RE: Complaint# [redacted] Dear Sir or Madame:After researching our files we cannot find a client by the name of [redacted] Possibly we can locate the client by their account number if the would provide thatHowever, universally all of our clients do have access to their files and copies of documents that we have within them upon written requestIf it is an active file we have days to produce the requested documents and closed files we have days to produce requested documentsthere is a copying charge for the documents the client receives and the client is asked to sign a release of PHI upon receiving their requested documentationHope this helpsIf more specific information is needed an account number will be required so we can locate the specific clientCordially, [redacted] ***Administrative Office Manager
[redacted] ***RE: Complaint# [redacted] Customer: [redacted] Complainant: [redacted] Dear Sir or Madame:I am responding to the above referenced complaint regarding transactions related to aprescribed medical deviceI would like to annotate that the complainant is apparently thespouse of the client and not the customer that we conducted business withThecomplainant was not present during the transaction period.I would first like to thank the patient for their payment that satisfies their financialobligation to the transaction that was conducted on 07-05-Now I would like toexplain how the transaction was conducted and the process by which the claim was filedand why the client was sent a bill of financial obligation.>The patient was delivered a prescribed medical deviceAt the point of delivery theclient was presented a Delivery Ticket that outlines precisely the item being received andhow much the item is along with acimowledgement that of their financial responsibilities.The patient signs the document and receive of copy of it for their records.>The patient also is given a Consent to Treat document that outlines our responsibilityfor delivery’ and billing of their specific deviceIt also specifically outlines our billingprocess and collections processThe patient signs the document and receives a copy of itfor their records.>The patient is given a Waiver of Liability’ that specifically outlines their potentialobligation if their insurance carrier does not provide payment for the device that they arereceivingIt list the specific item and the cost incurredThe patient signs the documentand receives a copy of it for their records.>The patient is given a Customer Satisfaction Survey at the end of our time with them sothey are given an opportunity to respond to our performance with them while we areproviding servicesThere are questions relating to the appointment, the quality of theequipment, the instructions that they received in correlation to their equipment, ourtechnicians helpfulness and courteousness, financial responsibilities being explained,after hour call policies explained, would they recommend our company to others and bowthey would rate our overall complete serviceThere are response options that rangefrom Poor to ExcellentThe client answered all questions EXCELLENTThe clientsigns the document and it becomes a part of their ifie at our location.page 2RE: Complaint # [redacted] Customer: [redacted] Complainant: [redacted] This demonstrates the thoroughness that we provide to EVERY client that allows them touse their device properly, understand their financial obligations, and have an opportunityto discuss concerns, or refuse services if they so wish.After we deliver services then paperwork is processed through our office for billing to theinsurance carrierWhether its TriCare or any and all other insurance carriers, Theprocess is conducted the same, this process is outlined and mandated through theinsurance carrier industry.We then filed the claim to the clients insurance carrier with all the supporting documentsof the Certificate of Medical Necessity and the authorization that we received at the timeof the referralThe claim was processed and denied because the device that the client hasreceived is no longer a covered benefit per the insurance coverage allowanceWhen aclaim is denied for being a non covered benefit that leaves the claim in a state of notbeing able to be appealedSince we have a Waiver of Liability signed at the time ofdelivery- that explained the clients possible financial responsibility in the case of a denialof the claim, we sent the client a statement of $75.00.When the client called to inquire about the statement she was relayed the informationwithin her file in a polite and courteous mannerShe spoke with our Senior OfficeAssistantI was present in the room during the call and everything was conducted withthe utmost respect and patienceNo THREATS were ever made and we never makeany assumptions to a person ability to pay or not to payComments made regardingthese issues from the complainant are unfounded and not accurateComplainant statedthat our customer service was horrible, but our Customer Satisfaction Survey reflects allExcellent ServiceThe complainant also stated that we should figure out what ourcontract statesWell we have be contracted with his specific insurance carrier for 18yearsOur contract states that we must bill every client their balance owed and are notallowed to “write off’ anything, because that is considered an inducement which isagainst the law, We also have a letter from the insurance carrier dated 08-01-thatspecifically states the item the client received is not covered, therefore allowing us to billthe client since we have a signed Waiver of Liability on file at the time of delivery.I am regretful that the complainant feels that he should not have had to pay, but hisinsurance carrier determines the outcome of every claim submitted.I would like to specifically address the comments on the desired settlement from thecomplainant:>We do not conduct shady business practicesEverything is very detailed in explanationas well as written so that the client is completely informed at the time of transaction.>We do provide excellent customer serviceThis is even documented by the clientreceiving the services,page 3RE: CompIaint [redacted] Customer [redacted] Coniplainant: [redacted] > We are completely aware of what our contract requirements with the insurance carrierare and are followed exactly as outlinedWe have been a contracted provider for 18years.>We do not have the client to sign one document that covers everythingThere areactually required signatures(Delivery Ticket, Consent to Treat, Waiver of Liability)Voluntary signature on the Customer Satisfaction Survey.> We cannot refund the $that has been paid toward the balance of the accountThe$is for the medical device that was received by the client since the insurance carrierhas stated that the device is a non covered benefit and is not payable under the terms oftheir contract with the client.I hope that this clears up any misunderstanding between the client and our company.Unfortunately when dealing with insurance claims many times things are not paid orcovered as the clients think they will be.Respectfully, [redacted] ***Administrative Office Manager [redacted] ***Local( [redacted] — Toll Free ( [redacted] FAX ( [redacted]
RE: Complaint# [redacted] Dear Sir or Madame:After researching our files we cannot find a client by the name of [redacted] Possibly we can locate the client by their account number if the would provide thatHowever, universally all of our clients do have access to their files and copies of documents that we have within them upon written requestIf it is an active file we have days to produce the requested documents and closed files we have days to produce requested documentsthere is a copying charge for the documents the client receives and the client is asked to sign a release of PHI upon receiving their requested documentationHope this helpsIf more specific information is needed an account number will be required so we can locate the specific clientCordially, [redacted] ***Administrative Office Manager
[redacted] ***RE: Complaint# [redacted] Customer: [redacted] Complainant: [redacted] Dear Sir or Madame:I am responding to the above referenced complaint regarding transactions related to aprescribed medical deviceI would like to annotate that the complainant is apparently thespouse of the client and not the customer that we conducted business withThecomplainant was not present during the transaction period.I would first like to thank the patient for their payment that satisfies their financialobligation to the transaction that was conducted on 07-05-Now I would like toexplain how the transaction was conducted and the process by which the claim was filedand why the client was sent a bill of financial obligation.>The patient was delivered a prescribed medical deviceAt the point of delivery theclient was presented a Delivery Ticket that outlines precisely the item being received andhow much the item is along with acimowledgement that of their financial responsibilities.The patient signs the document and receive of copy of it for their records.>The patient also is given a Consent to Treat document that outlines our responsibilityfor delivery’ and billing of their specific deviceIt also specifically outlines our billingprocess and collections processThe patient signs the document and receives a copy of itfor their records.>The patient is given a Waiver of Liability’ that specifically outlines their potentialobligation if their insurance carrier does not provide payment for the device that they arereceivingIt list the specific item and the cost incurredThe patient signs the documentand receives a copy of it for their records.>The patient is given a Customer Satisfaction Survey at the end of our time with them sothey are given an opportunity to respond to our performance with them while we areproviding servicesThere are questions relating to the appointment, the quality of theequipment, the instructions that they received in correlation to their equipment, ourtechnicians helpfulness and courteousness, financial responsibilities being explained,after hour call policies explained, would they recommend our company to others and bowthey would rate our overall complete serviceThere are response options that rangefrom Poor to ExcellentThe client answered all questions EXCELLENTThe clientsigns the document and it becomes a part of their ifie at our location.page 2RE: Complaint # [redacted] Customer: [redacted] Complainant: [redacted] This demonstrates the thoroughness that we provide to EVERY client that allows them touse their device properly, understand their financial obligations, and have an opportunityto discuss concerns, or refuse services if they so wish.After we deliver services then paperwork is processed through our office for billing to theinsurance carrierWhether its TriCare or any and all other insurance carriers, Theprocess is conducted the same, this process is outlined and mandated through theinsurance carrier industry.We then filed the claim to the clients insurance carrier with all the supporting documentsof the Certificate of Medical Necessity and the authorization that we received at the timeof the referralThe claim was processed and denied because the device that the client hasreceived is no longer a covered benefit per the insurance coverage allowanceWhen aclaim is denied for being a non covered benefit that leaves the claim in a state of notbeing able to be appealedSince we have a Waiver of Liability signed at the time ofdelivery- that explained the clients possible financial responsibility in the case of a denialof the claim, we sent the client a statement of $75.00.When the client called to inquire about the statement she was relayed the informationwithin her file in a polite and courteous mannerShe spoke with our Senior OfficeAssistantI was present in the room during the call and everything was conducted withthe utmost respect and patienceNo THREATS were ever made and we never makeany assumptions to a person ability to pay or not to payComments made regardingthese issues from the complainant are unfounded and not accurateComplainant statedthat our customer service was horrible, but our Customer Satisfaction Survey reflects allExcellent ServiceThe complainant also stated that we should figure out what ourcontract statesWell we have be contracted with his specific insurance carrier for 18yearsOur contract states that we must bill every client their balance owed and are notallowed to “write off’ anything, because that is considered an inducement which isagainst the law, We also have a letter from the insurance carrier dated 08-01-thatspecifically states the item the client received is not covered, therefore allowing us to billthe client since we have a signed Waiver of Liability on file at the time of delivery.I am regretful that the complainant feels that he should not have had to pay, but hisinsurance carrier determines the outcome of every claim submitted.I would like to specifically address the comments on the desired settlement from thecomplainant:>We do not conduct shady business practicesEverything is very detailed in explanationas well as written so that the client is completely informed at the time of transaction.>We do provide excellent customer serviceThis is even documented by the clientreceiving the services,page 3RE: CompIaint [redacted] Customer [redacted] Coniplainant: [redacted] > We are completely aware of what our contract requirements with the insurance carrierare and are followed exactly as outlinedWe have been a contracted provider for 18years.>We do not have the client to sign one document that covers everythingThere areactually required signatures(Delivery Ticket, Consent to Treat, Waiver of Liability)Voluntary signature on the Customer Satisfaction Survey.> We cannot refund the $that has been paid toward the balance of the accountThe$is for the medical device that was received by the client since the insurance carrierhas stated that the device is a non covered benefit and is not payable under the terms oftheir contract with the client.I hope that this clears up any misunderstanding between the client and our company.Unfortunately when dealing with insurance claims many times things are not paid orcovered as the clients think they will be.Respectfully, [redacted] ***Administrative Office Manager [redacted] ***Local( [redacted] — Toll Free ( [redacted] FAX ( [redacted]