Gateway Women's Health

Initial Business Response / [redacted] (1000, 6, 2016/02/25) */ Contact Name and Title: [redacted] MD, Owner Contact Phone: XXX-XXX-XXXX Contact Email: ***@sbcglobal.net We initially contacted the manufacturer of Prolia to ask if under the patient's specific insurance carrier and plan, the Prolia injection would require a prior-authorization for coverageWe were told there was no prior-authorization required and were faxed the attached response directly from themWith that information, we proceeded to submit an order to the hospital for the shot and set up an appointment for the patient to receive itOnly when we then submitted the claim to her insurance company for coverage were we told that prior-authorization was not necessary, but the patient did not meet the requirements of her plan to be approved for coverageWe went round and round with the insurance company for months trying to convince them that the manufacturer had given us the informationThey would not be convinced to reconsider or even accept the explanation of the situation In the mean time the hospital sent the patient's account to their collection department because they had not received payment for nearly a yearBefore sending her to collections, the hospital initially offered her a 40% discount for paying, but when they finally sent her to collections, it was for the full amountThe collection department proceeded to harassed the patient so much for payment that she finally paid the full amount to get them off her back To this day, we are still, striving to resolve this issue to everyone's satisfaction Respectfully, [redacted] MD Initial Consumer Rebuttal / [redacted] (3000, 8, 2016/02/25) */ (The consumer indicated he/she DID NOT accept the response from the business.) I wish that all of this effort had been done sooner rather than much later by the physician's officeI am hoping for some sort of resolution

Initial Business Response /* (1000, 6, 2016/02/25) */
Contact Name and Title: *** *** MD, Owner
Contact Phone: XXX-XXX-XXXX
Contact Email: ***@sbcglobal.net
We initially contacted the manufacturer of Prolia to ask if under the patient's specific insurance carrier and plan, the Prolia
injection would require a prior-authorization for coverage We were told there was no prior-authorization required and were faxed the attached response directly from them With that information, we proceeded to submit an order to the hospital for the shot and set up an appointment for the patient to receive it Only when we then submitted the claim to her insurance company for coverage were we told that prior-authorization was not necessary, but the patient did not meet the requirements of her plan to be approved for coverage We went round and round with the insurance company for months trying to convince them that the manufacturer had given us the information They would not be convinced to reconsider or even accept the explanation of the situation
In the mean time the hospital sent the patient's account to their collection department because they had not received payment for nearly a year Before sending her to collections, the hospital initially offered her a 40% discount for paying, but when they finally sent her to collections, it was for the full amount The collection department proceeded to harassed the patient so much for payment that she finally paid the full amount to get them off her back
To this day, we are still, striving to resolve this issue to everyone's satisfaction
Respectfully, *** *** MD
Initial Consumer Rebuttal /* (3000, 8, 2016/02/25) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I wish that all of this effort had been done sooner rather than much later by the physician's office I am hoping for some sort of resolution

Initial Business Response /* (1000, 6, 2016/02/25) */
Contact Name and Title: *** *** MD, Owner
Contact Phone: XXX-XXX-XXXX
Contact Email: ***@sbcglobal.net
We initially contacted the manufacturer of Prolia to ask if under the patient's specific insurance carrier and plan, the Prolia
injection would require a prior-authorization for coverageWe were told there was no prior-authorization required and were faxed the attached response directly from themWith that information, we proceeded to submit an order to the hospital for the shot and set up an appointment for the patient to receive itOnly when we then submitted the claim to her insurance company for coverage were we told that prior-authorization was not necessary, but the patient did not meet the requirements of her plan to be approved for coverageWe went round and round with the insurance company for months trying to convince them that the manufacturer had given us the informationThey would not be convinced to reconsider or even accept the explanation of the situation
In the mean time the hospital sent the patient's account to their collection department because they had not received payment for nearly a yearBefore sending her to collections, the hospital initially offered her a 40% discount for paying, but when they finally sent her to collections, it was for the full amountThe collection department proceeded to harassed the patient so much for payment that she finally paid the full amount to get them off her back
To this day, we are still, striving to resolve this issue to everyone's satisfaction
Respectfully, *** *** MD
Initial Consumer Rebuttal /* (3000, 8, 2016/02/25) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I wish that all of this effort had been done sooner rather than much later by the physician's officeI am hoping for some sort of resolution