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Mobility Professional Inc

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In response to the letter we received dated December 11, 2017 we would like to provide a clear understanding of how the order for the manual wheelchair (MWC) as identified in the above referenced dispute was processed. The insurance billing rate is based on our contract with [redacted]. Since [redacted]...

[redacted] would not provide a "Pre-authorization” our policy is to collect retail from the patient prior to placing the order for the equipment. Once we complete the delivery to the patient, we courtesy bill the insurance unassigned and any reimbursement that we receive is forwarded back to the patient up to the amount they paid. On 8/15/2017 we requested pre-authorization from the patient's primary and secondary insurances, [redacted] and Medi-Cal respectively. On 8/16/2017 wewere notified by the primary insurance, [redacted], that the codes that were submitted did not require pre-authorization and a determination of coverage would be decided at the point of claim. On 8/25/2017 we were notified by Medi the request was denied with the rationale stating the following: "for back up use, this complex MWC not substantiated pt received a complex pwc thru other provider".On 8/25/2017 we called and left a message for the patient's mother explaining both determinations received by the insurances and requested she contact me to further discuss. We followed up with an email to the patient explaining the determinations.Later that day we received a call from the patient's mother stating that her insurance was a "self-funded" plan and she wasn't concerned that the primarywouldn't pay as submitted. She stated she would discuss it with the patient and they would decide how they wanted to proceed. On 9/7/2017 we received a call from the patient stating that she wanted to proceedwith the order and was willing to pay retail up front and we would courtesy bill [redacted] unassigned and any money reimbursed would be forwarded back to her. Per our AR department, as of today the insurance has provided us with an EOB addressing 14 of the 18 items billed and payment for 13/18. The EOB also showed that the patient has a co-insurance of 30% which they deducted from the reimbursement rate for each item. We are currently processing the reimbursement, thus far received, back to the patient and will finalize once [redacted] provides us with an EOB/payment for the 4 remaining items. The entire team at Mobility Professionals works diligently to provide optimum customer service during the processing of each custom rehab equipment order we receive, from intake to final billing. We hope by means of this correspondence we have addressed the issue and provided you and the customer with a satisfactory explanation/resolution. Sincerely,Mobility Professionals, Inc.

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Address: 12 Rancho Cir, Lake Forest, California, United States, 92630

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