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This customer received a CPAP unit and CPAP supplies per the terms of her health insurance plan. Insurance coverage guidelines allow for rental of a CPAP unit on a trial basis for to months, during which time compliance with CPAP usage must be shown for the insurance to continue
coverage of CPAP rental. Disposable CPAP supplies are generally covered with authorization at delivery of the CPAP and replacement supplies may be covered every months thereafter. Disposable medical supplies cannot be reused or returned and resold. The insurance eligibility verification we performed at the time of the delivery indicated the CPAP rental and CPAP supplies would be covered at 100%; however, when the claim was filed her insurance plan applied a co-insurance amount to the claims, which we then billed her for. Delivery paperwork she signed states clearly: "I agree to financial responsibility for co-insurance, deductibles, and denials for non-covered items." Because she did not use her CPAP enough during the initial trial period, the insurance would not authorized continued CPAP rental, and so she returned her unit. The customer was instructed on these insurance coverage guidelines verbally, and in writing. She initialed and signed a CPAP Patient Compliance Agreement explaining in clear large font "I am receiving CPAP equipment on a trial basis, and must use my CPAP at least hours per night for days for my insurance to continue coverage of my CPAP" and further "If I am not able to demonstrate compliance with CPAP therapy sufficient for my insurance to continue coverage of the CPAP, I agree to either: Return the CPAP to Hope Medical Supply's office locationor Pay for recurring rental charges for the CPAP..."It seems that she states in her complaint that the amounts charged did not go to her insurance; however, all claims have been billed to her insurance and paid claims will apply to her deductible and out-of-pocket maximum. The customer is only being charged for co-insurance amounts determined by her insurance company after processing these health insurance claims for CPAP rental and disposable supplies. She is only being billed for the period of time that she had possession of the rental equipment. We apologize if our billing manager was rude to her at any time during any phone call. We are compassionate to the suffering of individuals with sleep apnea who are unable to get restful sleep without CPAP therapy, and understand the irritability and mental confusion that can accompany disordered sleep; however, we are bound by the health insurance rules with regard to our billing practices

This complaint was responded to via telephone call on 7/28/As explained on the phone, the customer's regular order shipped out to him on 4/22/He tried to return items on 8/20/in a box that had obviously been used as trash for a while and had a used tampon inside with the supplies he
was trying to returnWe explained very clearly why we could not take those supplies back and asked why he had not called sooner, considering those supplies were received months priorHe got very upset and at that time notified us that his insurance had changedWe took his insurance information and per his request billed the insuranceOn 8/29/the customer was advised that the claim may not be covered and he may be billedOn 9/10/2014, the claim was denied by the insurance and the customer was billedWe did not hear from Mr*** until 12/23/questioning why he was getting a bill from supplies in AprilAccording to the insurance that Mr*** gave us, we were told that he only had coverage from 1/1/2014-2/1/After being told this information, Mr*** began cursing at our biller and hung up on herIn June Mr*** called back to let us know that we had the wrong insurance information and provided the correct information at the time, unfirtunately it was past the timely filing allowed by the insurance and there was nothing else that could be doneIf the supplies had been brought back in a box that did not have trash and a used tampon in with them, we may have been able to work something out, but these are medical supplies and once they have been comtaminated, they are no longer our responsibiltyAll of this inforamtion is provided in Mr*** file as wll*** ***
*** *** ***
*** *** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID# ***, and have determined that my complaint has NOT been resolved because:
[Your Answer Here]
Both my wife and I are physicians and have a high level of integrityI am with her right now are we both clearly remember Adam giving us a verbal guarantee, and then when I called him again around the *** and asked him if he remembered guaranteeing us, he affirmed itMichelle was not there so she would not know thatWe also do not feel that the compensation that *** is providing is sufficientThere was a calculus here to determine if it would be cheaper to bring our belongings on time, or pay us a minimal compensation for being late, and this is not what I would call a good business practiceThe fact that while they were already late they were still picking up additional customers in another state is evidence that increasing profit was more important than moving our family.
In order for the Revdex.com to appropriately process your response, you MUST answer the question above
Sincerely,
*** ***

Hi ***,I totally understand your position and am in no way questioning your integrity I was not there for your conversation with Adam, however, I am responsible for training the sales team and they all know that there are never guaranteed dates, ever The transportation business is fraught with extenuating circumstances, trucks break down, movers get ill and any one of these things can lead to a delay This is why all shipments have a delivery spread of dates in which a shipment may be delivered A delay doesn't happen often and again, I feel badly that you are experiencing one.I was also not privy to your conversation with *** *** *** Operations Department or Claims Department regarding the reason for the delay The delay is a service failure based on *** *** *** scheduling and dispatching, from what I understand A-First Class Moving and Storage, which is a small family owned business, has absolutely no influence on the way *** *** *** operations does their scheduling and dispatching Your agreement and Order for Service are with *** *** ***, they are an interstate carrier, A-First Class Moving and Storage, is not, we are an agent for ***.A-First Class Moving and Storage did a good job packing, loading and preparing your household goods shipment for transport Your actual charges were even $less than Adam estimated I feel that we did an excellent job performing our part of your relocation.Again, I am very sorry that your delivery is being delayed If there was something Michelle, Adam or I could do to rectify this situation, we would You need to file your delay claim with *** *** *** to receive compensation for the delay, they will pay you for housing and some meal allowance to help defray the costs incurred due to the delay and I would encourage you to do so. Sincerely wishing you and your wife the best

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me and the matter has been resolved.
Sincerely,
*** ***

Complaint: ***
I am rejecting this response because: I signed that document on January and I returned the CPAP on end of February or the beginning of March , which is two month that bring it to the total of about $not $I already paid $for the used supplies, and I paid two payment of $for the two month rent, I also returned the CPAP, why are they charginger me more? As I was saying on the complaint that I did not use the machine because I had ear infection and the doctor prescribed to me antipaiotics for three different periods each one last ten days, during that time I cannot use the machine because it makes the infection worst that's what the doctor saysI have to sign the paperwork because if I don't sign it they will not give me the machinemail and whatever they said it just words no document has to prove that there not saying the trueNow they have sent me letter that they are going to move the account to collection which I do not want this to happen right now until we close this situation.
Regards,
*** ***

We are very sorry that *** ***'s household goods shipment is going to be delivered later than agreed, it doesn't happen very often but does occur occasionally in the peak moving season, which is now The last day of his delivery spread was 7/**/and it appears that his household goods
will be delivered this coming Tuesday, 8/*/15.I have attached the signed moving documents and also the actual charges for *** ***'s move, which were actually $less than the estimated charges.We are an agent for *** *** ***, we did not sub-contract them, and all interstate moves are done on their interstate operating authority We have no guaranteed delivery date and no one from this office ever said the word guaranteed Certainly, we strive to have 100% of our moves delivered within the agreed upon dates, however, we are at the mercy of *** *** *** to assign the resources to each shipment and deliver them within the spread.There is a process in place to file a delay claim in the event of a delayed delivery, as in the case of *** ***, which he has the choice to take advantage of, if he chooses A delay claim form will need to be completed and returned to the *** *** *** claims department for processing They are very good in responding.A-First Class Moving and Storage has no control over the delivery of *** ***'s household goods shipment, nor his delay claimThese are in the hands of *** *** ***, with whom the agreement was made as the interstate carrier We will be more than happy to facilitate the delay claim and do our best to help *** *** We are very sorry that this delay has happened on his move

The insurance originally processed the claim for the CPAP supplies and issued an Explanation of Benefits showing a patient co-insurance amount of $65.37; however the insurance reprocessed that claim and adjusted the patient amount owed for just the CPAP supplies to $50.56.  The patient has paid her co-insurance for these disposable supplies.Regarding the 2 month rental of the CPAP unit, the insurance originally processed the claim incorrectly, and also reprocessed that claim to reflect that the patient owes co-insurance of $72.87 per month according to the Explanation of Benefits issued by her insurance company.We have already lowered the patient's out-of-pocket costs for the CPAP and humidifer by 50%.   The insurance company processed these claims and the explanation of benefits indicates that she owes $257.88 for the humidifier chamber and two months rental of the CPAP; however, we are now only holding her responsible for half of that amount--$128.94.  We cannot make a better offer at this time.