MedEx PSI Premier Specialties Inc

Complaint: ***
I am rejecting this response because:
The response from the business states that they submitted original documentation/claim to Care Improvement Plus I have not had that insurance since and the hospital and doctors office had the correct insurance information on file and all their bills were submitted to the correct insurance company I do not know where they received the CIP information but it took several months for that to be corrected which delayed the processing The company indicates in their response that the paperwork they submitted to Blue Cross included a Letter of Medical Necessity, yet they tell me they do not have this & were unable to provide it to me Therefore I called Dr***'s office and he wrote a letter weeks ago which I mailed to the appeals deptat Blue Cross weeks ago I spoke with Blue Cross today and they informed me that they have received the letter but it was not entered into their system until yesterday I spoke with a supervisor who tells me that reprocessing through the appeals process takes up to days Therefore I cannot submit any payment which I might owe them until that processing is complete They also state that they contacted TMG and received no reply I have no way to contact or speak with TMG as the company is not able to provide me with contact info for TMG, nor will Blue Cross I will pay the amount which is due following the appeal process once it is completed The company was very rude during my multiple phone conversations with them and I believe that this information needs to be reflected in the Revdex.com online account provided to the publicI am not one to ignore bills which are my responsibility But my hands are tied at this point by Blue Cross' extended need for time to resolve this issue
Regards,
*** ***

Complaint: ***
I am
rejecting this response because:
I am including the additional information needed: Jessica Sizer account number *** She is over How does she give permission to talk to me There is no contact with the company you can only leave a message which is not returned We have left her information on the messages also and she has not received any calls back If needed her phone number is ***-***
Regards,
*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to meThe business' response regarding the Letter of Medical Necessity and my request for a copy if it does not jive with the what I was told on three occasions when I called their office It is my word against theirs at this pointI appreciate the days Hopefully I will have a response from Blue Cross by then
Regards,
*** ***

faxed in responseDecember 07, 2015Revdex.com La Posada Drive Austin, TX 78752Re: Case # ***Thank you for the opportunity to respond to the complaint filed by Ms*** ***Ms*** *** received a CPM machine, which was prescribed by Dr*** ***Ms***
*** was presented with a Medical Express, PSI Patient Product Agreement and RXThis document outlines the specific product (s) prescribed by the physician, Letter of Medical Necessity (signed by the prescribing doctor), Patient Acknowledgement, Authorization to Assignment of Benefits, Waiver of Liability and Proof of Delivery to which Ms*** *** signed on January 9, 2015.Medical Express, PSI did receive medical insurance billing from the doctor's office to file a claim with the above mentioned patients insurance and a claim was filed with the insurance information that was sent over by the doctor's office, which was Care Improvement Plus, PSI was sent an EOB (Explanation of Benefits) from Care Improvement Plus on May 4, 2015, stating that the patient's plan was ineligible at time of service, PSI then called the prescribing doctor's office to see if they were able to provide updated insurance information and Dr***'s office told us that they patient has BCBS as her primary insuranceOn May 4, 2015, the claim was sent to BCBSOn June 12, 2015, PSI received an EOB from BCBS denying the claim for the CPM and a statement was sent to the patientOn June 17, 2015, the patient called to make sure that we had the correct insurance informationPSI sent in an appeal for Medical necessity, with all required paperwork on 07/08/and on 08/04/15, PSI received a letter from the patient DEC/07/2015/MON 12:PM FAX No, P003insurance, requesting that the appeal be sent to a company called TMG and the appeal information was sent the same day to TMGOn 09/04/15, the appeal was sent in again to TMG, since PSI has not received any feedback from the insurance companyOn 10/07/15, P5I received an FOB from the patients insurance, which denied the claim and put the balance towards patient's responsibility and as a courtesy to the patient, PSI wrote off $and a patient statement was mailed out 10/08/for the $balance.The patient called on 10/13/and 11/24/and PSI explained to the patient that all paperwork requested by BCBS had been sent in.Ms***'s account will remain open until payment is received$will remain the balance for the above mentioned product that was received, signed for, utilized and prescribed by her physician

PSI is not able to answer any questions with out a patient name and date of birth. Also if the patient is over 18, information can not be given to anyone besides the patient with out a verbal consent from the patient

Complaint: [redacted]
I am rejecting this response because: I am...

including the additional information needed:  Jessica Sizer account number [redacted]0.  She is over 18.  How does she give permission to talk to me.  There is no contact with the company you can only leave a message which is not returned.  We have left her information on the messages also and she has not received any calls back.  If needed her phone number is [redacted].
Regards,
[redacted]

Complaint: [redacted]
I am rejecting this response because:1.  The response from the business states that they submitted original documentation/claim to Care Improvement Plus.  I have not had that insurance since 2013 and the hospital and doctors office had the correct insurance information on file and all their bills were submitted to the correct insurance company.  I do not know where they received the CIP information but it took several months for that to be corrected which delayed the processing.2.  The company indicates in their response that the paperwork they submitted to Blue Cross included a Letter of Medical Necessity, yet they tell me they do not have this & were unable to provide it to me.  Therefore I called Dr. [redacted]'s office and he wrote a letter 3 weeks ago which I mailed to the appeals dept. at Blue Cross 2 weeks ago.3.  I spoke with Blue Cross today and they informed me that they have received the letter but it was not entered into their system until yesterday.  I spoke with a supervisor who tells me that reprocessing through the appeals process takes up to 60 days.  Therefore I cannot submit any payment which I might owe them until that processing is complete.4.  They also state that they contacted TMG and received no reply.  I have no way to contact or speak with TMG as the company is not able to provide me with contact info for TMG, nor will Blue Cross.5.  I will pay the amount which is due following the appeal process once it is completed.6.  The company was very rude during my multiple phone conversations with them and I believe that this information needs to be reflected in the Revdex.com online account provided to the public.I am not one to ignore bills which are my responsibility.  But my hands are tied at this point by Blue Cross' extended need for time to resolve this issue. 
Regards,
[redacted]

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.
The business' response regarding the Letter of Medical Necessity and my request for a copy if it does not jive with the what I was told on three occasions when I called their office.  It is my word against theirs at this point.I appreciate the 70 days.  Hopefully I will have a response from Blue Cross by then.
Regards,
[redacted]

PSI is not able to answer any questions with out a patient name and date of birth.
 Also if the patient is over 18, information can not be given to anyone besides the patient with out a verbal consent from the patient.

Re: Case [redacted] Thank you for the opportunity to respond. 1. The response from the business states that they submitted original documentation/claim to Care Improvement Plus. I have not had that insurance since 2013 and the hospital and doctor's office had the correct insurance information on file and all their bills were submitted to the correct Insurance company. I do not know where they received the CIP information but it took several months for that to be corrected which delayed the processing. ,91L aUent and insurance Informationwas rovicI from , [redacted]'s [redacted] when the prescription was sent to PSI, 2 The company indicates in their response that the paperwork they submitted to Blue Cross Included a Letter of Medical Necessity, yet they tell me they do not have this & were unable to provide It to me. Therefore I called Dr. [redacted]'s office and he wrote a letter 3 weeks ago which I mailed to the appeals dept. at Blue Cross 2 weeks ago_ -PSI has always had the letter ofrnedical necessity. The letter of Medical Necessity is a part of the  Patient Product Agreement and prescription that Dr. [redacted] signed, and thatrartha [redacted] signed as well. Ms. [redacted] was told on numerous gccasions that the letter of medical necessity and all required  paperwork had been sent. 3.     I spoke with Blue Cross today and they informed me that they have received the letter but it was not entered into their system until yesterday. I spoke with a supervisor who tells me that reprocessing through the appeals process takes up to 60 days. Therefore I cannot submit any payment which I might owe them until that processing is complete. -As a courtesy to the patient, PSI will place a hold on the account for 70 days. if payment is not received within 70 days, the account will be seat to cQllections. 4.     They also state that they contacted TMG and received no reply. I have no way to contact or speak with TMG as the company is not able to provide me with contact info for TMG, nor will Blue Cross. -PSI recety~d a letter requestingthat the apQ1 paperwork be sent to [redacted], SCRANTON, PA 18505. A phone number was not given. All aop al paperworkQpli w mailedto the address as requested.

faxed in response
December 07, 2015
Revdex.com 1005 La Posada Drive Austin, TX...

78752
Re: Case # [redacted]
Thank you for the opportunity to respond to the complaint filed by Ms. [redacted]. Ms. [redacted] received a CPM machine, which was prescribed by Dr. [redacted]. Ms. [redacted] was presented with a Medical Express, PSI Patient Product Agreement and RX. This document outlines the specific product (s) prescribed by the physician, Letter of Medical Necessity (signed by the prescribing doctor), Patient Acknowledgement, Authorization to Assignment of Benefits, Waiver of Liability and Proof of Delivery to which Ms. [redacted] signed on January 9, 2015.
Medical Express, PSI did receive medical insurance billing from the doctor's office to file a claim with the above mentioned patients insurance and a claim was filed with the insurance information that was sent over by the doctor's office, which was Care Improvement Plus, PSI was sent an EOB (Explanation of Benefits) from Care Improvement Plus on May 4, 2015, stating that the patient's plan was ineligible at time of service, PSI then called the prescribing doctor's office to see if they were able to provide updated insurance information and Dr. [redacted]'s office told us that they patient has BCBS as her primary insurance. On May 4, 2015, the claim was sent to BCBS. On June 12, 2015, PSI received an EOB from BCBS denying the claim for the CPM and a statement was sent to the patient. On June 17, 2015, the patient called to make sure that we had the correct insurance information. PSI sent in an appeal for Medical necessity, with all required paperwork on 07/08/15 and on 08/04/15, PSI received a letter from the patient

DEC/07/2015/MON 12:01 PM                    FAX No,                   P. 003
insurance, requesting that the appeal be sent to a company called TMG and the appeal information was sent the same day to TMG. On 09/04/15, the appeal was sent in again to TMG, since PSI has not received any feedback from the insurance company. On 10/07/15, P5I received an FOB from the patients insurance, which denied the claim and put the balance towards patient's responsibility and as a courtesy to the patient, PSI wrote off $195.22 and a patient statement was mailed out 10/08/15 for the $350.00 balance.
The patient called on 10/13/15 and 11/24/15 and PSI explained to the patient that all paperwork requested by BCBS had been sent in.
Ms. [redacted]'s account will remain open until payment is received. $350.00 will remain the balance for the above mentioned product that was received, signed for, utilized and prescribed by her physician.