King Drug & Home Care

Business Response to a Complaint Complaint ID#: [redacted] Company Name: King Drug & Home Care Company Contact: [redacted] Company Phone: [redacted] Company Email: [redacted] Person Who Sent the Complaint: [redacted] Staff Member: Response: The patient received equipment with us on January 27, and was insured by [redacted] Patient signed an orientation packet that states his Rights and Responsibilities which include his responsibility to notify us if his insurance ChangesHe was informed that his insurance would pay for months and would then require a follow up download of his CPAP machine showing compliance of at least consecutive days using 70% of the time over hoursHe did not respond to our requests for down loads or our callsWe received denials on his rental and mailed Mr [redacted] a letter on September 28, notifiying him that his insurance denied due to other coverageHe did not respond until we were able to obtain his coverage electronically and found that his new insurance required a Prior authorization to billSince we were not notified of the change, we were unable to Prior Authorize his unit and the supplies he requested and receivedWe called Anthem and they will not consider a retro authorizationWe have documentation that Mr [redacted] states he works in the industry of insurance and he said the insurance would retro authWe encouraged him to interject and contact his insurance on his behalfWe didn't receive a response therefore we discounted his large due bill to what his insurance what have paid and sent the amount in a due bill to the patientHe was notified that we bill on their behalf but ultimately coverage is the responsibility of the individualThe download we obtained from his physician shows that he does not meet the New insurance compliance requirements and therefore, months 5-claims would have been denied due to medical justification not metHe still has the equipment and is responsible for the claimWe worked with Mr [redacted] and have already significantly discounted his due billWe regret the situation but had he followed our internal grievance procedures lined out in his orientation manual, we may have avoided this misfortunate complaint to your officeSent on: 8/15/1:19:PM

Business Response to a Complaint Complaint ID#: [redacted] Company Name: King Drug & Home Care Company Contact: [redacted] Company Phone: [redacted] Company Email: [redacted] Person Who Sent the Complaint: [redacted] Staff Member: ...

Response: The patient received equipment with us on January 27, 2015 and was insured by [redacted]. Patient signed an orientation packet that states his Rights and Responsibilities which include his responsibility to notify us if his insurance Changes. He was informed that his insurance would pay for 3 months and would then require a follow up download of his CPAP machine showing compliance of at least 30 consecutive days using 70% of the time over 4 hours. He did not respond to our requests for down loads or our calls. We received denials on his rental and mailed Mr. [redacted] a letter on September 28, 2015 notifiying him that his insurance denied due to other coverage. He did not respond until we were able to obtain his coverage electronically and found that his new insurance required a Prior authorization to bill. Since we were not notified of the change, we were unable to Prior Authorize his unit and the supplies he requested and received. We called Anthem and they will not consider a retro authorization. We have documentation that Mr. [redacted] states he works in the industry of insurance and he said the insurance would retro auth. We encouraged him to interject and contact his insurance on his behalf. We didn't receive a response therefore we discounted his large due bill to what his insurance what have paid and sent the amount in a due bill to the patient. He was notified that we bill on their behalf but ultimately coverage is the responsibility of the individual. The download we obtained from his physician shows that he does not meet the New insurance compliance requirements and therefore, months 5-10 claims would have been denied due to medical justification not met. He still has the equipment and is responsible for the claim. We worked with Mr. [redacted] and have already significantly discounted his due bill. We regret the situation but had he followed our internal grievance procedures lined out in his orientation manual, we may have avoided this misfortunate complaint to your office. Sent on: 8/15/2016 1:19:10 PM

Business Response to a Complaint Complaint ID#: [redacted] Company Name: King Drug & Home Care Company Contact: [redacted] Company Phone: [redacted] Company Email: [redacted] Person Who Sent the Complaint: [redacted] Staff Member: ...

Response: The patient received equipment with us on January 27, 2015 and was insured by [redacted]. Patient signed an orientation packet that states his Rights and Responsibilities which include his responsibility to notify us if his insurance Changes. He was informed that his insurance would pay for 3 months and would then require a follow up download of his CPAP machine showing compliance of at least 30 consecutive days using 70% of the time over 4 hours. He did not respond to our requests for down loads or our calls. We received denials on his rental and mailed Mr. [redacted] a letter on September 28, 2015 notifiying him that his insurance denied due to other coverage. He did not respond until we were able to obtain his coverage electronically and found that his new insurance required a Prior authorization to bill. Since we were not notified of the change, we were unable to Prior Authorize his unit and the supplies he requested and received. We called Anthem and they will not consider a retro authorization. We have documentation that Mr. [redacted] states he works in the industry of insurance and he said the insurance would retro auth. We encouraged him to interject and contact his insurance on his behalf. We didn't receive a response therefore we discounted his large due bill to what his insurance what have paid and sent the amount in a due bill to the patient. He was notified that we bill on their behalf but ultimately coverage is the responsibility of the individual. The download we obtained from his physician shows that he does not meet the New insurance compliance requirements and therefore, months 5-10 claims would have been denied due to medical justification not met. He still has the equipment and is responsible for the claim. We worked with Mr. [redacted] and have already significantly discounted his due bill. We regret the situation but had he followed our internal grievance procedures lined out in his orientation manual, we may have avoided this misfortunate complaint to your office. Sent on: 8/15/2016 1:19:10 PM