Filipino Combat Systems

Initial Business Response /* (1000, 7, 2015/10/19) */
We have reviewed the file and correspondence associated with this potential customer. Our product is a medical device used to relieve pain and promote healing. It requires a prescription and, in certain circumstances, may be partially covered...

by insurance. The product is available for purchase by a customer with a prescription and in some cases we are able to file insurance directly with medicare or third party payers. In this case, we are not credentialed "in network" with the insurance provider so claims must be submitted by the customer. We had offered to submit claims on her behalf and advised her that all correspondence and payments would go directly to her from the payer.
After some initial discussion with the customer in May & June 2015 regarding how to proceed, we finally received the necessary documentation on July 15, 2015. on July 16, 2015 a claim was filed electronically on behalf of the customer. On July 24, 2015 we were advised that electronic claims could not be filed as we are an out-of-network provider. We subsequently submitted a paper application on behalf of the customer which would normally take 3-4 weeks to process. In following up with the insurance provider we were informed that they had forwarded a payment and an "Explanation of Benefits" to the customer regarding the claim. This information was not provided to Neurolumen LLC.
The payment that the customer received was net of their deductible and also covering only one of two possible codes that were submitted. Had the customer informed Neurolumen LLC of this correspondence, we would have submitted an appeal. We will inform the customer that she will need to forward to us all communication from the insurance provider. The customer is aware that the product is sold directly to the customer and then the customer is reimbursed by their insurance provider based upon the terms of their coverage.
There have been no less than twelve communication attempts between Neurolumen LLC and the customer during this period. It took nearly six weeks to obtain the requisite documentation from the customer to begin the claim process. Unfortunately, the customer did not communicate to Neurolumen LLC the decision by her insurance provider and the claim remained in pending status. Neurolumen LLC has since taken action to obtain additional information necessary to refile the rejected insurance claim. A Neurolumen LLC representative will contact the customer and explain the current status of this transaction as well as to reinforce the need for the customer to keep Neurolumen LLC informed of all correspondence from her insurance provider.
Initial Consumer Rebuttal /* (3000, 9, 2015/10/19) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I informed them of every mailings I received from my insurance company & as you can see how long this has taken with me generating every phone call to Neurolumen without any information on an appeal to my insurance company. They never informed me of this & I sent them everything they needed to approve this. As of today 10/19/15 I received a phone call saying they received my doctors approval for medical necessity. This was sent to them this past summer & find it ridiculous that I filed this complaint & now all of sudden they found it. I also received an email for me to contact them instead of the reverse. Please get your protocol in order in what has to be done because I've done my share of trying to get this device approved.
Final Business Response /* (4000, 13, 2015/11/12) */
The Certificate of Medical Necessity (CMN) was obtained to help substantiate the appeal that Neurolumen LLC filed with the insurance provider on behalf of the customer in October. It was not required for the initial claim submission in July. On November 2, 2015 the customer's insurance provider responded to our appeal stating that they have reviewed the appeal and determined that the initial filing was processed correctly and that there would be no additional payments made on the claim. The customer has been notified by telephone that there would be no additional payments and that she is welcome to purchase the product from Neurolumen LLC.