General Plumbing Supply

Initial Business Response / [redacted] (1000, 5, 2016/09/09) */ Patient had colonoscopy with biopsy and submucosal injections; therefore procedure codes were used to bill the procedureAfter receipt of this complaint, we contacted Michigan Blue Cross Blue Shield and received a fax of patient's policy and benefitsThis policy has limited benefits under the Community Blue Program in MichiganAccording to the terms of the patient's policy, she has coverage for one colonoscopy procedure per year, so the additional colonoscopy codes used to also describe the additional biopsies and submucosal injections were denied as having maxed the benefitWe supplied the approopriate modifier (PT) per Anthem's policy to describe a screening exam where an issue is encountered during the preventive examIn all codes used the primary diagnosis was [redacted] - Encounter for screening for malignant neoplasm of colonThe first line item was paid at [redacted] with a contracted discount of $with no balance owing by the patientThe subsequent codes were allowed by her insurance plan but were processed as a "PR" code which means patient responsibilityThe patient therefore is responsible, according to her explanation of benefits, for the amount of $as her policy excluded this amount as having maxed the allowed benefitTwo certified coders reviewed both the clinical documentation and the procedure and diagnosis codes used and it was determined the coding is accurateAs stated, we reviewed this further with Anthem Blue Cross Blue Shield and believe the claim processed in accordance with the patient's benefits Initial Consumer Rebuttal / [redacted] (3000, 7, 2016/09/11) */ (The consumer indicated he/she DID NOT accept the response from the business.) I understand their reasoning behind the way they billed the removal of polypsIt is my and my insurance agents and the blue cross biller they spoke to belief that once a polyp was discovered, that the removal and biopsy of those polyps is a medical decision by the doctor to proceed to do so in this manner and should be billed as suchIn my opinion it is just a matter of making the customer pay for the insurance discount they would have to accept if billed as medical and not preventativeHow is the removal of polyps preventative? It just does not make sense and I will spread the word far and wide to avoid South Bend Clinic for any procedures and will be changing my doctor of the last twelve years because I so strongly disagree with this billing procedureAfter posting this situation on Facebook I've discovered many, many more people who have had to pay more than their fair share as well so that speaks volumesYou can close this case because obviously they don't care about their patients, only their bottom line

Initial Business Response /* (1000, 7, 2015/10/02) */
Contact Name and Title: Tonya ***
Contact Phone: XXX-XXX-XXXX
Contact Email: ***@southbendclinic.com
Patient contacted South Bend Clinic Bus Office on 9/stating that her derm path bill was processed out of network and that we
should have sent her derm path to an in-network providerWe contacted the patient's insurance carrier, *** and verified her benefitsWe were informed that Anthem would have to contact the lab to see if the lab would negotiate an out of network agreement; we were waiting on a response from Anthem
OFFER:
We contacted the patient twice to speak with her, on the 24th and the 25thOn 10/1, we offered to pay the out of network lab claim on her behalf, and she was informed of this yesterday, 10/The patient expressed that she was thankfulWe also contacted Quest labs and Aurora, and Aurora said they will likely offer a discount on the bill
Initial Consumer Rebuttal /* (2000, 9, 2015/10/10) */
(The consumer indicated he/she ACCEPTED the response from the business.)
SB Clinic only contacted me once, on Friday 9/25, and left a voicemailI had to call them back twice asking for a return call and I also offering to set meeting to speak in personOn 10/1, I finally receive a call backI was promised a letter confirming that payment to Aurora on my behalf, but have yet to receive it as of 10/I am indeed grateful that SB clinic is paying the claim, but I continue to be disillusioned by the hastle that I had to go through to get them to correct their own mistake
Final Consumer Response /* (3000, 16, 2015/10/26) */
On 10/21/2015, I received a call from the diagnostics company that the bill still had not been paid and is prepared for collectionsIndeed, the company has not received the check from South Bend Clinic that was promised to me, and in addition I have not received the promised letter confirming the check had been sentI have called Beth at the South Bend Clinic to try to resolve the issue, and I am waiting on her to return my callI would like this case reopened with the Revdex.com
Final Business Response /* (4000, 21, 2015/11/09) */
The South Bend Clinic did submit a check for payment of the outstanding balance to the pathology lab (Aurora labs)This check was issued on 10/and on 10/it was cashedWe reached out to the patient on 10/and clarified this with herPlease let us know if there are any other questions or unresolved items from this matterRegards,
Tonya ***

Initial Business Response /* (1000, 5, 2016/09/09) */
Patient had colonoscopy with biopsy and submucosal injections; therefore 3 procedure codes were used to bill the procedure. After receipt of this complaint, we contacted Michigan Blue Cross Blue Shield and received a fax of patient's policy and...

benefits. This policy has limited benefits under the Community Blue Program in Michigan. According to the terms of the patient's policy, she has coverage for one colonoscopy procedure per year, so the additional colonoscopy codes used to also describe the additional biopsies and submucosal injections were denied as having maxed the benefit. We supplied the approopriate modifier (PT) per Anthem's policy to describe a screening exam where an issue is encountered during the preventive exam. In all codes used the primary diagnosis was [redacted] - Encounter for screening for malignant neoplasm of colon. The first line item was paid at [redacted] with a contracted discount of $495.12 with no balance owing by the patient. The subsequent codes were allowed by her insurance plan but were processed as a "PR" code which means patient responsibility. The patient therefore is responsible, according to her explanation of benefits, for the amount of $2065 as her policy excluded this amount as having maxed the allowed benefit. Two certified coders reviewed both the clinical documentation and the procedure and diagnosis codes used and it was determined the coding is accurate. As stated, we reviewed this further with Anthem Blue Cross Blue Shield and believe the claim processed in accordance with the patient's benefits.
Initial Consumer Rebuttal /* (3000, 7, 2016/09/11) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I understand their reasoning behind the way they billed the removal of polyps. It is my and my insurance agents and the blue cross biller they spoke to belief that once a polyp was discovered, that the removal and biopsy of those polyps is a medical decision by the doctor to proceed to do so in this manner and should be billed as such. In my opinion it is just a matter of making the customer pay for the insurance discount they would have to accept if billed as medical and not preventative. How is the removal of polyps preventative? It just does not make sense and I will spread the word far and wide to avoid South Bend Clinic for any procedures and will be changing my doctor of the last twelve years because I so strongly disagree with this billing procedure. After posting this situation on Facebook I've discovered many, many more people who have had to pay more than their fair share as well so that speaks volumes. You can close this case because obviously they don't care about their patients, only their bottom line.

Review: I am writing this complaint on behalf of my parents who recently renovated their home. They purchased a [redacted] diverter tub spout/hand held shower/overhead shower set-up from the General Plumbing Supply Showroom (GPSS) in Morris Plains, NJ. However, it failed to operate correctly even though installed in accordance with recommendations provided by GPSS; when the spout is filling the tub with water, water unfortunately comes out of the overhead shower at the same time. A plumber, recommended by GPSS because of his expertise re [redacted] products, assessed the problem on premises and determined the problem was that the tub spout ordered by GPSS was too narrow and that there was a water pressure issue that should be solved by replacing the ordered tub spout with a tub spout with a consistently wider opening. GPSS agreed to make this replacement. In spite of repeated calls beginning at the onset of the problem on December 2, 2014, and, finally, a written reminder on March 23, 2015, to [redacted], the Showroom Manager, the promised installation has not taken place. As a result, my parents have been unable to properly use their new shower/bathtub and have yet to be able to install sliding glass shower doors (also purchased from GPSS) because they need to leave the space open for easy access to fix the tub spout.Desired Settlement: I would like the issue to be fixed immediately and with care.