill a daily per diem charge that includes suppliesThe charge is the same regardless of how many syringes or other supplies are sent

Coram has a signed agreement regarding the amount to be billed and reached a verbal understanding regarding the timing of paymentsPatient has not acted consistently with that understandingDetailed bills have been sent twice

Coram follows a standard operating procedure to confirm serial numbers of devices used by patients to infuse prescribed medicationsWe undergo this process every months for every patient that is renting and actively using a Coram owned deviceThe process is as simple as reading the serial number
that is clearly noted on the back of the device. This process is part of our asset management program and insures that each patient is using the pump that was specifically programmed for their therapy and the serial number matches our records regarding any necessary preventative maintenance required for that pump. The complainant was issued a Coram owned infusion pump in February of As part of our bi-annual outreach to patients, he was contacted on 8/19/and committed to calling the Coram representative back with the necessary serial number confirmationIn the absence of that return call, Coram representatives did try to reach the complainant at least times through the month of September and then on the 25th the complainant reached out to our local leadership to strongly discuss his concerns
While we can appreciate this may have been inconvenient, it is a critical part of our quality assurance and patient safety program and there is no intent to harass a patientWithout resolution, Coram’s Senior Branch Leader contacted the complainant to discuss the situation again in November and seek a resolution that would enable Coram to follow its processes, ensure patient safety, without creating a hardship for him. This call did not result in a resolution and without an ability to ensure ongoing patient safety, we find no other alternative than to work with the members of his healthcare team to make other arrangements for his care