Coram Healthcare Corporation of Massachusetts

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does satisfy my issues - FOR NOW - in reference to complaint #[redacted].  I deal with Coram on a monthly basis when I reorder my...

stepson's medically necessary supplies, including his specialized formula which is his ONLY source of nutrition.  I am hopeful, but not confident, that the issues are now resolved for the long term.  If they are not, another complaint will be filed after I deal directly with Coram.  Part of my complaint was apparently misunderstood by the representative of Coram (see Coram's response below).  My complaint was NOT related to the company questioning me about the amount of formula I have left when placing a refill order.  My complaint stated that, each time I place an order, the company representative asks me how much formula we have remaining.  This seems to be part of the standard order protocol.  If Coram is aware of the amount of formula we have left for our son, delays in shipping this medically necessary product should trigger some type of communication within Coram indicating that we are close to running out of our son's food, which is his only source of nutrition.  This hasn't been happening.  Even though we are asked how much formula we have left, we are not notified about delays in shipping.  Without my repeated follow up calls to Coram, there are several times when we would have run out of formula for him.  If they are aware that there is only one week of formula left in our home when I place the monthly order, they should also be aware that their shipping delays are about to result in my medically fragile son not eating.  They can question me all they want about how much formula we have left - nothing about this question seems 'unnecessary'.  My complaint is that my answer to the question is not used to facilitate shipping and/or communication with me when delays in shipping arise.  I ask that they use this information to expedite shipping and NOTIFY ME if there is an unexpected delay in shipping.  I agree that 'these questions are relevant' but my answer is not being used to improve Coram's 'services and the care of the patient'.  My answer is apparently being completely ignored which absolutely does not foster 'care of the patient'.
Item #4 questioning amount of
formula remaining
Response:  Please understand that Coram does not always
know how much formula a patient has remaining. 
Medical and social events can disrupt feeding schedules.   Coram understand that certain parts of the
ordering process can seem unnecessary and repetitive for our long-term
patients, but Coram believes these questions are relevant to its services and
the care of the patient.
Thank you,[redacted]

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].  
This issue has not been resolved with Coram. When I spoke with Coram, their goal was to advised me that my insurance still has bills that were not fully paid from 2 years ago. Even though I have met my out of pocket. The outcome of the call was to pass the buck and have my copay assist cover this charge.  Additionally, they did not acknowledge that they sent me a bill 7+ months after the DOS. 
Regards,
[redacted]

Please see attachment. Thank you.

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 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 2 calls on Friday while I was at work.  I am sorry but Coram/CVS does not get to call some one 5 times in a week because they waited to the last minute to complete their inventory check list.  On top of 5 calls in 1 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 5 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 crazy. I 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 decently. The callers even gave me the first 2 or 3 numbers of the 5 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 cooperate. Cooperating 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 organization. One of my main issues is who CVS shared my info with without permission. The reverse search showed this as a cell phone in lower NE Philly. Coram does not have a location in this area.
Regards,
[redacted]

Coram is unable to provide the patient's financial responsibility for claims that the insurance provider has not yet processed. We called the customer again  to review the detailed bills and were advised that they did want any further calls on the subject. Patient has been provided direct...

manager points of contact in the past. If the customer wants to speak to the manager’s manager, we can certainly arrange that. We would like to resolve this issue but need to be able to discuss with the customer.

[A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update...

it before sending it.]
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 #[redacted]. I understand that by choosing to accept the business response that my complaint will be closed as resolved. 
Regards,
[redacted] Hello Mr. [redacted], it was a pleasure speaking with you today. Again, please accept my apologies for the limited responses you have received prior to our conversation today. To recap what we discussed, I will be adjusting off the balances on your wife’s account that were for nursing visits. We are also re-billing Medicare for the cath care services she received. Per our conversation and the document you signed at onset of service, the estimated patient responsibility will be $20.00 per day for the services. We need to re-bill Medicare so that we can receive the Explanation of Benefits from them to allow for those balances to be allocated to patient responsibility. In speaking with the billing team, these re-bills to Medicare can at times take up to 60-90 days (though it may be sooner) to receive a response. I have the billing team keeping an eye on these rebills and will work to get these resolved and to you as soon as possible. Once you receive the statement from Coram, we do have the option of setting up a payment plan if that would better fit your needs. Should you have any questions, please feel free to do so using my contact information below. Thank you and have a great weekend. [redacted] | Manager A/R Infusion Shared Services, CVS/Specialty

We make every effort to provide appropriate and safe patient care. Our intention is to work with patients collaboratively. We also make every effort to protect a patient’s health care and personal information. The gentlemen who reached out to the complainant works for our contractor who routinely makes deliveries direct to patient homes. The contractual relationship requires they follow the same rules to protect patient information.

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

The patient was prescribed [redacted] formula and 7-10 syringes.  The patients insurance, [redacted], does not cover [redacted] formula. The 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 2/12/16 and a void claim request was sent to [redacted] on 2/15/16 .  An overpayment was identified on the patient's account  and a refund request for patient overpayment on formula and supplies has been initiated for $72.36 .  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.

We sent her the detail twice and our pharmacy and billing office have talked to her several times. The detail only consists of 3 line items. Drug cost, Per diem, and Nursing visit. The per diem includes all the items listed below. Billing all of these charges together is a widely accepted industry standard and most insurance companies are billed using this methodology. The patient agreed to the cost at the initiation of therapy. Regards, [redacted] 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 set-up and 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 1990 (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.g. liability), 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 24 hours/day, 7 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 error. The patient's outstanding balance is zero dollars.

The patient received service beginning June 06, 2015. She received Total Parenteral Nutrition Therapy and Nursing.  Her coverage was [redacted] through June 30, 2015. The patient received retroactive coverage for [redacted], effective May, 2015. Coram was notified of this change on...

July 1, 2015. Coram is not a Certified Home Health Agency and therefore cannot provide nursing for [redacted] recipients. The 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 2015. 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 # [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 questions. About charges.I do not know what is involved in the above charges dated 2/13, 2/20,  and 2/17.   What is included? Delivery of supplies? IV antibiotics?  I am still asking for a break down of those charges.  I know the 90 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 sent. A separate bill for March 1, so that can be sent to Medical Assistance.
Regards,
[redacted]

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.

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 blood tests were inadvertently sent to a lab that was not contracted with the patient’s payer. Coram will settle the lab invoices.

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

Our billing center talked to the patient and resolved this issue. There 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 fully satisfy or resolve my issues and/or concerns in reference to complaint # [redacted]. Please add your rejection comments below. 
Thank you for the response but it only half addresses the issues.  I am glad that the billing is being taken care of.  The other item is the NUMBER of syringes that we're being billed.  We feel that too many were being charged and we did not receive all of them - nor did we need/want any more.  I am requesting Coram to reconcile how many syringes were shipped and how many were billed to [redacted]/us.  Thank you.  
Regards,
[redacted]

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]. Coral Healthcare has verbally assured me many times in the past 8 months that they would settle the charge.  Several assurances came from [redacted]  in the St. Louis billing center and several have come from [redacted] in the Dallas office.  I would like the complaint to be kept open until the bill is actually settled and proof is provided to me by either Coram or LabCorp that it has, if fact, been paid.Regards,
[redacted]