In response to the letter we received dated December 11, 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 processedThe insurance billing rate is based on our contract with [redacted] Since *** [redacted] would not provide a "Pre-authorization” our policy is to collect retail from the patient prior to placing the order for the equipmentOnce 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 paidOn 8/15/we requested pre-authorization from the patient's primary and secondary insurances, [redacted] and Medi-Cal respectivelyOn 8/16/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 claimOn 8/25/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/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 discussWe 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 submittedShe stated she would discuss it with the patient and they would decide how they wanted to proceedOn 9/7/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 herPer our AR department, as of today the insurance has provided us with an EOB addressing of the items billed and payment for 13/The EOB also showed that the patient has a co-insurance of 30% which they deducted from the reimbursement rate for each itemWe 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 remaining itemsThe 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 billingWe hope by means of this correspondence we have addressed the issue and provided you and the customer with a satisfactory explanation/resolutionSincerely,Mobility Professionals, Inc
In response to the letter we received dated December 11, 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 processedThe insurance billing rate is based on our contract with [redacted] Since *** [redacted] would not provide a "Pre-authorization” our policy is to collect retail from the patient prior to placing the order for the equipmentOnce 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 paidOn 8/15/we requested pre-authorization from the patient's primary and secondary insurances, [redacted] and Medi-Cal respectivelyOn 8/16/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 claimOn 8/25/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/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 discussWe 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 submittedShe stated she would discuss it with the patient and they would decide how they wanted to proceedOn 9/7/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 herPer our AR department, as of today the insurance has provided us with an EOB addressing of the items billed and payment for 13/The EOB also showed that the patient has a co-insurance of 30% which they deducted from the reimbursement rate for each itemWe 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 remaining itemsThe 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 billingWe hope by means of this correspondence we have addressed the issue and provided you and the customer with a satisfactory explanation/resolutionSincerely,Mobility Professionals, Inc