Home Medical Products and Services, LLC

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Home Medical Products & Services set up this equipment on 3/18/2015. On the signed work order is the charges for the monthly rental of the equipment and the charges for the purchase of the ResMed tubing and ResMed filters. Home Medical Products & Services can not send a
claim to an insurance company without a signed and dated Certificate of Medical Necessity (CMN) from the ordering physician. We received the CMN signed and dated on 5/12/2015. Home Medical Products & Services processed this claim to be sent to Security Health on 5/20/2015. Home Medical Products & Services works with the insurance company and the physician to ensure that the qualifications required are met so that the patient qualifies for the equipment they are receiving. Home Medical Products & Services does not have information on the deductibles for each patient. Security Health processed the claim on 5/27/and on 6/30/they sent an Explanation of Benefits (EOB) to both Home Medical and to the patient (with most insurance companies patients have the option of receiving the EOB via mail, email, or logging into a website so the date received or seen by a patient would vary depending on their selection). On the EOB each charge is listed, each allowed amount is listed, who is responsible, and the reason for the decision. This EOB states it is the patients responsibility because it is part of her deductible.Medical facilities vary with when statements are sent to patients. When billing an insurance, medical facilities typically have a set number of days (either contracted with an insurance or a facilities own policy) to allow a claim to be processed before a statement will be sent to a patient. This timeframe is typically anywhere from 30-days. Home Medical Products & Services does not send statements to patients on equipment that qualifies through their insurance until the claim has been fully processed.For equipment and supplies that are billed through an insurance prices are already negotiated and/or contracted. For this equipment there is an allowed rental amount which is given for the first months and then that allowed amount is reduced by 25% thereafter.If there are further questions or concerns I will be happy to address them.Thanks*** ***Regional SupervisorHome Medical Products & Services

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.[To assist us in bringing this matter to a close, we would like to know your view on the matter.]Home Medical in their response to my complaint says that on 6/30/they sent an explanation of charges to me the patient or that my insurance sent an explanation of charges. I received absolutely nothing from Home Medical or my Insurance until August 10th, when I received the 1st statement from Home MedicalHome Medical in their response said that typically insurance claims and billing occurs - days after service. I received absolutely nothing until days after my initial visit on March 18thThis delay in billing is excessive!The problem is Home Medicals policy of NOT sending monthly statements regardless of whether insurance has been settled. By not sending monthly statements, charges build up and the patient is kept in the dark. There are a lot less expensive options for medical equipment that I would have taken advantage of months earlier if I had know these charges were building up and it was unclear what my insurance was paying for. I do not want to pay for the equipment after the 1st days. If I had received monthly statements I would have ended service after days and gone with the less expensive options, which I now have done
Regards,
*** ***

Complaint ID: ***
To Whom It May Concern,
Our company abides by Medicare's guidelines and regulations; therefore since the wheelchair for Ms*** was ordered by her doctor, and the wheelchair was received by Ms***, we are under obligation to Medicare to bill for that chair
As far as someone from our company telling Ms*** that the wheelchair was hers to keep and that she owned it, the document that she signed indicates otherwise. Our employees are trained to explain that rental agreement to our customers. For your convenience, I have again attached the agreement signed and dated by Ms*** on 8/3/2011, and she was also given a copy. This explains the rent-to-purchase process that began on 8/3/2011. After the rental period of months, the chair would have been hers to keep
Regarding any copays/deductibles mentioned in Mr***'s response - that is between Ms*** and her insurance company. We are legally bound to bill for copays and deductibles as outlined in the Explanation Of Benefits sent to us by insurance companies
As I stated in my previous response, at any time during the rental period, if Ms*** expressed to us that she no longer needed the wheelchair, we would have gladly picked it up
Thanks,
*** *Billing Manager

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
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]Evasive response. This statement from HMS does not say that the calls will stop, merely that they (HMS) no longer uses Resmed resupply service, so this will no longer be an issue......for whom? Them?Since this reads as if they are claiming that they are not responsible for the calls directly, but instead supplied my info to Resmed for their call list, I want to know if my name has been removed from the call list and I will no longer be receiving calls.
Regards,
Scott ***

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Home Medical Products & Services received an rx brought in by the patients daughter on 6/8/15.  The rx was signed and dated by Dr [redacted].  Medicare has specific criteria in order for oxygen to be covered in the home, one of which is a qualifying O2 saturation level.  O2...

saturation levels must be at 88% or below while at rest OR if above 88% at rest and they drop below that level when a patient is walking then there must be 3 different tests. 1 at rest (showing normal levels), 1 while walking (showing a drop in O2 levels to 88% or lower), and 1 while walking with oxygen that shows improvement (O2 saturation levels improve to above 88% while wearing oxygen).  Home Medical did not have the results of any of those tests in order for Medicare to cover the oxygen.  On 6/10/15 we received notes from the Main Street Clinic that showed 2 separate tests after walking.  These tests alone did not qualify the patient based on Medicares criteria.  On 6/18/15 we received (via fax) a hand written addended note from the Main Street Clinic signed by Dr [redacted] stating that the original test was documented incorrectly and that the patient tested at 87% on room air while at rest which would have qualified her for the oxygen.  After that time the saturation levels did qualify the patient for home oxygen per insurance guidelines and the daughter came in and picked up the equipment.Home Medical Products & Services does regret and apologizes that the patient had to wait to receive her home oxygen due to insurance guidelines because we strive to work with all of our referral sources in order to set up oxygen on a timely basis (same day in most instances) for all patients.  Since 2013 Medicare has had much more stringent regulations to follow in order for all equipment to be covered and they send regular updates on documentation requirements to doctors, clinics, and hospitals with Dear Physician letters.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]Home Medical in their response to my complaint says that on 6/30/2015 they sent an explanation of charges to me the patient or that my insurance sent an explanation of charges.  I received absolutely nothing from Home Medical or my Insurance until August 10th, when I received the 1st statement from Home Medical. Home Medical in their response said that typically insurance claims and billing occurs 30 - 90 days after service.  I received absolutely nothing until 146 days after my initial visit on March 18th. This delay in billing is excessive!The problem is Home Medicals policy of NOT sending monthly statements regardless of whether insurance has been settled.  By not sending monthly statements, charges build up and the patient is kept in the dark.  There are a lot less expensive options for medical equipment that I would have taken advantage of months earlier if I had know these charges were building up and it was unclear what my insurance was paying for.  I do not want to pay for the equipment after the 1st 90 days.  If I had received monthly statements I would have ended service after 90 days and gone with the less expensive options, which I now have done.
Regards,
[redacted]

Revdex.com:
font-family: Georgia;">I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
I appreciate the response but it does not cover the main concern which is that she was discharged with a wheel chair she did not need. I was called to pick up the wheel chair that she did not need because it was 'hers'- she 'owned' it.
Jewel is not an insurance company and does not have the money to pay for a 'rental' that sat in the garage. There was no agreement on a deductible and she has no recollection of the insurance companies switching coverage...
But, again, the issue is really that she was told the chair was hers to keep, and told to have someone pick it up, (even though she did not need it), and they are now claiming that it was never hers to keep. It's probably very confusing, but since she never needed it or used it after discharge, the 'rental' fees should be forfeited. The company has their chair and let's just move on.
Regards,
[redacted]

Home Medical Products no longer has the ResMed Resupply service so it will no longer be an issue.

**SEE ATTACHED DOCUMENT**

[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. 
Regards,
Scott [redacted]