Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***
I apologize I have not met your expectations. The Director of Credit and Collections is now reviewing this case. Can you please provide a telephone number you may be contacted at to discuss this in more detail?
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it. If you and the business have reached an agreement and compliance is set for a future date, we trust the business will comply. Please contact us after that time if the matter is not resolved as agreed and we will review the complaint and proceed accordingly.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that their proposed resolution is satisfactory to me. Thank you.The information they require is as follows: Patient name: [redacted] Account Number: [redacted]
Regards,
[redacted]
[redacted],
Thank you for bringing this to our attention. We will gladly adjust off the $25.00 [redacted] fee on your mother's account and provide the credit for the returned medication.
However, we do not have your mother's name or account number to complete the process. Please...
provide same so we can reconcile this matter.
Thank you,
Holly V[redacted]
We had sent in the application to Omin care for my brother in law [redacted] and were told he was denied due to he was not eligible for medicare or medicaid. I had attached a copy of the application that they said the did not receive and a copy of the original notice telling them who at Omni care we spoke to and they said they had the application and it was denied. The last message here I received was from Omni care stated they have the application I attached through Revdex.com and they would get back to us. We have not heard back anything. They has been no agreement or conclusion to this issue.
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
Regards,
[redacted]
Again the reason for the complaint was because we were never given any directions on what the requirements were of policy on eligibility ( which I still have not received). You denial that you have only recently produced to me after stating you had never received an application ( which I provided to you a few messages ago) shows two reasons for denial ( which when I called to your home office in the area of [redacted] residency stated the reason for denial was because he did not get health coverage through medicaid). The fist is that you found assets which were not disclosed. All information was provided to you at the time of his application. At the time of application he was going through a divorce and the house ( Property) was being foreclosed in bankruptcy, 15317-ME-DE-028234305 file number. But at know time did you request any information on the "assets" you had found and asked about them. The question was and still is answered correctly. The second reason for denial was because he was not eligible for Medicaid. If [redacted] was eligible for Medicaid he would not need to have your help covering medication through your hardship program because Medicaid would have covered the medication. Also if you had provided program and eligibility requirements this would have been stated, I find denying someone a hardship because they cant find another way to get it is an oxymoron. Medicaid is a federal and state program which I'm very family with since I work for the program as a state employee in another state than to what [redacted] and I had applied for him. This website will give you a little back ground in case you are not familiar with the program. Most people think just because you have no income you are automatically eligible for Medicaid and the is not true. You must first and foremost be categorically eligible. If you don't meet any of the categories the you go no further. So of course he was not eligible he was a man without dependent not disabled or elderly. So to deny a hardship because he can get other insurance is ridiculous. That is what a hardship is because you cant assess other benefits. But again if you had given us the requirements at the time of the application if that was your policy we would have known but we did not and still have not received your eligibility requirements or any policy an procedure about your hardship program. I was told by the person on the phone that I spoke to and shared her information in past messages that you decided on a case by case bases and there are no written rules to go by so as far as i'm concerned based upon what she has told me and the fact that you still have not provided any policy on your program and for the most ridiculous reason for a Hardship denial I have ever heard that you don't truly have a program in place that you offer. https://kaiserfamilyfoundation.files.wordpress.com/2013/05/mrbeligibilit...⇄ Medicaid which is a federal and state
programs means you have to fit into category first… Child, Pregnant, Adults
with children in house, Disabled, and elderly……
!!!!!!! Step one [redacted] does not qualify. So the buck
stops there go don’t move on to income or any other eligibility requirements
because you didn’t make it past the first requirement. Unlike your program which gave no steps Medicaid
denied him. Hence he could not get
health coverage and this is why we applied for your hardship. You have a hardship program that denies
people for a hardship because they could not get other means to pay. Is there
not something wrong with that?
Categorical
Eligibility Medicaid eligibility is limited to individuals who fall into
specified 5 categories. The federal Medicaid statute identifies over 25 different
eligibility categories for which federal matching funds are available.These statutory categories can be classified into five broad coverage
groups: Children Pregnant WomenAdults in families with dependent
children;Individuals with disabilitiesElderlyOf course, many of
the elderly also have disabilities and could potentially meet the categorical
eligibility requirement for Medicaid on the basis of their disabilities.
However, in order to avoid the administrative cost and burden associated with
disability determinations, state Medicaid programs generally establish
categorical eligibility for an elderly individual based on age. The federal
Medicaid statute also establishes some eligibility categories based on a
particular disease or condition (e.g., tuberculosis, breast cancer.So in closing as I have stated in the beginning, there was no direct or correct communication given on your hardship program either by a written policy or by eligibility requirements ( which I have requested and still have not received), we completed the application accurately at the time and was truthful and that no one from Omnicare contacted us about assets or medicaid. Your denial of a hardship to help pay for medication based upon not having other coverage to cover medications defeats the point of you having a hardship program at all. Also the fact again that you have no written rules or regulations on requirements to be eligible for the Omnicare hardship program leads me to believe that the program is only there as a front and does not service any clients or members. I would like an explanation to the requirements to your program and the written policy and eligibility requirements to be accepted for your hardship program. I do plan on sending this and all other other information I have gathered on your company in the unethical and unfair practice of the program you state you offer to the state level not only here in my state but in the state of Maine to make sure there is not insurance fraud in this process or insurance or civil rights violations. Brenda [redacted]
We, at Omnicare, appreciate the opportunity to provide pharmaceutical care for you or your loved one. We are committed to continually improving our processes in order to better serve you. We apologize for the inconvience this may have caused you. We have set this account up...
to be written off. If you have any other issues or concerns, please contact me immediately. Thanks for choosing Omnicare.
Omnicare values their customers and appreciates the opportunity to respond to the complaint. Upon reivew there was a discharge on 3/19 and a readmit on 3/23 where orders were received and sent. Due to the customers concerns Omnicare will credit the customer $463.92 leaving a...
balance on the account in the amount of $50.54. The customer has been contacted and has agreed to the balance due.
Thanks for contacting Omnicare. We take great care to ensure that each and every one of our customers are satisfied. I have reached out and asked for your name to be removed from all future concerns on this account due to you not being the responsible party. If you have any other...
January 30, 2015 [redacted] Dear [redacted] Omnicare’s central billing center has received your concerns from the Revdex.com, regarding [redacted]’s medications dispensed and billed during his stay at the [redacted] Health and...
Rehabilitation Center. I want to be sure that we answer all your questions and concerns, with that in mind we have established a time line of events that I hope will be helpful. 06/02/2014 – [redacted] was admitted to the facility. Omnicare received orders and filled them. However, we did not enter insurance at this time. Insurance was listed on the face sheet but not a copy of the insurance card. 06/10/2014 – Resident’s daughter ([redacted]) called our Central Billing Center regarding the Welcome Packet. We explained what it was and how she needed to complete it. No mention of insurance. 06/10/14 – Received a fax from facility indicating resident discharged from the facility on 06/04/2014. 06/30/2014 – Private pay invoice was generated. We still did not have insurance on the account so a statement note was added to this invoice requesting responsible party to call CBC with insurance information. Invoice date: 06/30/2014 Amount due: 498.03 07/14/2014 – CBC received a call asking if we had billed insurance yet. Advised that we had not and caller stated she would locate insurance information and call us back. 07/14/2014 – Received second call from family today and at this time they did provide us with the insurance information. We entered the insurance on to the account and rebilled the charges. 07/31/2014 – The second private pay statement was generated. This statement showed the reversals of the sales since we had transferred the sales to the insurance plan on 07/14/14. Many of the sales had rejected by the insurance plan for ‘refill too soon’ and were still in a rejected status at this time. A few claims had processed successfully and there were three over-the-counter meds which are not billable to the insurance so there was a balance due for these items on this statement but it did not include the claims still pending with the insurance. ...⇄ ...⇄ Invoice date: 07/31/2014 Amount due: 39.99 08/14/2014 – We received payment for the amount due of $39.99 08/26/2014 – Omnicare’s adjudication department tried to get an override on the ‘refill too soon’ rejections. They called the insurance plan and were told the meds were filled at [redacted] on 06/02/14 so they would not give us an override but stated the patient would be able to send in a paper claim to request an override and reimbursement. 08/31/2014 – The rejected sales were transferred back to the private pay account with a statement note indicating the “Medication or Product was Denied by Third Party Coverage”. ...⇄ Invoice date: 08/31/2014 Amount due: 342.55 09/29/2014 – [redacted] called in to question why the bill was now so high. We explained that the claims had been rejected by his insurance plan. She also wanted to know why there were 30 day supplies when he was only there for 2 days. We only received a few of the meds returned for credit and credit was issued for those. She was going to check to see if the meds were sent with him when they transferred him to another facility. 10/08/2014 – [redacted] called back and stated she thought she had paid in full when she paid the July statement of $39.99 and does not want to pay for 30 day supply of these rejected meds. We called the facility to see if they had any of these meds left that they could return or if they knew if they sent them with the resident and according to the facility they had no record of meds being sent with the resident and no record of any being returned to the pharmacy. We also called the insurance plan again to see if we could obtain an override on the ‘refill too soon’ rejections. Again we were instructed by the plan that the member would need to submit a paper claim and request the override and reimbursement. 10/08/2014 – [redacted] called in to the Central Billing Center to find out what was going on with this account. [redacted] is also listed as a contact on the face sheet. It was at this time we decided to assist the family and mail the statement in to the insurance plan on their behalf with an explanation requesting an override for the resident. 10/17/2014 – We received a call from Caremark regarding the claim we mailed in. They stated we needed an actual claim form signed by the member to be completed and mailed in (BCBS Federal). We contacted [redacted] to let her know this and we emailed the claim form to her to get it signed by the resident or his POA. 10/22/2014- We had not received the form back from [redacted] so we sent her a follow up email to inquire about the form. She responded via email that she wanted to speak to a supervisor. 10/22/14 – [redacted] called in and spoke to a different biller. She stated biller was pleasant and knowledgeable but [redacted] needed to end the call and would call in on another day. 10/30/14 – [redacted] called in and spoke to a Supervisor, requesting to see an EOB to prove that we submitted the claims to the insurance plan. [redacted] let us know at this time that she would not be signing the form. Also, stated she was not going to pay and was going to the Revdex.com and her attorney. 11/04/2014 – The facility called to inquire on the account. We explained it and the facility planned to follow up with the family. I understand that this has been a lengthy and unpleasant experience for you with Omnicare’s Billing Center and for that I apologize. I do want to assure you that pharmacy billing is highly regulated, and Omnicare’s billing staff strives to follow those rules and regulations to the letter. Unfortunately we were not able to accommodate your request for an EOB showing the rejected claims. We bill the pharmacy claims electronically at the point of sale and the claim is either positively adjudicated or rejected all within the electronic point of sale system. The insurance plan creates and sends the EOBs to their members for the paid claims. Due to the many issues and concerns with this account, I want to offer a courtesy credit in the amount of $357.94. This will clear the balance for [redacted]’s account. If I can be of further assistance, please do not hesitate to contact me at [redacted] Sincerely, [redacted] Central Billing Center Manager Omnicare Central Billing Center [redacted] [redacted]
Omnicare values their customers and appreciates the opportunity to respond to the concerns forwarded to us from you on behalf of [redacted].
Omnicare of Northern IL provided medications to her Mother [redacted] at [redacted] in 2014. Omnicare billed all applicable...
prescription drug coverage since her admission at [redacted].
Since [redacted] has asked us not to contact her regarding the outstanding balance and has provided us with updated information that indicates the patient had no estate or assets, we will adjust the account to zero. In addition all written and verbal communication to [redacted] will cease.
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***
I apologize I have not met your expectations. The Director of Credit and Collections is now reviewing this case. Can you please provide a telephone number you may be contacted at to discuss this in more detail?
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it. If you and the business have reached an agreement and compliance is set for a future date, we trust the business will comply. Please contact us after that time if the matter is not resolved as agreed and we will review the complaint and proceed accordingly.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that their proposed resolution is satisfactory to me. Thank you.The information they require is as follows: Patient name: [redacted] Account Number: [redacted]
Regards,
[redacted]
[redacted],
Thank you for bringing this to our attention. We will gladly adjust off the $25.00 [redacted] fee on your mother's account and provide the credit for the returned medication.
However, we do not have your mother's name or account number to complete the process. Please...
provide same so we can reconcile this matter.
Thank you,
Holly V[redacted]
We had sent in the application to Omin care for my brother in law [redacted] and were told he was denied due to he was not eligible for medicare or medicaid. I had attached a copy of the application that they said the did not receive and a copy of the original notice telling them who at Omni care we spoke to and they said they had the application and it was denied. The last message here I received was from Omni care stated they have the application I attached through Revdex.com and they would get back to us. We have not heard back anything. They has been no agreement or conclusion to this issue.
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
Regards,
[redacted]
Again the reason for the complaint was because we were never given any directions on what the requirements were of policy on eligibility ( which I still have not received). You denial that you have only recently produced to me after stating you had never received an application ( which I provided to you a few messages ago) shows two reasons for denial ( which when I called to your home office in the area of [redacted] residency stated the reason for denial was because he did not get health coverage through medicaid). The fist is that you found assets which were not disclosed. All information was provided to you at the time of his application. At the time of application he was going through a divorce and the house ( Property) was being foreclosed in bankruptcy, 15317-ME-DE-028234305 file number. But at know time did you request any information on the "assets" you had found and asked about them. The question was and still is answered correctly. The second reason for denial was because he was not eligible for Medicaid. If [redacted] was eligible for Medicaid he would not need to have your help covering medication through your hardship program because Medicaid would have covered the medication. Also if you had provided program and eligibility requirements this would have been stated, I find denying someone a hardship because they cant find another way to get it is an oxymoron. Medicaid is a federal and state program which I'm very family with since I work for the program as a state employee in another state than to what [redacted] and I had applied for him. This website will give you a little back ground in case you are not familiar with the program. Most people think just because you have no income you are automatically eligible for Medicaid and the is not true. You must first and foremost be categorically eligible. If you don't meet any of the categories the you go no further. So of course he was not eligible he was a man without dependent not disabled or elderly. So to deny a hardship because he can get other insurance is ridiculous. That is what a hardship is because you cant assess other benefits. But again if you had given us the requirements at the time of the application if that was your policy we would have known but we did not and still have not received your eligibility requirements or any policy an procedure about your hardship program. I was told by the person on the phone that I spoke to and shared her information in past messages that you decided on a case by case bases and there are no written rules to go by so as far as i'm concerned based upon what she has told me and the fact that you still have not provided any policy on your program and for the most ridiculous reason for a Hardship denial I have ever heard that you don't truly have a program in place that you offer. https://kaiserfamilyfoundation.files.wordpress.com/2013/05/mrbeligibilit...⇄ Medicaid which is a federal and state
programs means you have to fit into category first… Child, Pregnant, Adults
with children in house, Disabled, and elderly……
!!!!!!! Step one [redacted] does not qualify. So the buck
stops there go don’t move on to income or any other eligibility requirements
because you didn’t make it past the first requirement. Unlike your program which gave no steps Medicaid
denied him. Hence he could not get
health coverage and this is why we applied for your hardship. You have a hardship program that denies
people for a hardship because they could not get other means to pay. Is there
not something wrong with that?
Categorical
Eligibility Medicaid eligibility is limited to individuals who fall into
specified 5 categories. The federal Medicaid statute identifies over 25 different
eligibility categories for which federal matching funds are available.These statutory categories can be classified into five broad coverage
groups: Children Pregnant WomenAdults in families with dependent
children;Individuals with disabilitiesElderlyOf course, many of
the elderly also have disabilities and could potentially meet the categorical
eligibility requirement for Medicaid on the basis of their disabilities.
However, in order to avoid the administrative cost and burden associated with
disability determinations, state Medicaid programs generally establish
categorical eligibility for an elderly individual based on age. The federal
Medicaid statute also establishes some eligibility categories based on a
particular disease or condition (e.g., tuberculosis, breast cancer.So in closing as I have stated in the beginning, there was no direct or correct communication given on your hardship program either by a written policy or by eligibility requirements ( which I have requested and still have not received), we completed the application accurately at the time and was truthful and that no one from Omnicare contacted us about assets or medicaid. Your denial of a hardship to help pay for medication based upon not having other coverage to cover medications defeats the point of you having a hardship program at all. Also the fact again that you have no written rules or regulations on requirements to be eligible for the Omnicare hardship program leads me to believe that the program is only there as a front and does not service any clients or members. I would like an explanation to the requirements to your program and the written policy and eligibility requirements to be accepted for your hardship program. I do plan on sending this and all other other information I have gathered on your company in the unethical and unfair practice of the program you state you offer to the state level not only here in my state but in the state of Maine to make sure there is not insurance fraud in this process or insurance or civil rights violations. Brenda [redacted]
We, at Omnicare, appreciate the opportunity to provide pharmaceutical care for you or your loved one. We are committed to continually improving our processes in order to better serve you. We apologize for the inconvience this may have caused you. We have set this account up...
to be written off. If you have any other issues or concerns, please contact me immediately. Thanks for choosing Omnicare.
Omnicare values their customers and appreciates the opportunity to respond to the complaint. Upon reivew there was a discharge on 3/19 and a readmit on 3/23 where orders were received and sent. Due to the customers concerns Omnicare will credit the customer $463.92 leaving a...
balance on the account in the amount of $50.54. The customer has been contacted and has agreed to the balance due.
Thanks for contacting Omnicare. We take great care to ensure that each and every one of our customers are satisfied. I have reached out and asked for your name to be removed from all future concerns on this account due to you not being the responsible party. If you have any other...
concerns, please feel free to contact us.
January 30, 2015 [redacted] Dear [redacted] Omnicare’s central billing center has received your concerns from the Revdex.com, regarding [redacted]’s medications dispensed and billed during his stay at the [redacted] Health and...
Rehabilitation Center. I want to be sure that we answer all your questions and concerns, with that in mind we have established a time line of events that I hope will be helpful. 06/02/2014 – [redacted] was admitted to the facility. Omnicare received orders and filled them. However, we did not enter insurance at this time. Insurance was listed on the face sheet but not a copy of the insurance card. 06/10/2014 – Resident’s daughter ([redacted]) called our Central Billing Center regarding the Welcome Packet. We explained what it was and how she needed to complete it. No mention of insurance. 06/10/14 – Received a fax from facility indicating resident discharged from the facility on 06/04/2014. 06/30/2014 – Private pay invoice was generated. We still did not have insurance on the account so a statement note was added to this invoice requesting responsible party to call CBC with insurance information. Invoice date: 06/30/2014 Amount due: 498.03 07/14/2014 – CBC received a call asking if we had billed insurance yet. Advised that we had not and caller stated she would locate insurance information and call us back. 07/14/2014 – Received second call from family today and at this time they did provide us with the insurance information. We entered the insurance on to the account and rebilled the charges. 07/31/2014 – The second private pay statement was generated. This statement showed the reversals of the sales since we had transferred the sales to the insurance plan on 07/14/14. Many of the sales had rejected by the insurance plan for ‘refill too soon’ and were still in a rejected status at this time. A few claims had processed successfully and there were three over-the-counter meds which are not billable to the insurance so there was a balance due for these items on this statement but it did not include the claims still pending with the insurance. ...⇄ ...⇄ Invoice date: 07/31/2014 Amount due: 39.99 08/14/2014 – We received payment for the amount due of $39.99 08/26/2014 – Omnicare’s adjudication department tried to get an override on the ‘refill too soon’ rejections. They called the insurance plan and were told the meds were filled at [redacted] on 06/02/14 so they would not give us an override but stated the patient would be able to send in a paper claim to request an override and reimbursement. 08/31/2014 – The rejected sales were transferred back to the private pay account with a statement note indicating the “Medication or Product was Denied by Third Party Coverage”. ...⇄ Invoice date: 08/31/2014 Amount due: 342.55 09/29/2014 – [redacted] called in to question why the bill was now so high. We explained that the claims had been rejected by his insurance plan. She also wanted to know why there were 30 day supplies when he was only there for 2 days. We only received a few of the meds returned for credit and credit was issued for those. She was going to check to see if the meds were sent with him when they transferred him to another facility. 10/08/2014 – [redacted] called back and stated she thought she had paid in full when she paid the July statement of $39.99 and does not want to pay for 30 day supply of these rejected meds. We called the facility to see if they had any of these meds left that they could return or if they knew if they sent them with the resident and according to the facility they had no record of meds being sent with the resident and no record of any being returned to the pharmacy. We also called the insurance plan again to see if we could obtain an override on the ‘refill too soon’ rejections. Again we were instructed by the plan that the member would need to submit a paper claim and request the override and reimbursement. 10/08/2014 – [redacted] called in to the Central Billing Center to find out what was going on with this account. [redacted] is also listed as a contact on the face sheet. It was at this time we decided to assist the family and mail the statement in to the insurance plan on their behalf with an explanation requesting an override for the resident. 10/17/2014 – We received a call from Caremark regarding the claim we mailed in. They stated we needed an actual claim form signed by the member to be completed and mailed in (BCBS Federal). We contacted [redacted] to let her know this and we emailed the claim form to her to get it signed by the resident or his POA. 10/22/2014- We had not received the form back from [redacted] so we sent her a follow up email to inquire about the form. She responded via email that she wanted to speak to a supervisor. 10/22/14 – [redacted] called in and spoke to a different biller. She stated biller was pleasant and knowledgeable but [redacted] needed to end the call and would call in on another day. 10/30/14 – [redacted] called in and spoke to a Supervisor, requesting to see an EOB to prove that we submitted the claims to the insurance plan. [redacted] let us know at this time that she would not be signing the form. Also, stated she was not going to pay and was going to the Revdex.com and her attorney. 11/04/2014 – The facility called to inquire on the account. We explained it and the facility planned to follow up with the family. I understand that this has been a lengthy and unpleasant experience for you with Omnicare’s Billing Center and for that I apologize. I do want to assure you that pharmacy billing is highly regulated, and Omnicare’s billing staff strives to follow those rules and regulations to the letter. Unfortunately we were not able to accommodate your request for an EOB showing the rejected claims. We bill the pharmacy claims electronically at the point of sale and the claim is either positively adjudicated or rejected all within the electronic point of sale system. The insurance plan creates and sends the EOBs to their members for the paid claims. Due to the many issues and concerns with this account, I want to offer a courtesy credit in the amount of $357.94. This will clear the balance for [redacted]’s account. If I can be of further assistance, please do not hesitate to contact me at [redacted] Sincerely, [redacted] Central Billing Center Manager Omnicare Central Billing Center [redacted] [redacted]
Omnicare values their customers and appreciates the opportunity to respond to the concerns forwarded to us from you on behalf of [redacted].
Omnicare of Northern IL provided medications to her Mother [redacted] at [redacted] in 2014. Omnicare billed all applicable...
prescription drug coverage since her admission at [redacted].
Since [redacted] has asked us not to contact her regarding the outstanding balance and has provided us with updated information that indicates the patient had no estate or assets, we will adjust the account to zero. In addition all written and verbal communication to [redacted] will cease.