Goulds Discount Medical Patient: [redacted] Patient ID: [redacted] Complaint ID: [redacted] To Whom It May Concern, We have reviewed the complaint notice and the account with Gould’s for Mr. [redacted]. Mr. [redacted] was contacted by Gould’s in regards to supply replenishment for his PAP machine in February 2016....
He states he asked questions regarding the supplies and one of those was ‘were all supplies covered by insurance at no cost’. He said that he was told yes they would be covered at no cost. When the claim billed to his insurance they applied the allowed charges of $62.32 to his annual deductible of $1,000.00. Although the insurance did cover the supplies the patient states he specifically asked if they would be covered with no charge to him and was told yes. We will be using this information as a re-education tool for our team to better detail the deductible and copay information to our patients. We have contacted Mr. [redacted] regarding this concern and after reviewing all information have agreed to adjust his account of the $62.32. Sincerely, [redacted] Goulds Discount Medical, Inc. 3901 Dutchman's Lane Louisville KY 40207 [redacted]
[redacted] I am in receipt of this complaint and I apologize for the oversight that our billing personnel made on this account. As a result of the reduction of payments by Medicare and the Insurance Companies for equipment dispensed to patients, we have had to...
outsource our private pay receivables. At the time of this particular transaction we were in the process of transitioning to this outsourced vendor, who is responsible for collecting our private pay receivables. So when Mr. [redacted] called to explain that he didn’t owe the $17.88, the message was not relayed properly to our outsourcing company, in spite of our personnel who took the calls thought that they were relaying the correct information. Again, I apologize for this error and Mr. [redacted]’s inconvenience and his account has been properly credited and his balance is zero. Thank you for bringing this to my attention. [redacted], President [redacted]
Revdex.com:
I have review** the response made by the business in reference to complaint ID [redacted], and find...
that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolv**.
Regards,
[redacted]
THANK YOU Revdex.comFor Revdex.com help, it's a shame it had to come to me filing an complaint to get help. When I did ask** for help at the Gould's store on servile occasion/months. I believe that Mr ** Gould help fix the problem for me and others in the future in there stores.Also would like to point out. I know Kentucky is a one-party state for Eavesdropping. How ever this doesn't apply to a business. Mr ** Gould call** me on my cellphone and didn't advis** me the phone was being record** until haft way through the call it came up about me not getting a call form Gould's he said the had proof of a call to my house. I had nothing on my caller ID of same. Someone must have answer the phone on the first ring. However their was no beeping noise/tone to let me know of same that is requir** by law ether see attachments. I feel like their was an Eavesdropping violation occur during his phone call to me. Please correct me if I wrong on this. THANK You again Revdex.com and ** Gould. [redacted]
To Whom It May Concern, The following is in response to complaint ID [redacted] Gould’s received a referral from sleep lab for PAP setup on 9/26/2016. Insurance was verified and benefits obtained. When our CSR’s call Anthem for benefits/verification they are tal[redacted] to...
whatever state that patient’s group plan is out of. For example Mr. [redacted] has alpha pre-fix WMW which is [redacted] Anthem is based out of [redacted].Mr. [redacted] lived in Kentucky at the time of the setup. Anthem of Kentucky requires us to rent to purchase the PAP. If this patient lived in [redacted] and we were a DME provider in that state then yes we could rent or purchase the machine. Because this patient lives in Kentucky then these claims must process through Anthem Kentucky and adhere to the Kentucky guidelines of rent to purchase. We cannot bill these claims directly to Anthem [redacted] as they will just kick them back to Kentucky. It can get really confusing especially for the patient. The patient will call the phone number on their card which is the state their plan is based out of. In this patient’s case it is [redacted]. Their customer service rep will give you their state’s guidelines not ta[redacted] into consideration that they live in Kentucky and must adhere to Anthem Kentucky processes. Not all reps at this payer realize that and therefore do not provide clear information. I contacted Mr. [redacted] and discussed this information and explained that our CSR also was not clear on this process with Anthem and therefore offered a rent or purchase option in error. I thanked him for reaching out as this allows us to re-educate our intake staff on exactly how to handle these specific referrals for Anthem PAP patients that have out of state group plans. I explained that after discussing with the owners, Gould’s will accept the payments we received thus far by the payer and patient’s copays as payment in full. Gould’s will honor this because according to the explanation our CSR provided and the signed documentation on file he had no expectation it would be anything except a purchase at the time his deductible was met in 2016. A refund of $162.28 was processed to the patient. Mr. [redacted] thanked me for handling this situation and providing a resolution that we both agree with. Sincerely,[redacted]Billing Manager
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.
Regards,
[redacted]
Subject: Revdex.com Complaint # [redacted] Thank you for bringing this complaint to my attention. After receiving this complaint I have conferred with my Service Manager, our Sanitation Personnel and our Power Wheelchair Technician in order to answer this letter. [redacted] applied...
for a new Power Wheelchair in August, 2015. The process of getting evaluated and approved by Medicare is a lengthy process which sometimes takes 5 to 6 months or more. In the meantime, we , on occasion “ voluntarily lend” a Power Wheelchair to a patient while this evaluation process is going on to help them through the process. Over the years we have worked very diligently with Ms. [redacted] to ensure her needs and comfort were being met. In the past, we have exclusively loaned MS. [redacted] that same Power Wheelchair on four to five other separate occasions while her equipment was being repaired. Because of her particular physical needs that particular loaner Power Wheelchair was the only one she could use and was not used by anybody else. Each and every time a piece of equipment comes to our facility from a person’s home it is thoroughly chemically cleaned, sanitized and exterminated for any living organisms. We have been in business for over 25 years and we use a very effective means of sanitation and extermination process of any bugs encountered. Ms. [redacted] loaner wheelchair was, indeed , properly sanitized and inspected each time prior to it being delivered to her home. We know that bed bugs are a real problem in peoples’ homes today and that’s why we are so careful in our sanitation process. I am terribly sorry that Ms. [redacted] has had this terrible problem with bed bugs. I do not see how the bed bugs emanated from our Power Wheelchair and will not take responsibility for them. In the over 25 years that Gould’s has been in business and the hundreds of thousands of pieces of equipment that we have provided to patients we have NEVER encountered this complaint from a patient in the past. We look forward to taking care of Ms. [redacted] and her needs in the future and wish her well. Very truly yours, [redacted], President 3901 Dutchmans Ln, Suite 100 Louiville, Ky 40207 [redacted]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID[redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.
I took my [redacted] to the Hospital today to have a procedure done, and since I had been told no problem on the return and to ask for [redacted] I felt all would be taken care of. I went in and still had my [redacted] in the car and parked where I could see [redacted]. As soon as **. [redacted] found out why I was there, she went around to every other customer and made me wait for 20 minutes before I finally asked her again. She was hateful about it and made me feel awful that I had to bother her. She had a smart mouth and treated me like dirt. I WILL never go back to that store again and I will make sure that all of my mother's friends don't make the mistake either. Customer Service with **. [redacted] was non existant. What a horrible experience.
Regards,
[redacted]
SEE ATTACHMENT FOR ORIGINAL RESPONSE.
Here are the facts regarding the process for Ms. [redacted]'s power chair.
Ms.. [redacted]'s seating evaluation was done at[redacted] on 9/22/14. Her Face to Face evaluation was done 2 months later w/her doctor on 11/20/2014.
On 12/17/2014 we...
received the Face to Face notes but they didn't meet criteria for [redacted] so we contacted Dr. [redacted]'s office to let them know and to request amended notes. By 1/20/15 we were still trying to receive the updated office notes but had not been successful. Again on 1/27/15 we contacted the physician's office about sending the updated/corrected notes but again nothing arrived. All the while Ms. [redacted] was kept in the loop but of course assumed, unfortunately, we were not being completely honest with her.
Sometime within a month's period of time we had gotten the notes we needed and had sent the last of two documents to the doc for signature. On 3/2/15 we were waiting on the last document, the DPD, to be signed by the doctor. It was returned to us on 3/3/15. It was during this time that Ms. [redacted] thought we had already submitted our paper work to [redacted] and that I was lying to her. I was not lying and can only imagine that when I told her we had received information it meant to her that we received all that we needed. It's stated as such in [redacted] (our computer notes) on that date. It was Ms. [redacted]'s misunderstanding and I assure she was NEVER lied to or misled. I apologized to her but she would not take my word or my apology. She asked me what good would my apology do for her? On 3/4/15 we had submitted all documents to [redacted] ADMC (prior approval department) for review. We received a preliminary decision letter from them on 3/23/15 and they wanted additional information from the physician. I contacted the physician the same day and explained what was needed. The physician didn't return the document until April 17, 2015. On 4/27/2015 I resubmitted the new information to ADMC but did not hear back from them. I called and was told they never received the documentation from us (although I had proof of my fax cover that 45 pages went through on 4/27/2015). I resubmitted w/my fax cover sheet as proof hoping they would expedite faster!
Currently I am waiting on ADMC's final decision since re-submitting the amended information. [redacted]/ADMC only gives providers 2 attempts at getting the documentation correct. If we don't, the consumer is forced to wait 6 months to even try again. No other vendor in the state of KY can attempt to get him a wheelchair!!!
Hope this helps,
Thank you [redacted]
[redacted] [redacted]
[redacted] [redacted]
[redacted]
[redacted] [redacted]
[redacted] [redacted]
[redacted] [redacted]
[redacted] [redacted] The details of this matter are as follows: Complaint Involves: Billing or Collection Issues ...
To Whom It May Concern, I have reviewed the account and outstanding private pay balances due for Mr. [redacted] [redacted], account number [redacted]. The patient received a brace, a BIPAP machine (rental) and BIPAP supplies (purchase) from Gould’s for services dates 11/6/2014 to 5/4/2016. Mr. [redacted] has Medicare primary with a secondary insurance of Physicians Mutual. All medical equipment and/or supplies billed to Medicare on Mr. [redacted]’s behalf were assigned a billing code (by the manufacture of that product) that is identified as a HCPCS code. Medicare’s reimbursement on the approved HCPCS codes is 80% of their allowed amounts. The difference between Gould’s charge amount and Medicare’s approved allowed amount is never billed to the patient. That amount which is called a contractual adjustment is automatically adjusted once Medicare processes their payment. The secondary policy through Physicians Mutual has an annual deductible of $2,180.00 that has to be met before they will begin covering the 20% that is not covered by Medicare. Medicare covers 80% of durable medical equipment / supplies after their annual deductible which although it has increased slightly each year is currently $166.00 for the 2016 calendar year. When a claim is filed with Medicare they will automatically forward the secondary balance they deem payable to Physicians Mutual on the patient’s behalf. Physicians Mutual has process all of the secondary claims for Mr. [redacted] and applied them accordingly to his annual deductible. I confirmed with Medicare on 9/7/2016 that the balances attached are accurate according to their policy guidelines for services rendered by Gould’s. Medicare states that Gould’s is only able to bill the patient the amount that is listed in PT RESP ( patient responsibility) section on the explanation of benefits unless there is a secondary policy that covers and reimburses those charges. As Mr. [redacted] requested I have cancelled the sales order that was recently generated for new BIPAP supplies. At this time his total balance private pay due with Gould’s per Medicare is $267.81. There are no late fees associated with this balance due. Mr. [redacted] spoke with two employees from the Billing department at Gould’s that explained the reason for the private pay balances due. We understand the patient’s strong frustration with having to pay out of pocket for items that are covered by insurance but there are few insurance policies out there these days that do not have a deductible to meet before they begin to reimburse. All of the Medicare EOB’s associated with the balance due were faxed to the patient on 9/6/2016 at 3:21 pm as requested by Mr. [redacted]. I emailed Mr. [redacted] on 9/7/2016 detailing his account information and attached his Medicare EOB’s that reflect what Medicare deems is the patient responsibility. I also mailed these to the patient for his records. If any further information is required please feel free to contact me. Sincerely, [redacted] Billing Manager Goulds Discount Medical [redacted]
Goulds Discount Medical Patient: [redacted] Patient ID: [redacted] Complaint ID: [redacted] To Whom It May Concern, We have reviewed the complaint notice and the account with Gould’s for Mr. [redacted]. Mr. [redacted] was contacted by Gould’s in regards to supply replenishment for his PAP machine in February 2016....
He states he asked questions regarding the supplies and one of those was ‘were all supplies covered by insurance at no cost’. He said that he was told yes they would be covered at no cost. When the claim billed to his insurance they applied the allowed charges of $62.32 to his annual deductible of $1,000.00. Although the insurance did cover the supplies the patient states he specifically asked if they would be covered with no charge to him and was told yes. We will be using this information as a re-education tool for our team to better detail the deductible and copay information to our patients. We have contacted Mr. [redacted] regarding this concern and after reviewing all information have agreed to adjust his account of the $62.32. Sincerely, [redacted] Goulds Discount Medical, Inc. 3901 Dutchman's Lane Louisville KY 40207 [redacted]
[redacted] I am in receipt of this complaint and I apologize for the oversight that our billing personnel made on this account. As a result of the reduction of payments by Medicare and the Insurance Companies for equipment dispensed to patients, we have had to...
outsource our private pay receivables. At the time of this particular transaction we were in the process of transitioning to this outsourced vendor, who is responsible for collecting our private pay receivables. So when Mr. [redacted] called to explain that he didn’t owe the $17.88, the message was not relayed properly to our outsourcing company, in spite of our personnel who took the calls thought that they were relaying the correct information. Again, I apologize for this error and Mr. [redacted]’s inconvenience and his account has been properly credited and his balance is zero. Thank you for bringing this to my attention. [redacted], President [redacted]
Revdex.com:
I have review** the response made by the business in reference to complaint ID [redacted], and find...
that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolv**.
Regards,
[redacted]
THANK YOU Revdex.comFor Revdex.com help, it's a shame it had to come to me filing an complaint to get help. When I did ask** for help at the Gould's store on servile occasion/months. I believe that Mr ** Gould help fix the problem for me and others in the future in there stores.Also would like to point out. I know Kentucky is a one-party state for Eavesdropping. How ever this doesn't apply to a business. Mr ** Gould call** me on my cellphone and didn't advis** me the phone was being record** until haft way through the call it came up about me not getting a call form Gould's he said the had proof of a call to my house. I had nothing on my caller ID of same. Someone must have answer the phone on the first ring. However their was no beeping noise/tone to let me know of same that is requir** by law ether see attachments. I feel like their was an Eavesdropping violation occur during his phone call to me. Please correct me if I wrong on this. THANK You again Revdex.com and ** Gould. [redacted]
To Whom It May Concern, The following is in response to complaint ID [redacted] Gould’s received a referral from sleep lab for PAP setup on 9/26/2016. Insurance was verified and benefits obtained. When our CSR’s call Anthem for benefits/verification they are tal[redacted] to...
whatever state that patient’s group plan is out of. For example Mr. [redacted] has alpha pre-fix WMW which is [redacted] Anthem is based out of [redacted].Mr. [redacted] lived in Kentucky at the time of the setup. Anthem of Kentucky requires us to rent to purchase the PAP. If this patient lived in [redacted] and we were a DME provider in that state then yes we could rent or purchase the machine. Because this patient lives in Kentucky then these claims must process through Anthem Kentucky and adhere to the Kentucky guidelines of rent to purchase. We cannot bill these claims directly to Anthem [redacted] as they will just kick them back to Kentucky. It can get really confusing especially for the patient. The patient will call the phone number on their card which is the state their plan is based out of. In this patient’s case it is [redacted]. Their customer service rep will give you their state’s guidelines not ta[redacted] into consideration that they live in Kentucky and must adhere to Anthem Kentucky processes. Not all reps at this payer realize that and therefore do not provide clear information. I contacted Mr. [redacted] and discussed this information and explained that our CSR also was not clear on this process with Anthem and therefore offered a rent or purchase option in error. I thanked him for reaching out as this allows us to re-educate our intake staff on exactly how to handle these specific referrals for Anthem PAP patients that have out of state group plans. I explained that after discussing with the owners, Gould’s will accept the payments we received thus far by the payer and patient’s copays as payment in full. Gould’s will honor this because according to the explanation our CSR provided and the signed documentation on file he had no expectation it would be anything except a purchase at the time his deductible was met in 2016. A refund of $162.28 was processed to the patient. Mr. [redacted] thanked me for handling this situation and providing a resolution that we both agree with. Sincerely,[redacted]Billing Manager
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.
Regards,
[redacted]
Subject: Revdex.com Complaint # [redacted] Thank you for bringing this complaint to my attention. After receiving this complaint I have conferred with my Service Manager, our Sanitation Personnel and our Power Wheelchair Technician in order to answer this letter. [redacted] applied...
for a new Power Wheelchair in August, 2015. The process of getting evaluated and approved by Medicare is a lengthy process which sometimes takes 5 to 6 months or more. In the meantime, we , on occasion “ voluntarily lend” a Power Wheelchair to a patient while this evaluation process is going on to help them through the process. Over the years we have worked very diligently with Ms. [redacted] to ensure her needs and comfort were being met. In the past, we have exclusively loaned MS. [redacted] that same Power Wheelchair on four to five other separate occasions while her equipment was being repaired. Because of her particular physical needs that particular loaner Power Wheelchair was the only one she could use and was not used by anybody else. Each and every time a piece of equipment comes to our facility from a person’s home it is thoroughly chemically cleaned, sanitized and exterminated for any living organisms. We have been in business for over 25 years and we use a very effective means of sanitation and extermination process of any bugs encountered. Ms. [redacted] loaner wheelchair was, indeed , properly sanitized and inspected each time prior to it being delivered to her home. We know that bed bugs are a real problem in peoples’ homes today and that’s why we are so careful in our sanitation process. I am terribly sorry that Ms. [redacted] has had this terrible problem with bed bugs. I do not see how the bed bugs emanated from our Power Wheelchair and will not take responsibility for them. In the over 25 years that Gould’s has been in business and the hundreds of thousands of pieces of equipment that we have provided to patients we have NEVER encountered this complaint from a patient in the past. We look forward to taking care of Ms. [redacted] and her needs in the future and wish her well. Very truly yours, [redacted], President 3901 Dutchmans Ln, Suite 100 Louiville, Ky 40207 [redacted]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID[redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.
I took my [redacted] to the Hospital today to have a procedure done, and since I had been told no problem on the return and to ask for [redacted] I felt all would be taken care of. I went in and still had my [redacted] in the car and parked where I could see [redacted]. As soon as **. [redacted] found out why I was there, she went around to every other customer and made me wait for 20 minutes before I finally asked her again. She was hateful about it and made me feel awful that I had to bother her. She had a smart mouth and treated me like dirt. I WILL never go back to that store again and I will make sure that all of my mother's friends don't make the mistake either. Customer Service with **. [redacted] was non existant. What a horrible experience.
Regards,
[redacted]
I spoke with on 2 occasions and have straighten** out his problem. Thank you, [redacted]
SEE ATTACHMENT FOR ORIGINAL RESPONSE.
Here are the facts regarding the process for Ms. [redacted]'s power chair.
Ms.. [redacted]'s seating evaluation was done at[redacted] on 9/22/14. Her Face to Face evaluation was done 2 months later w/her doctor on 11/20/2014.
On 12/17/2014 we...
received the Face to Face notes but they didn't meet criteria for [redacted] so we contacted Dr. [redacted]'s office to let them know and to request amended notes. By 1/20/15 we were still trying to receive the updated office notes but had not been successful. Again on 1/27/15 we contacted the physician's office about sending the updated/corrected notes but again nothing arrived. All the while Ms. [redacted] was kept in the loop but of course assumed, unfortunately, we were not being completely honest with her.
Sometime within a month's period of time we had gotten the notes we needed and had sent the last of two documents to the doc for signature. On 3/2/15 we were waiting on the last document, the DPD, to be signed by the doctor. It was returned to us on 3/3/15. It was during this time that Ms. [redacted] thought we had already submitted our paper work to [redacted] and that I was lying to her. I was not lying and can only imagine that when I told her we had received information it meant to her that we received all that we needed. It's stated as such in [redacted] (our computer notes) on that date. It was Ms. [redacted]'s misunderstanding and I assure she was NEVER lied to or misled. I apologized to her but she would not take my word or my apology. She asked me what good would my apology do for her? On 3/4/15 we had submitted all documents to [redacted] ADMC (prior approval department) for review. We received a preliminary decision letter from them on 3/23/15 and they wanted additional information from the physician. I contacted the physician the same day and explained what was needed. The physician didn't return the document until April 17, 2015. On 4/27/2015 I resubmitted the new information to ADMC but did not hear back from them. I called and was told they never received the documentation from us (although I had proof of my fax cover that 45 pages went through on 4/27/2015). I resubmitted w/my fax cover sheet as proof hoping they would expedite faster!
Currently I am waiting on ADMC's final decision since re-submitting the amended information. [redacted]/ADMC only gives providers 2 attempts at getting the documentation correct. If we don't, the consumer is forced to wait 6 months to even try again. No other vendor in the state of KY can attempt to get him a wheelchair!!!
Hope this helps,
Thank you [redacted]
[redacted] [redacted]
[redacted] [redacted]
[redacted]
[redacted] [redacted]
[redacted] [redacted]
[redacted] [redacted]
[redacted] [redacted] The details of this matter are as follows: Complaint Involves: Billing or Collection Issues ...
To Whom It May Concern, I have reviewed the account and outstanding private pay balances due for Mr. [redacted] [redacted], account number [redacted]. The patient received a brace, a BIPAP machine (rental) and BIPAP supplies (purchase) from Gould’s for services dates 11/6/2014 to 5/4/2016. Mr. [redacted] has Medicare primary with a secondary insurance of Physicians Mutual. All medical equipment and/or supplies billed to Medicare on Mr. [redacted]’s behalf were assigned a billing code (by the manufacture of that product) that is identified as a HCPCS code. Medicare’s reimbursement on the approved HCPCS codes is 80% of their allowed amounts. The difference between Gould’s charge amount and Medicare’s approved allowed amount is never billed to the patient. That amount which is called a contractual adjustment is automatically adjusted once Medicare processes their payment. The secondary policy through Physicians Mutual has an annual deductible of $2,180.00 that has to be met before they will begin covering the 20% that is not covered by Medicare. Medicare covers 80% of durable medical equipment / supplies after their annual deductible which although it has increased slightly each year is currently $166.00 for the 2016 calendar year. When a claim is filed with Medicare they will automatically forward the secondary balance they deem payable to Physicians Mutual on the patient’s behalf. Physicians Mutual has process all of the secondary claims for Mr. [redacted] and applied them accordingly to his annual deductible. I confirmed with Medicare on 9/7/2016 that the balances attached are accurate according to their policy guidelines for services rendered by Gould’s. Medicare states that Gould’s is only able to bill the patient the amount that is listed in PT RESP ( patient responsibility) section on the explanation of benefits unless there is a secondary policy that covers and reimburses those charges. As Mr. [redacted] requested I have cancelled the sales order that was recently generated for new BIPAP supplies. At this time his total balance private pay due with Gould’s per Medicare is $267.81. There are no late fees associated with this balance due. Mr. [redacted] spoke with two employees from the Billing department at Gould’s that explained the reason for the private pay balances due. We understand the patient’s strong frustration with having to pay out of pocket for items that are covered by insurance but there are few insurance policies out there these days that do not have a deductible to meet before they begin to reimburse. All of the Medicare EOB’s associated with the balance due were faxed to the patient on 9/6/2016 at 3:21 pm as requested by Mr. [redacted]. I emailed Mr. [redacted] on 9/7/2016 detailing his account information and attached his Medicare EOB’s that reflect what Medicare deems is the patient responsibility. I also mailed these to the patient for his records. If any further information is required please feel free to contact me. Sincerely, [redacted] Billing Manager Goulds Discount Medical [redacted]