We provided Mr. [redacted] with a vasopneumatic compression unit, which was prescribed by Dr. Bach on 10/23/15 for use following his knee surgery on 10/17/15. This is comprised of the rental of the machine and the purchase of the soft goods, the wraps that go around the calves and knee, as these cannot...
be re-used by another patient. The butterfly wrap goes around the knee of the surgery and there are two DVT wraps, one for each calf.After receiving the order from his surgeon, we checked Mr. [redacted] benefits and then phoned him to explain his benefits as they pertained to our equipment on 10/26/15. We were unable to reach Mr. [redacted], but did leave a voice mail message with a very brief explanation and a request to return the call to explain and discuss further. We did not receive a return call.Insurance companies process claims and calculate deductibles based on the date of service and the insurance plan year, not the date of the patient's invoice. Mr. [redacted] insurance claim was filed with his insurance company on 12/4/15. His insurance company processed the claim as out-of-network, indicating $934.40 as his coinsurance to pay and $3000 deductible. They denied a part of the claim, so we submitted an appeal, but the original denial was upheld. Mr. [redacted] insurance company should have provided him with an Explanation of Benefits for both of these. We issued an invoice to Mr. [redacted] for the coinsurance and deductible as indicated by his insurance company on 02/08/16. Included with that invoice was a PPACA letter and form with an offer to reduce that bill to $250.00 so as to not be a financial hardship to the patient. A statement was issued on 03/09/16, again with the PPACA form and offer. Mr. [redacted] contacted our office about his bill by phone on 03/28/16 and left a voice mail message to return the call. The call was returned on 03/28/16 with no answer, but a voice mail message was left. Statements were also issued on 04/06/16 and 05/10/16.After receipt of this Revdex.com complaint on 05/18/16, I phoned Mr. [redacted] to discuss his bill and explain the deductible and the PPACA form, but could only leave a brief explanation on his voice mail and request that he return my call. We received a call from his insurance company on 05/18/16 that he had complained to them they were going to reprocess his claim as in-network. Mr. [redacted] returned my call on 05/20/16. I explained the deductible and his insurance company's reprocessing of his claim. We agreed to wait until the insurance company reprocesses his claim and we will contact him then to discuss the status and changes of his financial responsibility for this.Regards,D. [redacted]Accounting/Compliance Manager
We provided Mr. [redacted] with a vasopneumatic compression unit, which was prescribed by Dr. Bach on 10/23/15 for use following his knee surgery on 10/17/15. This is comprised of the rental of the machine and the purchase of the soft goods, the wraps that go around the calves and knee, as these cannot...
be re-used by another patient. The butterfly wrap goes around the knee of the surgery and there are two DVT wraps, one for each calf.After receiving the order from his surgeon, we checked Mr. [redacted] benefits and then phoned him to explain his benefits as they pertained to our equipment on 10/26/15. We were unable to reach Mr. [redacted], but did leave a voice mail message with a very brief explanation and a request to return the call to explain and discuss further. We did not receive a return call.Insurance companies process claims and calculate deductibles based on the date of service and the insurance plan year, not the date of the patient's invoice. Mr. [redacted] insurance claim was filed with his insurance company on 12/4/15. His insurance company processed the claim as out-of-network, indicating $934.40 as his coinsurance to pay and $3000 deductible. They denied a part of the claim, so we submitted an appeal, but the original denial was upheld. Mr. [redacted] insurance company should have provided him with an Explanation of Benefits for both of these. We issued an invoice to Mr. [redacted] for the coinsurance and deductible as indicated by his insurance company on 02/08/16. Included with that invoice was a PPACA letter and form with an offer to reduce that bill to $250.00 so as to not be a financial hardship to the patient. A statement was issued on 03/09/16, again with the PPACA form and offer. Mr. [redacted] contacted our office about his bill by phone on 03/28/16 and left a voice mail message to return the call. The call was returned on 03/28/16 with no answer, but a voice mail message was left. Statements were also issued on 04/06/16 and 05/10/16.After receipt of this Revdex.com complaint on 05/18/16, I phoned Mr. [redacted] to discuss his bill and explain the deductible and the PPACA form, but could only leave a brief explanation on his voice mail and request that he return my call. We received a call from his insurance company on 05/18/16 that he had complained to them they were going to reprocess his claim as in-network. Mr. [redacted] returned my call on 05/20/16. I explained the deductible and his insurance company's reprocessing of his claim. We agreed to wait until the insurance company reprocesses his claim and we will contact him then to discuss the status and changes of his financial responsibility for this.Regards,D. [redacted]Accounting/Compliance Manager