Optimal Rehab Inc

We are Optimal Rehab, Inc. and are a durable medical equipment supplier. We provided the patient with the rental of a Knee CPM machine per Dr. [redacted]' orders. This patient has a right total knee replacement. Upon receiving this order we made contact with the patient to inform them that we...

would be the DME provider. Yes, we are also a contracted vendor with the hospital that the surgery was performed at. In relation to what the patients insurance will cover is always presented as "SUBJECT TO REVIEW". Our patient service representatives are to go out and fit the patient with the required equipment that was ordered and to properly train the patient on the proper use of this equipment. The patient service representatives do not disclose any information regarding the billing and what may or may not be covered. This process is only done within the billing department (in office). The area on the patient contract states all the information and it is clearly marked "SUBJECT TO REVIEW". The patient at this time should review all the information on the patient contract and understand the policies and procedures of our company before they agree and sign the agreement. If the patient is not in agreement or may have any questions, they should not sign the contract or have the patient service rep contact our office at the time of delivery.
The issue was not with Medicare, it was with the secondary insurance. The secondary insurance did not pickup the remaining balance that Medicare showed that the patient was responsible for. We were informed of this issue when we received correspondence form the insurance company. It was then that we sent correspondence to the patient informing them of this information. The correspondence was sent in a timely manner. The process of claims is a 45/60 day turnaround from 1 insurance company, let alone we were waiting for correspondence from 2 insurance companies, so the process will take longer than expected.
Please note that we send out statements to the patient within a timely manner and it also allows the patient to contact our office when the statement is received if they may have any questions and/or concerns. The billing department is happy to answer any questions that the patient may have. In regards to the conversations we had with this patient (spouse of the patient) she was understanding at first and the process was explained to her. After the last call we had, she was very upset and frustrated and kept saying that it was our companies fault for misleading her to what will or will not be covered with the insurance companies. Please keep in mind, that there are insurance companies that we are contracted with and others that we are considered out of network. This important information is always reviewed with jour patients. Yes, we kept redirecting her to the Patient Contract because that's where the most important information is stated and is in agreement with the policies and procedures of our company. It was then that the patient wife did not want to hear what we had to say and the Supervisor got on the call and tried to explain that all of our efforts have been exhausted.
We apologize that we are not in agreement with the patient but there is only so much we can do as a DME provider and we can not determine what the insurance will or will not cover!
We handle all of our cases with great professionalism and customer service and we are not misleading in any way.
Thank you!

Initial Business Response /* (1000, 5, 2015/08/19) */
Contact Name and Title: [redacted], President
Contact Phone: XXX-XXX-XXXX
Contact Email: [redacted]@gmail.com
We received a call from Apple Valley Post Acute Center for a patient regarding an order for a TLSO Brace. We then received the patient...

measurements and waist size. We ordered the TLSO Brace. Once we received the brace on 08/05/2015, we delivered it to the patient. Our rep went out and fitted the brace on the patient. It's our protocol to have the patient review, and sign all paperwork, after the fitting is completed. This shows that the patient agrees with the type of equipment given the way it was fitted and understands the policies and procedures or our company. At this point the patient didn't complain about brace not being the right size or anything. If the patient is unhappy with our equipment or something is wrong we fix it immediately. After 5 days have gone by we receive a call from the patient son stating the brace doesn't fit his mother and they are unhappy with the brace and they need a smaller size. We were confused because at the time of delivery we fitted the patient, and the patient did not complain or state they were unhappy with the brace. If the brace didn't fit the patient, we would have never left the TLSO Brace (incorrect size) with her. We would have ordered another one. After we received the call in the office, we went out same day to the patient's home to address the issue and re fit the patient. When our rep got there he saw that the brace was taken apart. The son and the husband took the brace taken apart, that's why the brace was not fitting correctly. Our rep refitted and set-up the brace on the patient. Patient was satisfied with how the brace fit and our rep left.
Our company has been fitting braces for many years and we know what we are doing. And if a patient is unhappy we fix the issue the same day. The staff here is professional trained to deal with customer service and calls of complaints. The patient service reps are to treat the patients with respect and would not hang up on a patient due to an escalated situation.
Initial Consumer Rebuttal /* (3000, 7, 2015/08/19) */
(The consumer indicated he/she DID NOT accept the response from the business.)
first they did not measure and fit before giving me the brace he brought one brace and was determined to make that brace fit. Secondly my son and husband never touched the brace when the representative arrived he cut off over 8 inches from shoulder straps and also 7 inches on backstrap we still have the cut off pieces here and willing to submit pictures. I don't understand why they would lie just admit they made a mistake. Also it should be noted that my sons house is under surveillance so we have video of the whole encounter. Via high desert alarm
Final Consumer Response /* (4200, 12, 2015/08/20) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Obviously this company cannot be trusted. All they do is lie make up Stories and slander patients and their family this whole company is a joke the people who run it need to be changed out this company will fail. I will take all my evidence to the local newspaper and publish everything. We do not wish to be contacted anymore by this company because of the level of disrespect and lies.
Final Business Response /* (4000, 10, 2015/08/20) */
Today is Wednesday 8/19/2015, a call was received in our office at 3:20pm, regarding patient [redacted]. The caller was patient's son, [redacted]. He asked to speak with our rep's supervisor regarding a complaint towards our rep [redacted]. He spoke with the CEO of the company regarding our response to the Revdex.com complaint. [redacted] said our response to the complaint was incorrect and that's not what happened. He got very disrespectful with the CEO and the CEO stayed calm and listened to what the patient's son had to say, as he tried to explain that the issue was resolved. During the conversation, the patient's son stated he was recording the call and that he had his lawyer present. The CEO explained to him that by law he has to ask permission to record a call. The CEO explained that we took care of the problem and it's been resolved and we responded back to the complaint. He then called the CEO a "[redacted] Face" and then hung up. We are requesting for the patients son [redacted], not contact or harass our company any further, and as his harassing calls will not be taken, due to his disrespectful behavior.

I am writing you to formally respond to the complaint that was filed with our company, Optimal Rehab, Inc. This complaint is in regards to the above mentioned patient that was supplied with a standard pair of crutches, gait training and delivery. The patient that states she should not be responsible...

for the cost of Gait Training ($35.00) because she did not receive any training on "how to use or operate" the crutches. She states that she informed the PSR that the training was not needed because she already knew how to use them. Now, when the paperwork was returned to the billing department upon reviewing all required documents it was shown that the patient received the crutches, received the gait training and the crutches were delivered to her home. The patient signed the documents that show that she agreed to all of the policies and procedures of our company and she agreed to the services rendered. No where on the Patient Contract or the supporting documentation does it state that the patient refused the gait training or that she did not need or want it. In this case that the patient states "she did not receive any gait training upon delivery of the crutches". If this was true then the patient should of wrote on the patient contract "did not receive gait training" or "refused gait training because its not needed". It is the patients' responsibility to review the paperwork before signing it. Once the paperwork is signed, it is proof that you received all of our services and you are in agreement. Yes, the patient called in regarding her statement and spoke to a Billing Manager, the Supervisor as well as the delivery representative Phillip. The rep stated to the patient that they did give gait training to her upon delivery (as he does with every delivery of Durable Medical Equipment). The patient was not in agreement and continues to state that NO gait training was done, the crutches were ONLY delivered. At this point, the disagreement was passed on to the Manager/Supervisor and all the paperwork was reviewed and it will remain that the patient did receive the gait training for the crutches and will be responsible for the cost. All of our signed documents are proof and the patient should understand the policies and procedures of our company. If there are any further questions and/or concerns, our office can be contacted at ###-###-####. Thank you,[redacted] Billing Office Manager