Edwards Health Care Services

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 [redacted] only received a one month supply in October as indicated, she would have run out of supplies at the beginning of November 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 [redacted] 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 $ (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

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 $was paid The $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 $divided by which is $ Rather, we collected $which is exactly 20% of $ 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 $which would have taken the total payment for that order to $ 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 suppliesIt would have been much easier to investigate this entire situation if only 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 pounds The records for the October package also weighed pounds If it only included a one month supply, it would weigh significantly less You mentioned that you called two months ago regarding this situationWe do have a record of a call from December 21, 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 issueOur 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 $from your account hy here

Initial Business Response / [redacted] (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 31stThere is no way for me to confirm if that did or did not happenIt is fraudulent for EHCS to change a date on any order to a previous dateWe just cannot do thatHowever, I do show that efforts were made by Mrand or Mrs [redacted] to assure that the order shipped prior to 9-1-Due to the above situation, we will not be billing the [redacted] 's for the order in questionI am writing off the balance on the 8-31-order as settled in fullI will alert the billing team as wellIf there are further questions, please reach out Initial Consumer Rebuttal / [redacted] (2000, 7, 2016/07/18) */ (The consumer indicated he/she ACCEPTED the response from the business.)

Initial Business Response / [redacted] (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 timeMr [redacted] 's insurance, Medicare, has specific requirements for customers that are on insulin pump therapy and use insulin pump suppliesMr [redacted] s's insurance requires that a customer must be seen by their physician every months based on his disease stateWhen 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 monthsThis was communicated to Mrs [redacted] and an appointment was scheduled with his physician for 2-26-We called Mr [redacted] 's physician's office on 2-26-(Friday) to confirm that Mr [redacted] was seen and indeed he wasMr [redacted] 's package was shipped on the next business day 2-29-(Mon) by mail and was slated to arrive on 3-or 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-next day air at our costIt is expected to be delivered on 3-3-before 12:Mr [redacted] 's 2-26-required office visit is good for three monthsHe will need to be seen again by his physician prior to 5-26-for ongoing shipmentsWe already have his March 28th order in our system and ready to shipIt is a three month supply which will last him through the end of JuneWe 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 / [redacted] (2000, 7, 2016/03/04) */ (The consumer indicated he/she ACCEPTED the response from the business.) He has his supplies now

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 insuranceI will have our team adjust the balance on your account, which is normally pretty quick so you should not receive any additional invoices

Initial Business Response / [redacted] (1000, 5, 2016/06/13) */ The insurance company allowed more per box than what was quoted to the customerMs***'s quote was an estimate, which happened to be less than the amount that her insurance is stating is her responsibility to payThe allowable per box was $and we had it listed in our system as $I will courtesy credit that additional amount of money that was charged for this particular orderSince the insurance has made payment, we now have the allowable that they have approved per boxUnfortunately, when we call an insurance company, a quote of benefits is not a guarantee of paymentMs [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 / [redacted] (2000, 7, 2016/06/15) */ (The consumer indicated he/she ACCEPTED the response from the business.) Thank you for writing this offThe amount I was asked to pay was never presented to me as a 'quote' but as a straight up co-payAs 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