Exact Sciences

Thank you for your letter to Kevin [redacted] of November 27, in follto the above-referenced complaint regarding our patient’s Cologuard test We have reviewed the patient’s additional questions and comments Exact Sciences is just as dissatisfied with her insurer’s failure to cover her Cologuard test as is the patient We do include in all of our patient-facing material that patients should check their own benefits before proceeding with the test Our sales representatives are also trained to provide this message to ordering providers We regret if this message was not given to this patient by her ordering provider However, we strongly dispute that our test is unreliable The Cologuard test has been approved by the FDA since October 2014, following an extensive 10,patient study It has also been covered by the Medicare program since that time The test is approved by the American Cancer Society, the National Cancer Care Network, the United States Preventive Services Taskforce and many other healthcare organizations Unfortunately, commercial carriers are usually the last to adopt and cover new technologies Exact Sciences continues to work hard to advocate for increased commercial coverage for patients and has made significant strides ***, this patient’s insurer, does, as of July 2017, now cover the test for commercial patients Finally, we also strongly dispute the allegation that doctors receive any kind of remuneration in return for ordering our test Such a suggestion is inaccurate and we take it very seriously, as it would be a violation of federal law for a health care provider to provide kickbacks to induce ordering of a medical service Exact Sciences has strong compliance policies and procedures to ensure these laws are adhered to at all times While we regret the patient’s dissatisfaction, there is nothing further we can do for the patient As we indicated previously, there are legal limitations on a medical provider’s ability to write-off amounts that the patient’s insurance company has determined are the patient’s responsibility We hope this resolves the patient’s inquiryPlease let us know if you have further questions

Thank you for your letter to Kevin [redacted] of September 22, regarding our patient’s Cologuard test While we regret that a billing issue has caused dissatisfaction for our patient, we are glad that the patient is being screened for colorectal cancer, the second leading cancer killer in the United States We have researched the patient’s question and have communicated directly to the patient our decision to forgive the remaining balance due in this circumstance We hope this resolves the patient’s inquiryPlease let us know if you have further questions

Thank you for your letter to Kevin [redacted] of December 18, regarding our patient’s Cologuard test While we regret that a billing issue has caused dissatisfaction for our patient, we are glad that the patient is being screened for colorectal cancer, the second leading cancer killer in the United States We have researched the patient’s question and have communicated directly to the patient that a refund is in process We hope this resolves the patient’s inquiryPlease let us know if you have further questions

Thank you for your letter to Kevin [redacted] of November 4, regarding our patient’s Cologuard test While we regret that a billing issue has caused dissatisfaction for our patient, we are glad that the patient is being screened for colorectal cancer, the second leading cancer killer in the United States We have researched the patient’s question After completing the patient’s Cologuard test, we billed her insurer Unfortunately, her insurer, ***, denied coverage for our test While we appealed this decision on the patient’s behalf, [redacted] maintained its denial of this patient’s claim As a result, we billed the patient for the cost of the service ($649.00) We do advise patients and ordering providers to call the patient’s insurance prior to completing the test to determine their out of pocket costs This information is on our website and in our written promotional materials While we regret the patient’s dissatisfaction, at this point, there is nothing further we can do for the patient There are legal limitations on a medical provider’s ability to write-off amounts that the patient’s insurance company has determined are the patient’s responsibility We hope this resolves the patient’s inquiryPlease let us know if you have further questions

They are not going to be fair about thisYou can drop the caseThank you for your attempt to help them realize how unfair they are They will not get a dime from me.Tell us why here

January 3, Bradley [redacted] Operations Manager Revdex.com of Wisconsin WGreenfield Avenue Milwaukee, WI Re: Revdex.com Complaint No [redacted] VIA EMAIL Dear Mr [redacted] : Thank you for your letter to Kevin Conroy of December 27, regarding our patient’s Cologuard test We are glad that the patient is being screened for colorectal cancer, the second leading cancer killer in the United States We have researched the patient’s question It appears that when the patient’s provider submitted an order for this patient, they provided an incorrect address for the patient on the order form UPS was unable to deliver the kit Since at that point Exact Sciences Labs had no indication that the address was incorrect, a replacement kit was shipped to the patient using the original address after the first kit was returned Again, this was unsuccessful The patient called Exact Sciences on December which is when the address error was identified As of December 15, 2016, we were in the process of re-shipping the kit We hope this resolves the patient’s inquiry Please let us know if you have further questions Sincerely, Nicole [redacted] Litigation Counsel Exact Sciences Corporation 608-535- [redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below
I understand positive results, as I worked in clinical diagnostics for many yearsIf my follcolonoscopy had found even a single polyp, I would understand the positiveBut there was nothingFor this reason, I believe the product or technician or some other part of the processing of this test was in errorDue to this error, my doctor ordered a diagnostic colonoscopy for which I had to pay $2,out of pocket instead of the screening colonoscopy which is covered by insuranceThat is my complaint
Regards,
Mary ***

Please see attached

[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 made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me. Please note however that while Exact Sciences Litigation Counsel indicates in their 10/18/communication to Mr*** that they communicated with me regarding the decision to forgive the remaining balance, I have received no such communication to date.I will retain a copy of Nicole ***'s response for record keeping purposes.Your assistance with resolving this issue is greatly appreciated
Regards,
Norman ***

November 1, Bradley *** Operations Manager Revdex.com of Wisconsin WGreenfield Avenue Milwaukee, WI VIA MAIL and EMAIL Re: Revdex.com Complaint ID *** Dear Mr***: Thank you for your letter to Kevin *** of October regarding DrCarlos ***’s additional submission to the Wisconsin Revdex.com related to his complaint about the billing for his order of the Cologuard test for a patient. We take all customer concerns seriously and regret Dr***’s continued dissatisfaction with the service he received from Exact Sciences. As I indicated in Exact Science’s initial response to this complaint, Exact Sciences Laboratories’ sales personnel are trained to advise ordering physicians that any applicable pre-authorization needs to be done by the physician’s office or the patient. Exact Sciences does not contact patients’ insurers to obtain coverage information prior to shipping a test. Therefore, we do not know of an insurer’s refusal to cover Cologuard until a claim comes back to us as denied. At that point, we do reach out to patients to explain what we can do to appeal the determination We apologize to Dr*** for any misunderstanding of our process As we do not know to which specific patient claim this physician is referencing, we would suggest that he advise the patient to call our billing department for further information on what additional measures, if any, can be done to contest the coverage determination. Billing Support Center Exact Sciences Laboratories Phone: 844-870-Fax: 608-535-*** We would appreciate the opportunity to assist the patient directly with his/her concerns. We trust that this responds to your correspondence. Please let us know if you have further questions Sincerely, Nicole *** Litigation Counsel Exact Sciences Corporation 608-535-***

November 29, 2016 Bradley [redacted] Operations Manager Revdex.com of Wisconsin 10019 W. Greenfield Avenue Milwaukee, WI 53214   VIA EMAIL   Re:  Revdex.com Complaint No. [redacted]   Dear Mr. [redacted]:   Thank you for your letter to Kevin [redacted] of November 7 regarding our patient’s...

Cologuard test.  We are glad that the patient has been screened for colorectal cancer, the second leading cancer killer in the United States.  We are hopeful that the patient found the test easy to use and was otherwise satisfied with the test experience.   We have researched the patient’s billing question.  It appears that the patient’s insurance company initially denied the claim for coverage for the Cologuard test.  Both Exact Sciences and the patient filed appeals of that denial decision.  The appeal was ultimately resolved in the patient’s favor – the insurer did cover the test.  The balance owed by the patient to Exact Sciences is patient responsibility per the terms of the patient’s health insurance policy.  Exact Sciences has no control or influence over the terms of any individual’s insurance policy with a third-party insurance company.    The patient requested that Exact Sciences waive the patient responsibility payment owed to Exact Sciences per the terms of his insurance policy.  Unfortunately, Exact Sciences cannot accommodate that request.  Various laws restrict a medical provider’s ability to waive patient cost share amounts.    Please let us know if you have further questions.   Sincerely, Nicole [redacted] Litigation Counsel Exact Sciences Corporation 608-535-8751 [redacted]

Thank you for your letter to Kevin [redacted] of February 24,
2018 regarding our patient’s Cologuard test.  While we regret that a
billing issue has caused dissatisfaction for our patient, we are glad that the
patient is being screened for colorectal cancer, the second leading cancer
killer in...

the United States.  We have researched the patient’s question.  After
completing the patient’s Cologuard test, we billed her insurer.  Unfortunately, the patient’s insurance denied
her claim for coverage of the test.  We
appealed that decision on behalf of the patient and attempted to obtain
additional medical documentation, even though none should be needed for a
screening test, from the patient’s ordering provider.  However, since we have not received payment
from the patient’s insurer, we billed the patient for the cost of the service
($649.00).  While we regret the patient’s
dissatisfaction, at this point, there is nothing further we can do for the
patient.  There are legal limitations on
a medical provider’s ability to write-off amounts due for medical services
performed.  We hope this resolves the patient’s inquiry. Please let us know if you have further questions.

Thank you for your letter to Kevin [redacted] of November 8,
2017 regarding our patient’s Cologuard test.  While we regret that a
billing issue has caused dissatisfaction for our patient, we are glad that the
patient is being screened for colorectal cancer, the second leading cancer
killer in...

the United States.  We have researched the patient’s question.  After
completing the patient’s Cologuard test, we billed her insurer.  Unfortunately, the patient did not have
applicable insurance at the time of her test. 
As a result, we billed the patient for the cost of the service
($649.00).  The patient does not want to
pay for the test because she believes she had a false positive result.  No laboratory test is perfect.  However, we do report our sensitivity and specificity
results from our 10,000 patient study on our website and on patient and
provider brochures.  While we regret the
patient’s dissatisfaction, at this point, there is nothing further we can do
for the patient.  There are legal
limitations on a medical provider’s ability to write-off amounts due for
medical services performed.  We hope this resolves the patient’s inquiry. Please let us know if you have further questions.

They are not going to be fair about this. You can drop the case. Thank you for your attempt to help them realize how unfair they are . They will not get a dime from me.Tell us why here...

October 18, 2016Bradley [redacted]Operations ManagerRevdex.com of Wisconsin10019 W. Greenfield AvenueMilwaukee, WI 53214 VIA MAIL and EMAIL  Dear Mr. [redacted]: Thank you for your letter to Kevin [redacted] of October 11 regarding Dr. Carlos [redacted]’s order of the Cologuard test for a...

patient.  We are glad that this patient has been screened for colorectal cancer, the second leading cancer killer in the United States.  We are hopeful that the patient found the test easy to use and was otherwise satisfied with the test experience. We have researched the physician’s billing question.  While we are unable to locate any claims for Cologuard orders by this physician that were denied by a patient’s insurer based on a failure to do a pre-authorization, Exact Sciences Laboratories’ sales personnel are trained to advise ordering physicians that any applicable pre-authorization needs to be done by the physician’s office or the patient.  Exact Sciences has no control or influence over the terms of any individual’s insurance policy with a third-party insurance company and as a laboratory, we do not have access to the patient’s medical history.  Because we want all eligible patients to be screened for colorectal cancer and believe all insurance carriers should be covering the Cologuard test, we do file appeals of insurance claims denials on behalf of patients where possible.  Unfortunately, we are not always successful in those efforts.  In those situations, however, we do still have a legal obligation to bill patients for services rendered and are legally restricted from writing off those bills simply because a physician requests we do so given the insurer’s failure to provide coverage.       We trust that this responds to your correspondence.  Please let us know if you have further questions. Sincerely,Nicole [redacted]Litigation CounselExact Sciences Corporation608-535-8751[redacted]

Thank you for your letter to Kevin [redacted] of November 27,
2017 in follow-up to the above-referenced complaint regarding our patient’s Cologuard
test.  We have reviewed the patient’s additional questions and
comments.  Exact Sciences is just as dissatisfied with her insurer’s
failure to cover her Cologuard test as is the patient.  We do include in all of our patient-facing
material that patients should check their own benefits before proceeding with
the test.  Our sales representatives are
also trained to provide this message to ordering providers.  We regret if this message was not given to
this patient by her ordering provider. 
However, we strongly dispute that our test is unreliable.  The Cologuard test has been approved by the
FDA since October 2014, following an extensive 10,000 patient study.  It has also been covered by the Medicare
program since that time.  The test is
approved by the American Cancer Society, the National Cancer Care Network, the
United States Preventive Services Taskforce and many other healthcare
organizations.  Unfortunately, commercial
carriers are usually the last to adopt and cover new technologies.  Exact Sciences continues to work hard to
advocate for increased commercial coverage for patients and has made
significant strides.  [redacted], this
patient’s insurer, does, as of July 2017, now cover the test for commercial
patients.  Finally, we also strongly dispute the allegation that
doctors receive any kind of remuneration in return for ordering our test.  Such a suggestion is inaccurate and we take
it very seriously, as it would be a violation of federal law for a health care
provider to provide kickbacks to induce ordering of a medical service.  Exact Sciences has strong compliance policies
and procedures to ensure these laws are adhered to at all times.  While we regret the patient’s dissatisfaction, there is nothing
further we can do for the patient.  As we
indicated previously, there are legal limitations on a medical provider’s
ability to write-off amounts that the patient’s insurance company has
determined are the patient’s responsibility.  We hope this resolves the patient’s inquiry. Please let us know if you have further questions.

Thank you for your letter to Kevin [redacted] of December 18,
2017 regarding our patient’s Cologuard test.  While we regret that a
billing issue has caused dissatisfaction for our patient, we are glad that the
patient is being screened for colorectal cancer, the second leading cancer
killer in...

the United States.  We have researched the patient’s question and have
communicated directly to the patient that a refund is in process.  We hope this resolves the patient’s inquiry. Please let us know if you have further questions.

[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 made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.

Thank you for your letter to Kevin [redacted] of November 4,
2017 regarding our patient’s Cologuard test.  While we regret that a
billing issue has caused dissatisfaction for our patient, we are glad that the
patient is being screened for colorectal cancer, the second leading cancer
killer in...

the United States.  We have researched the patient’s question.  After
completing the patient’s Cologuard test, we billed her insurer.  Unfortunately, her insurer, [redacted], denied
coverage for our test.  While we appealed
this decision on the patient’s behalf, [redacted] maintained its denial of this
patient’s claim.  As a result, we billed
the patient for the cost of the service ($649.00).  We do advise patients and ordering providers
to call the patient’s insurance prior to completing the test to determine their
out of pocket costs.  This information is
on our website and in our written promotional materials.  While we regret the patient’s dissatisfaction,
at this point, there is nothing further we can do for the patient.  There are legal limitations on a medical
provider’s ability to write-off amounts that the patient’s insurance company
has determined are the patient’s responsibility.  We hope this resolves the patient’s inquiry. Please let us know if you have further questions.

Thank you for your letter to Kevin [redacted] of December 14,
2017 regarding our patient’s Cologuard test.  While we regret that a
billing issue has caused dissatisfaction for our patient, we are glad that the
patient is being screened for colorectal cancer, the second leading cancer
killer in...

the United States.  We have researched the patient’s question and have
communicated directly to the patient our decision to forgive the remaining
balance due in this circumstance.  We hope this resolves the patient’s inquiry. Please let us know if you have further questions.