New West Medical, Inc.

Review: New West Medical is Durable Medical Equipment vendor. November 22,2012 a right side gear box was delivered by their repairman and installed on my power wheelchair. New West required my up front payment of $566.03.This amount was charged to my VISA card. My Health Net Insurance paid New West Medical $479.03 on March 7,2013. Upon receipt of the Explanation of Benefits from my insurance which showed the payment to New West Medical, I requested a refund of the $479.03 from New West. I was told by the New West biller that a refund could not be issued directly to me but would be sent to my insurance company. My insurance has requested the refund from New West multiple times over the last FIVE MONTHS but New West Medical continue to keep the $479.03 which rightfully belongs to me.

Product_Or_Service: Gear box (right) for power wheelchair

Desired Settlement: DesiredSettlementID: Refund

A prompt refund to me of my $479.03 from New West Medical. There is absolutely no reason for them to refund my insurance company instead of me.

Business

Response:

Initial Business Response

This letter is in response to a complaint filed with the Revdex.com on 8/8/2013 by (Patient name excluded) The patient complaint pertains to the purchase of a gearbox that was replaced on her power mobility device on 11/22/2012.

It was understood by the patient, that the gearbox would not be covered by her primary insurance Noridian (Medicare) due to the purchase of a new wheelchair in 2011. The gearbox that was replaced was for her previous power mobility device that she received in 2006. Noridian will only pay for replacement parts and repairs on mobility devices that are on file. Since the patient received a new mobility device in 2011, Noridian would not replace parts on her previous chair that the patient uses as a back-up device. Patient's spouse signed an Advanced Beneficiary Notice (ABN) to this affect stating that she understood the gearbox would not be covered by Noridian and that she would need to fund the purchase of the gearbox privately. In addition the "GA" modifier was used on the claim submitted to Noridian indicating that a waiver of liability is on file with the provider (ABN).

The claim for the gearbox was submitted to Noridian on 2/7/2013. New West Medical received the Noridian denial on 2/15/2013. The claim was denied, as expected for "Non-Covered Service". This claim was forwarded electronically by Noridian to the patient's secondary insurance, Health Net. New West Medical did not ever send Health Net a claim assigned or unassigned. If a patients secondary insurance is on file, there is no reason for a provider to send a paper claim to a secondary insurance unless contacted by Noridian stating the claim was not crossed over electronically.

On 3/14/2013, New West Medical received payment remittance advice with a bulk check from Health Net. The bulk check was payment on various patient accounts. In this remittance advice and check was the payment made by Health Net for the patient's gearbox. Since the payment check was not only for the payment of the patient's gearbox but was also payment on other patient accounts, the check was deposited and it was noted that a refund was due to Health Net for paying New West Medical money that was to be paid to the patient.

The patient contacted New West Medical on multiple occasions inquiring on when New West was to send her the refund for the gearbox. It was explained to the patient multiple times that New West was not able to refund her directly. The reason New West was not able to refund her directly was

Because the monies paid on the claim were from Health Net to New West Medical, and not to the patient. New West Medical can only refund monies paid to them from the person or entity that paid it to New West Medical. A refund check was sent via paper mail to Health Net on 6/7/2013.

On 9/5/2013, I, Lindsey S. contacted Health Net to ensure the refund check was received and cashed by them. I spoke with Representative [redacted] who researched my request. He confirmed that the refund check was received on 6/13/2013 and was cashed by Health Net on 6/22/2013. He also explained that the subscriber, (The patient), had contacted Health Net one week prior to 9/5/2013 inquiring on her refund from them, at that point it was explained to the patient that the refund from New West Medical had been received by Health Net and that her refund from Health Net would be "escalated" and that The patient should receive her refund from Health Net within 7-10 business days. Reference number for this telephone conversation is: IXXXXXXX.

It is asked that the Revdex.com look very closely at this complaint. It is felt that New West Medical was not negligent in any practices nor was New West attempting to keep monies owed to this patient

In reviewing this complaint please keep the following in mind:

* New West Medical did not ever directly send a secondary claim to this patient's secondary insurance Health Net. The claim was crossed over electronically to Health Net.

* It was explained to the patient on many occasions that New West Medical would not be able to refund Health Nets payment directly to her.

* Health Net received and cashed New West's refund check in June 2013. At that point, the patient receiving a refund from Health Net was her responsibility to pursue.

Thank you for taking the time to read this response. It is anticipated that this complaint will be handled fairly and in a timely manner, and that all parties involved will be satisfied with the outcome.

We also would like to supply supporting documentation, within the limits of HIPPA requirements. However, I see no option for uploading documents.

Sincerely,

[redacted], CEO

Prepared by:

New West Medical, Inc, Billing Department

Final Consumer Response

Hello,

I finally received a long awaited refund check from Health Net Insurance last Thursday 9/26.

Health Net received the refunded payment from New West Medical Aug 18 ( made to them in error Mar 7,2013) after a formal refund request from Health Net was generated June 22,2013 plus the inquiry from your Bureau in August. I seriously doubt they would have ever refunded that money had the Revdex.com not become involved.

Thank you!