Initial Business Response /* (1000, 5, 2017/07/11) */
Re: Case # XXXXXXXX
To whom it may concern:
On July 9, 2017 I received a letter from the Revdex.com notifying me of a complaint with case # XXXXXXXX. I believe there may be some confusion regarding the paper work this patient...
is reviewing, It appears she is looking at the Financial Agreement form from when she received her prosthesis in July 2016.
On this form, the first line labeled "Professional Fee" is the TOTAL cost of the prosthesis which is the total amount we submitted to the inSuranee company for review, Line 1 of the patient's form reads [redacted] This amount is and was not duo from the patient. This is our initial fee.
Line two of this agreement labeled "Less Estimated Insurance' is the amount Prevail estimated the insurance company would pay, out of the [redacted] total charge. Line 2 of her form reads [redacted] This amount is and was not due from the patient. It was due from the insurance company.
Line three, labeled "El stmated Responsible Party Portion" is the amount we estimated thepatielit would QW0 for her prosthesis. This is the amount we told her she owed, and also the amount that she paid on the day she received her prosthesis. In this case, line 3 read [redacted]
Line four labeled "Less Initial Payn-icnt" is the amount we collected from the patient up front. Which was the full [redacted] on the patient's form.
Line five labeled "Balance" indicates any balance due from the patient. On the form it reads "0" as she had already paid in full_
We do provide all eour patients with quotes prior to making any device. However, we cannot provide a quote until the patient is seen by one of our practitioners as there are several options for prostheses and we need to know what kind of prosthesis the patient is receiving before we can provide the quote.
This patient was seen on July 15, 2016 for a no charge evaluation_ After seeing her and finding out what kind of prosthesis she was going to be receiving, we provded her with. a written quote of [redacted] that she signed off on at her next appointment on July 20, 2016 (5 days following her initial, evaluation) and she then informed us she wanted to proceed. I think the confusion may be coming into play from her appointment on July 29, 2016, because this is the day she received bar prosthesis and also the date we collected payment of [redacted] and provided her with the financial agreement form (explained above),
Since we talked WI her about money on July 20, 2016 (when we quoted the [redacted] and also talked to her about the financial agreement on July 29, 2016, it may have appeared we were asking for money from her on both dates. This is not the case. We asked for payment on July 29, 2016 when we collected the estimated [redacted] Nothing further is due from her. That is also the only payment we have collected from her it was not our intention to indicate to the patient that we would be collecting the [redacted] or the [redacted] from her and I apologize for the confusion.
Please note that following insurance processing of the [redacted] her insurance company ended. up only applying [redacted] as the patient's cost. We received the notice from the insurance carrier on 8/22/2016 and sent the patient a refund of [redacted] the next day, on 8/23/2016, check # XXXXX.
If she is filing this complaint in conjunction with her 2017 date of service and charges, the patient was seen en February 17, 2017 where we provided her with a quote for a new socket en the same day. The patient was quoted [redacted] She asked us to put the prosthesis on hold at that time as she was having difficulty coming up with that amount, Understanding the cost of prostheses management can get expensive, we offered her a discount of [redacted] and told her we would charge her an even [redacted] She wanted to still think about it. We've left her a few messages asking if she had made a decision on whether she wanted to move forward with the replacement, but we have not heard back from her. Nothing has been made for her and no money has been collected for 2017.
Regarding the refund. of the prosthesis and the amount of sockets, when a patient is a new amputee, it is customary to assume there will be two check sockets and one final socket per prosthesis. The reason for the two cheek sockets is because throughout the first year or so after an amputation, the patient's residual lirrib (the section that was not amputated) will be continually changing shape and volume as the limb gets accustomed to using new muscles and healing. The check sockets are made of a clear material that is fit to the patient's residual limb and allows us to see if thete are problem areas. It's customary to make 2 check sockets, which we did. Then we made the final socket that was molded after getting the check sockets to fit, which was delivered on July 29, 2016 when we billed the items to Medicare, While it is true that we made 4 sockets for her, because her limb shape kept changing from the healing process, we only billed Medicare for I final socket and the two check sockets. Patients do bot leave out office with the check socketS. The check sockets are used to make the final socket, I believe the patient thinks we billed Medicare every time we remade the sockets, however we did those remakes free of charge.
Again, given that is very common and expected that a new amputee's residual limb will change shape throughout their first year post amputation, and we remade three final sockets at no charge, we will not be issuing a refund to Medicare as we are justified in our charges. We started her off with a temporary prosthesis because we knew she had volume change issues and diabetes which could cause changes to the residual limb. She had several follow-up visits with us because of these changes, and in 2017 our practitioner felt that her limb had fluctuated enough that there would minimal volume change going forward so we were going to move her into a definitive socket (essentially taking her from a temporary leg to a final leg). This is when [redacted], her practitioner, made the suggestion of making another socket for her, which would be a more permanent solution for her, and likely why SRT was able to get a proper fit since her limb was done fluctuating, And as a result, we will not be issuing a refund to Medicare,
Initial Business Response /* (1000, 5, 2017/07/11) */
Re: Case # XXXXXXXX
To whom it may concern:
On July 9, 2017 I received a letter from the Revdex.com notifying me of a complaint with case # XXXXXXXX. I believe there may be some confusion regarding the paper work this patient...
is reviewing, It appears she is looking at the Financial Agreement form from when she received her prosthesis in July 2016.
On this form, the first line labeled "Professional Fee" is the TOTAL cost of the prosthesis which is the total amount we submitted to the inSuranee company for review, Line 1 of the patient's form reads [redacted] This amount is and was not duo from the patient. This is our initial fee.
Line two of this agreement labeled "Less Estimated Insurance' is the amount Prevail estimated the insurance company would pay, out of the [redacted] total charge. Line 2 of her form reads [redacted] This amount is and was not due from the patient. It was due from the insurance company.
Line three, labeled "El stmated Responsible Party Portion" is the amount we estimated thepatielit would QW0 for her prosthesis. This is the amount we told her she owed, and also the amount that she paid on the day she received her prosthesis. In this case, line 3 read [redacted]
Line four labeled "Less Initial Payn-icnt" is the amount we collected from the patient up front. Which was the full [redacted] on the patient's form.
Line five labeled "Balance" indicates any balance due from the patient. On the form it reads "0" as she had already paid in full_
We do provide all eour patients with quotes prior to making any device. However, we cannot provide a quote until the patient is seen by one of our practitioners as there are several options for prostheses and we need to know what kind of prosthesis the patient is receiving before we can provide the quote.
This patient was seen on July 15, 2016 for a no charge evaluation_ After seeing her and finding out what kind of prosthesis she was going to be receiving, we provded her with. a written quote of [redacted] that she signed off on at her next appointment on July 20, 2016 (5 days following her initial, evaluation) and she then informed us she wanted to proceed. I think the confusion may be coming into play from her appointment on July 29, 2016, because this is the day she received bar prosthesis and also the date we collected payment of [redacted] and provided her with the financial agreement form (explained above),
Since we talked WI her about money on July 20, 2016 (when we quoted the [redacted] and also talked to her about the financial agreement on July 29, 2016, it may have appeared we were asking for money from her on both dates. This is not the case. We asked for payment on July 29, 2016 when we collected the estimated [redacted] Nothing further is due from her. That is also the only payment we have collected from her it was not our intention to indicate to the patient that we would be collecting the [redacted] or the [redacted] from her and I apologize for the confusion.
Please note that following insurance processing of the [redacted] her insurance company ended. up only applying [redacted] as the patient's cost. We received the notice from the insurance carrier on 8/22/2016 and sent the patient a refund of [redacted] the next day, on 8/23/2016, check # XXXXX.
If she is filing this complaint in conjunction with her 2017 date of service and charges, the patient was seen en February 17, 2017 where we provided her with a quote for a new socket en the same day. The patient was quoted [redacted] She asked us to put the prosthesis on hold at that time as she was having difficulty coming up with that amount, Understanding the cost of prostheses management can get expensive, we offered her a discount of [redacted] and told her we would charge her an even [redacted] She wanted to still think about it. We've left her a few messages asking if she had made a decision on whether she wanted to move forward with the replacement, but we have not heard back from her. Nothing has been made for her and no money has been collected for 2017.
Regarding the refund. of the prosthesis and the amount of sockets, when a patient is a new amputee, it is customary to assume there will be two check sockets and one final socket per prosthesis. The reason for the two cheek sockets is because throughout the first year or so after an amputation, the patient's residual lirrib (the section that was not amputated) will be continually changing shape and volume as the limb gets accustomed to using new muscles and healing. The check sockets are made of a clear material that is fit to the patient's residual limb and allows us to see if thete are problem areas. It's customary to make 2 check sockets, which we did. Then we made the final socket that was molded after getting the check sockets to fit, which was delivered on July 29, 2016 when we billed the items to Medicare, While it is true that we made 4 sockets for her, because her limb shape kept changing from the healing process, we only billed Medicare for I final socket and the two check sockets. Patients do bot leave out office with the check socketS. The check sockets are used to make the final socket, I believe the patient thinks we billed Medicare every time we remade the sockets, however we did those remakes free of charge.
Again, given that is very common and expected that a new amputee's residual limb will change shape throughout their first year post amputation, and we remade three final sockets at no charge, we will not be issuing a refund to Medicare as we are justified in our charges. We started her off with a temporary prosthesis because we knew she had volume change issues and diabetes which could cause changes to the residual limb. She had several follow-up visits with us because of these changes, and in 2017 our practitioner felt that her limb had fluctuated enough that there would minimal volume change going forward so we were going to move her into a definitive socket (essentially taking her from a temporary leg to a final leg). This is when [redacted], her practitioner, made the suggestion of making another socket for her, which would be a more permanent solution for her, and likely why SRT was able to get a proper fit since her limb was done fluctuating, And as a result, we will not be issuing a refund to Medicare,