Edwards Health Care Services, Inc.

Initial Business Response /* (1000, 5, 2015/09/02) */
This maybe a little lengthy, but I want to make sure you have everything
The customer was contacted 9/30/about her order that was going to ship on 10/9/and she had Medicare insurance to be billedAt this time she had a co-pay amount of
$85.53, which she paid on 9/30/
The 10/9/order was shippedIn accordance with Medicare rules we can't ship a customers order before days from the last one, which shipped on 7/9/As a company we need to collect the co-pay upfront before the order is shipped
to the customerThe customer had a 1/9/order that was okayed, but since this is the first order of a new year, like most insurances there is a deductible that needs to be met prior to Medicare paying
anythingSo Medicare paid $of the $balance, which left $openThis open balance should have been billed to the customer, but instead we took the customer's co-payments for March, April, and May
that the customer made on her insulin pump rentals and applied them to the open balance on her 1/9/orderThis left a balance open on the customer rentals and she probably received a bill for these, which prompted
the customer to call in on 5/8/When the customer called in on 5/8/and was upset, we told her we would check on thisLater that day we found out what had happened and left her a message
The customer then called back on 6/12/and we explained what had happened and she paid the $at that timeThe next contact was on 6/30/for her July order which shipped on 7/14/
The next contact was on 8/3/that she was sent to collections, which she was, but the collection agency's first contact is a letter saying that this is a balance verification letterThis is sent out for the very
purpose of letting the customer dispute where the balance owedWhat we do is remove them from listThe customer currently doesn't have any balance owing in our system
do this and e-mailed her confirmation that this was doneWe always strive to make things better for our customer's experience

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to meHowever I did request an updated invoice reflecting $Is there any way you could assist with this? I spoke with Diane from Edwards yesterday and she said she was going to email itI have yet to receive it.thank you,***

We are in receipt of your recent correspondence and hopefully we can get this resolved quickly. We ship a large number of breast pumps and submit claims to Aetna on a daily basis. A quote of benefits is not a guarantee of payment, however, I can understand the frustration when you were
told that it is covered and then Aetna denied the claim as being considered a convenience item Unfortunately, if we are not given accurate information when benefits are verified, then we cannot guarantee coverage for the product. However, Ms***'s benefits were verified twice by our representatives prior to shipment to confirm that the information that we were receiving was accurate. EHCS strives to make each customer's experience a satisfying one.
Due to the passing of the Affordable Care Act, breast pumps are considered a covered product under Aetna's benefits. I called Aetna myself today, in addition to the calls that we have previously made and the rep confirmed that the breast pump is a covered benefit at 100% with no deductible. The reference number that I received for this call is 3148574921. I inquired as to why Aetna continues to deny payment as the product being a convenience item and honestly, could not get an answer from the representative handling the call. It has been sent back to be reprocessed (for a third time now). It is our company policy that once we have appealed a claim, any continued denials need to be appealed by the member. Often times, members have better results than the billing provider. Due to the circumstances, I would like to see if "reprocessing" the claim again will get us a resolution It was stated to me that it takes days to reprocess the claim. I will follow up with Aetna in two weeks to see if it has been reprocessed. We will certainly refund Ms*** once Aetna has reprocessed the claim for payment

I am rejecting this response because:
On my last shipment date October, I did not receive a 90-day
supply (cartridges) orderWhat I did receive is box of infusion sets
and box of cartridges Edwards Health Care is correct that I would
have ran out of product in early November and I would not have had any supplies
in November and December from this shipment.
Unfortunately, what they billed towards my insurance company and what is
listed on the packing list they provided is not what I received
For the July, shipment their attachment reads that they only
billed me for a co-pay of $which is not true I was charged $
for this shipment where I did request and received a 90-day supplyOn 05/and 04/I called in and placed a 30-day supply
order which I paid for in full when the order was placed
When speaking with Amanda she stated that they would have never
sent me a 30-day supply which is incorrect because it was done prior in the
year I would really like to resolve this as soon as possible If I
was sent the product the bill would have been paid in full when received
however I cannot pay for product I did not receive. It may be
difficult to rectify inventory after months, but I called into customer
service over two months ago. Where I was
treated rudely and no one wanted to assist me in correcting this issue. I would have not known that I was billed
incorrectly until I received the statement and then viewed my EOB from my
insurance company.
Finally, the amount on the bill is not what is currently owed. I made a payment to cover the one-month
supply that I received, but there is still an outstanding balance of $
which I am disputing
I have attached documentation from my previous orders in
along with a copy of payments made when these orders were placed
Thank you,
***
***

Initial Business Response /* (1000, 5, 2015/12/22) */
Contact Name and Title: Barb L*** VP Operations
Contact Phone: ***
Contact Email: ***
I am showing that the package shipped on the 21st second day air to arrive on the 23rdI am trying to determine where the hold up
wasWe do have a prescription from the physician that does not expire until August of Can you please call us on the 23rd when you receive the package so that we know that it arrived? Toll free number is ***I do show that we have your orders on a regular shipment so that this should not occur in the future

Thank you for reaching out to EHCS regarding the most receipt bill/shipment. Our records indicate that we shipped a three month supply (each of cartridges and each of infusion sets). I have attached the delivery ticket to this email for the October order. I also attached the
July delivery ticket as well, showing that it was exactly the same amount of supplies. If Ms*** only received a one month supply in October as indicated, she would have run out of supplies at the beginning of November 2016. This also means that she would not have had any supplies to use in November or December. The packing slip clearly states that we shipped of each item. When a customer is short of supplies, a phone call needs to be made to EHCS at the time that the package is received if there is a discrepancy in the order. It is very difficult to rectify our inventory months later. We did not receive any correspondence from Ms*** until she received a bill. The total collected on her October order at the time that it was placed was $as she indicated, a 20% co pay for that order. Her insurance company would have picked up the other 80%. It is not noted in our system that we called her insurance to verify if her deductible was met, so only the copay was collected. However, when the claim was processed by BCBS of Michigan, the insurance applied the full amount to her deductible, which resulted in a bill for $347.07. (I have also included a copy of the eob for the date of service in October, showing the entire amount owed from the subscriber). The amount that was indicated on the bill is what is currently owed for that order. If there is any additional information that is required, please reach out to me directly

Good Morning,
Thank you for reaching out.  I read through the information that was submitted by Ms. [redacted] and can see where the wording of the emails could be deceiving.  "Considering" can mean different things to different customers.  We have changed some of our processes since her...

order was originally processed to make sure that our new moms understand what they are or are not getting.   We do show that we sent out the ups labels and Ms. [redacted] confirmed that she did receive them and send the pump back.  We have no record of the return which is why the invoice generated.  Our software system handles invoices automatically, so until Ms. [redacted] received an invoice for the product and prompted her call and complaint, this would not have been caught.  Thank you for bringing it to our attention.  We will deal directly with UPS as to why the pump was not returned to us.  We have also adjusted the balance from Ms. [redacted]'s account showing that there is no balance owed.  I apologize that you had to take time of your busy day to get this handled.

I would like to address the items that were in the most recent response.  The delivery ticket that we sent copies of are exactly that, delivery tickets.  They are not invoices nor do they reflect what was paid on a particular order.  Delivery tickets are used to show what was on the order, and what was shipped to our customer.  It does list what a co pay would have been IF the insurance paid for their portion of the order. 
I will confirm that one month supply orders were shipped in both April and May.  We do show that the July order was a three-month supply and the amount of $433.80 was paid.  The $86.76 that was paid in October was only a 20% copay for a three month supply.  It was not payment for a "one month order".  A one month order would be $433.80 divided by 3 which is $144.60.  Rather, we collected $86.76 which is exactly 20% of $433.80.  We were expecting her insurance to pay the other 80%, however, they applied the entire order toward her deductible, just like they did in July.  We did receive the payment of $57.84 which would have taken the total payment for that order to $144.30.   
I am still unclear as to why you did not call when you received your October order if the delivery ticket did not match what you received.  Maybe you thought it was a one month supply, which I can understand since you received one month supply orders in the past.  However, in November, you would have needed another supply order because you would have been out of supplies. It would have been much easier to investigate this entire situation if only 30 days had passed.  We do keep records of the weights of our packages in the event that we have issues where products are missing from a package.  I had our warehouse director pull the July records and that package weighed 4 pounds.  The records for the October package also weighed 4 pounds.  If it only included a one month supply, it would weigh significantly less. 
You mentioned that you called two months ago regarding this situation. We do have a record of a call from December 21, 2016 when you received the bill.  I apologize for the rudeness that you refer to in your letter and I will address that as a separate issue. Our billing representative explained the situation to you and the notes stated that you disagreed with the invoice and were not going to pay for something that you did not receive.  I totally understand and cannot say that I disagree.  However, our records indicate that we shipped a three-month supply, the weights of the packages are exactly the same for the July and October shipments, we did not receive any notification from the delivery service that we use that the package was damaged and we did not receive a call from you stating that you did not receive what the delivery ticket indicated.
We strive on customer service and quality at EHCS and I’m not saying that we do not make mistakes.  But for the reasons that I have listed above, I cannot adjust the $289.20 from your account.  hy here...

I wasn't sure how to respond to the message from the business. I am grateful for the acknowledgment and I happy with the steps that they are resolved to taking. I however received a bill in the email last week still reflecting outstanding amount of $250.00. Please  have the company send me a receipt satisfying the debt as stated in their response. Thank you for your time and concern.[redacted]

Initial Business Response /* (1000, 5, 2015/09/22) */
Thank you for contacting us. I just actually replied to a previous email from a [redacted] which I could not match to any of our records.
Mr. [redacted] called our facility on 8-11 and placed an order to ship on 8-14-15. His insurance has...

specific guidelines and he needs to be seen by his physician every three months. We called the physician's office on 8-11 to obtain the date that he was last seen. There was no answer and no voice mail to leave a message. We called again to make sure that the correct number was dialed, and we deemed that it was correct. On 8-12-15, we sent a fax to the physician's office hoping that we would get a reply. Mr. [redacted] called into our office on 8-26-15 and was told that we could not reach the physician's office and he asked us to refax the paperwork. that was done on 8-26-15. We called the office again on 9-1 to get the information that we needed. The office requested that we fax the paperwork again. That was done on 9-1 after verifying that the fax number we have is correct. We followed up with the physician's office again on 9-14 and spoke with a receptionist who stated that she would give the message to the person that handles these requests. As of today, we have not received anything from the physician's office. I checked our inbound faxes and we have nothing coming in from that area code. In order for Mr. [redacted]'s insurance to pay for the supplies, we need this information from the physician's office or his insurance will not cover the cost of the products. I sent another request to the department manager within our company to follow up with the physician's office to see why we cannot seem to get the information that we need.
Initial Consumer Rebuttal /* (3000, 7, 2015/09/23) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Every time you say you haven't received a response,they say they have responded every time.you need to call and talk to [redacted].you guys are supposed to handle all this.but every time I have to call for weeks and months trying to get something done.its getting ridiculous.please take care of this .its getting close to 2 months without any supplies.that's long enough!!!
Final Business Response /* (4000, 9, 2015/09/25) */
We have spoken to Mr. [redacted]'s physician's office. The physician will not prescribe the frequency that Mr. [redacted] wants to test. He stated that he does not need to test that often. According to the physician's office, this has been conveyed to Mr. [redacted] on more than one occasion. Mr. [redacted]'s order is shipping today for the pump supplies and testing supplies based on what his physician wants him to test.

Initial Business Response /* (1000, 5, 2016/03/03) */
Thank you for reaching out to us in regards to Mr. [redacted]. The quality of service that we provide to our customers is very important to us and we want to make sure that every customer receives their package on time. Mr. [redacted]'s insurance,...

Medicare, has specific requirements for customers that are on insulin pump therapy and use insulin pump supplies. Mr. [redacted]s's insurance requires that a customer must be seen by their physician every 3 months based on his disease state. When it was time for Mr. [redacted]'s shipment, he had not been seen by his physician and evaluated for his diabetes within the last three months. This was communicated to Mrs. [redacted] and an appointment was scheduled with his physician for 2-26-16. We called Mr. [redacted]'s physician's office on 2-26-16 (Friday) to confirm that Mr. [redacted] was seen and indeed he was. Mr. [redacted]'s package was shipped on the next business day 2-29-16 (Mon) by mail and was slated to arrive on 3-2 or 3-3. However, when we received communication from Mrs. [redacted] regarding the shipment, we wanted to make sure that Mr. [redacted] received the order immediately, so a second shipment was sent on 3-2-16 next day air at our cost. It is expected to be delivered on 3-3-16 before 12:00. Mr. [redacted]'s 2-26-16 required office visit is good for three months. He will need to be seen again by his physician prior to 5-26-16 for ongoing shipments. We already have his March 28th order in our system and ready to ship. It is a three month supply which will last him through the end of June. We are not able to place Mr. [redacted] on an automatic delivery because his insurance, Medicare, regulation's will not allow for it.
Initial Consumer Rebuttal /* (2000, 7, 2016/03/04) */
(The consumer indicated he/she ACCEPTED the response from the business.)
He has his supplies now

Initial Business Response /* (1000, 5, 2016/06/13) */
The insurance company allowed more per box than what was quoted to the customer. Ms. [redacted]'s quote was an estimate, which happened to be less than the amount that her insurance is stating is her responsibility to pay. The allowable per box was...

$23.27 and we had it listed in our system as $17.00. I will courtesy credit that additional amount of money that was charged for this particular order. Since the insurance has made payment, we now have the allowable that they have approved per box. Unfortunately, when we call an insurance company, a quote of benefits is not a guarantee of payment. Ms. [redacted] should have also received an explanation of benefits from her insurance company showing how much her responsibility is for that order.
Initial Consumer Rebuttal /* (2000, 7, 2016/06/15) */
(The consumer indicated he/she ACCEPTED the response from the business.)
Thank you for writing this off. The amount I was asked to pay was never presented to me as a 'quote' but as a straight up co-pay. As I said, I was asked to pay a copay with no mention that it would be more or any charges would occur.
Thank you for writing this off.

Initial Business Response /* (1000, 5, 2016/07/15) */
All of the above appears to be accurate based on our notes in the account of Mr. [redacted]. The order did have a print date of 8-31-15, however, since it was late in the day on the 31st when it went back to our warehouse, a verbal communication...

should have been sent to our warehouse that there was an order that needed to ship on the 31st. There is no way for me to confirm if that did or did not happen. It is fraudulent for EHCS to change a date on any order to a previous date. We just cannot do that. However, I do show that efforts were made by Mr. and or Mrs. [redacted] to assure that the order shipped prior to 9-1-15. Due to the above situation, we will not be billing the [redacted]'s for the order in question. I am writing off the balance on the 8-31-15 order as settled in full. I will alert the billing team as well. If there are further questions, please reach out.
Initial Consumer Rebuttal /* (2000, 7, 2016/07/18) */
(The consumer indicated he/she ACCEPTED the response from the business.)

Ms. [redacted],Thank you for reaching out regarding the challenge that you are having regarding the breast pump that you received.  The information that you received from Aetna was is not completely accurate, however, so I would just like to explain what we show on file.  The breast...

pump was originally denied by Aetna stating that there was no medical need for it.  They stated that your physician had not yet informed them that you were pregnant (this is usually done by the physician's office submitting a claim for one of your office visits).  We appealed the denial and sent Aetna a copy of the prescription from your physician stating that you needed a breast pump.  Unfortunately, Aetna would not accept the prescription without your physician actually submitting a claim to them as proof that you were pregnant.  When our team called again, Aetna was tried to tell us that because you had already given birth, they would not pay for a breast pump.  We challenged that decision and Aetna found that you had coverage for a breast pump for one year after giving birth, and therefore, we proceeded to appeal the claim again.  There are certain time frames that come into play when submitting for appeals.  I do believe that during the last appeal, it was submitted by EHCS outside of that time frame window.  I do apologize for the inconvenience that this has caused, we appealed the claim on more than one occasion as this item is a covered benefit under your insurance. I will have our team adjust the balance on your account, which is normally pretty quick so you should not receive any additional invoices.