Pacific Medical, Inc.

I am rejecting this response...

because: the wrist brace in question probably cost less than $5.00 to make and could be bought at [redacted] for $30.00.... This is part of the reason the medical industry has gotten out of control..... I don't mind them making a profit, but this is absolutely absurd....... to the point of almost criminal in my eyes.....

Our Collection Manager called and left the patient a message today in regards to her account to let her know that it has been resolved and she no longer has a balance.

Please let us know once they have spoken to the [redacted] at the doctor's business license.

Each product is assigned a HCPC codes by [redacted] based upon the item description.  The HCPC codes are then assigned an allowable amount by [redacted].  Our contract with the patient's insurance is based off of the Medicare allowable.  The patient's insurance allowed $202.57 for the code and product that he received and applied this amount to his annual deductible.  [redacted] sets the pricing for each code and the insurance then sets the contracted pricing with providers based on this amount.  The product was provided to the patient based on the prescription from his physician.  This amount was applied to his deductible by his insurance.

We billed the patients insurance for this item and his insurance allows $202.57 for this item and applied it to the patients deductible.  We are billing the patient the amount that his insurance applied to the deductible as per our agreement with the insurance.

I am rejecting this response because:We have also been in contact with the clinic.  The clinic has stated on more than one occasion, any money they collect for the braces in forwarded to Pacific Medical Inc.

The customer is correct.  We were billing them incorrect for a patient with a similar name.  The account balance for this customer is now zero.

The patient was provided a splint on 12/10/14 and did sign our form (copy attached) that states products that come in contact with the body cannot be returned.  We billed the patients insurance and they applied $129.83 to her deductible.  The patient did contact our office on 2/17/15 and...

left a message.  We did contact the patient on 2/19/15 and she advised us that she did not expect such a large bill and we advised her it was applied to her deductible per her insurance.  We also advised that we would accept monthly payments from her.  She said she would think about it and call us back the next week.  We have no documentation that she wanted to return the brace.    The patient states that she was not properly notified that she could not return the item if she was not pleased with it.  She states that the equipment did not work and is useless.  Please note that she did sign the form stating she understood that the item could not be returned.  She also did not let us know if her phone call that the item did not work for her.  We are unable to accept the item back but we are willing to accept monthly payments as we indicated on our phone call with her last month.

Review: A custom, orthotic knee brace was delivered to me on March 10, 2014. At the time that the service was provided, I was advised (by Pacific Medical) that it would be covered by Medicare. The first time that I was made aware that Medicare had denied coverage was in late September (apparently the "original" Medicare denial was lost in the mail) when I received a notice from my Supplemental Medicare Carrier that the original claim was denied. Pacific Medical contacted me in early October, and advised me that I was responsible for the payment for the knee orthotic. I advised them that I was in the process of appealing the denial, and was told that as long as I kept them advised of the appeal process, I would not be asked to pay for the device. I have kept Pacific Medical advised. The Medicare appeal was recently denied, due to the fact that the original appeal was made after the 120 day limit from the original denial. However, I was given the chance to appeal again, with an argument that I did not receive the original denial, and could not have replied in a timely fashion. I have made that second appeal. Pacific Medical has now become aggressive, and nasty, insisting that I start payment immediately, and charging me a $25 late fee without any advanced notice.Desired Settlement: Eliminate the $25 late fee, and return to a cooperative working relationship regarding payment options. Assuming Medicare again denies coverage, I fully agree to work with Pacific Medical on a payment plan to pay for the orthotic device.

Business

Response:

We advised the patient on 1/16/15 that we would waive the late fee of $25 and we would work with him after the appeal. Our bills automatically generate the $25 late fee each month but we do have it noted on his file that we have waived the late fee.

Consumer

Response:

I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.

Review: Refered by [redacted] to get orthotics from Pacific Medical, [redacted]. [redacted]. Visit 1 on 10-12-15, I paid $90 deposit on orthotics, firm unsure what part [redacted] covered. Next appointment 11-19-15 picked up orthotics. [redacted] reimbursed Pacific on 11-17-15 for covered billing. [redacted] noted my portion only $37.60.

Pacific Medical has failed to reimbursement since they received payment. Today is 3-3-16. I have called mutiple times. Corp [redacted]. Also called Roseville. Responses I will get refunf 12-15-16, I will get 1-15-16, last contact Check mailed 2-19-16. I have not received my refund. Now they are blaming post office for me not getting my check.

[redacted] indicated it is not egal to collect money from customers up front, must bill [redacted] and bill customer for what [redacted] did not cover.Desired Settlement: I want an immediate refund of the $52.40 due to me.

Business

Response:

Our Collection Manager, [redacted] spoke to the patient on 3/2/16 and advised that the refund check was sent to the wrong address and we have put a stop paymenton it. A new check will be re-issued on 3/7/16.

Review: I saw a Doctor at UC Davis Orthopedic office in Sacramento for a knee problem. They gave me a Durable Medical knee brace worth about $25 street price (may list for around $50) for my knee problem. I was never given any information about this third party Pacific Medical and wouldn't have accepted the knee brace if I was told in advance. Further, they did not bill Medicare as required for all my health insurance charges. My secondary Insurance, Tricare for Life, requires Medicare to be billed first (even if they do not pay anything) before they will pay. Pacific Medical billed $141.00 for a gold plated knee brace but the gold plaiting was missing and the product was possible used. The sizing information was completely wrong and I the Size large which should have fit but was way too small; after trying on two others, I ended up with an XX Large. The way knee brace packing is that can be tried on numerous times before being selected or repackaged. There was no agreement in principal to to pay a third party a ripoff charge when this was not disclosed up front by the Doctor or others at the office. This should have been disclosed at time of office for my informed consent.I have received one bill Dated 1/06/2014 from Pacific Medical and refused the second. Today 2/19/14 I received what I consider a harassing call from someone who said they were from Pacific Medical I told them I did not have an account with them and not to call back. There was NO information given to me about Pacific Medical being the owner of the Knee brace, and there is a possibility of claims from other company to be the rightful owners.Desired Settlement: Medicare needs to be billed then Tricare re-billed In no event I should be libel for more than $ the $50.00 list price. I believe I should be paying UC Davis a reasonable amount, not to exceed the list price of $50.00 for the knee brace, or I could exactly replace the one I was furnished by the doctors office I could settle this matter with Pacific Medical in Sacramento Small Claims Court

Business

Response:

To Whom it May Concern:

Please allow the following to serve as Pacific Medical's response to the Complaint filed against Pacific Medical, Inc. by Mr. [redacted]. Pacific Medical, Inc and UC Davis have a contractual relationship that makes DME equipment available for UC Davis patients at thier offices for the convenience of thier patient population. Mr. [redacted] was provided DME products on November 19, 2013. With that said, Mr. [redacted]' statement in collection with the complaint is factually deficient in several areas. First, Mr. [redacted] indicates that he was not told in advance or given any information regarding Pacific Medical and the provision of the product as a third party. This is inaccurate. Mr. [redacted] signed the attached Patient Product Agreement which clear indicated Pacific Medical as the providing party and also clearly states in bold print that patients are not obligated to utilize Pacific Medical and are free to purchase the products elsehwere. Second, Mr. [redacted] states that Pacific Medical did not bill Medicare for the products and services provided. This is also inaccurate in that the claim was submitted to Medicare. Unfortunately, the claim was denied by Medicare as a non-covered item. As such, financial responsiblity shift back to the patient or other insurance provider. Finally, Mr. [redacted] indicates that Pacific Medical failed to bill his secondary insurer Tri-Care. This is also innaccurate. Tricare was billed and rendered and EOB for $87.38 which is/was applied to Mr. [redacted] outstanding deductible obligation under his TriCare policy. As such, the $87.38 financial obligation of Mr. [redacted] remains outstanding.

It is unfortunate that Mr. [redacted] is unhappy with the situation. However, Pacific Medical, UC Davis, Medicare and TriCare have all fullfilled thier obligations via appropriate documentation and/or determinations under the applicable contracts, regulations and/or policies and the $87.38 obligatoin remains the financial obligation of Mr. [redacted].

Thank you.

Review: Pacific Medical inc has been sending us bills for my daughter 10 years old who went to Whidbey General Hospital ER for a fractured arm, post treatment she went to Whidbey Orthopedic surgeons for cast and follow up, our insurance is with [redacted], she is covered 100%, we started getting bills from Pacific Medical inc, I called and spoke to them personally and then contacted [redacted] who confirmed that they have not been billed and that [redacted] is covered 100%, I called Pacific Medical inc and passed this information on to them and wrote a letter on 11-10-14 instructing them that they need to bill the insurance company, Pacific Medical Inc to date has not billed [redacted], yet they continue to send bills to [redacted] who is a minor at 10 years of age, letters enclosed, their billing practice is negligent and has become harassing.Desired Settlement: Bill the insurance as they should, stop billing a minor and address the parent, Validate the debit and provide any and all copies of their billing to insurance to show compliance of billing practices. Dismiss debit in good standing. Remove any and all reports to any and all credit reporting agencies if so reported.

Business

Response:

We have billed the insurance for this charge. We have written this charge off and they should not recive any further statements. This was not reported to any agencies.

Consumer

Response:

I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.

Review: I had a below knee amputation on my right leg at Rogue Valley Hospital on 8/2/2012. I was referred yo Pacific Medical by the surgeon, Dr. [redacted]. [redacted] at Pacific Medical in Medford Oregon was the Prosthetist who fit me for my 2 prosthetics. It has now been just over 2 years since my accident. The following is a fraction of my misery suffered through [redacted]'s poor ability to design a prosthetic to fit properly. Both [redacted]'s prosthetics were so large causing me to wear up to 16 ply & prosthetic socks: causing my wright to be distributed on the stump rather than the knee causing extreme pain and also causing me to stumble and fall numerous times. My hospital and doctor visits I can supply you with if you want! After talking with many other amputees, I now have a thud prosthetic made by someone else that fits properly.Desired Settlement: You will no longer receive monthly payments from me for the rest of the 2nd prosthetic. I also did not receive a spare prosthetic as all thuds do! I can send you a numerous page detailed list of all the issues your product has caused me. Justin wouldn't return my calls and now you have replaced him. I do wonder why?

Account no [redacted]

Business

Response:

Dear Ms. [redacted]:We are in receipt of your letter regarding dissatisfaction with products and services received in our Medford facility. It is true that Mr. [redacted] is no longer employed by Pacific Medical as he left the company to pursue other opportunities. With that said, we are truly sorry that you had a negative experience with our company. We strive for excellence in all that we do. At times, we fall short and, when brought to our attention, we do all we can to rectify those situations.In your circumstances, your letter is the first notice we received regarding your dissatisfaction with the goods and services provided by Mr. [redacted] and Pacific Medical, Inc. I have had a chance to review the chart notes and it obvious there was some confusion or misunderstanding as the notes specifically indicate that you were "satisfied" with the prosthetic and services at that time of the appointment. Based on your letter, this is inconsistent with your and services at the time of the appointment. Based on your letter, this is inconsistent with your recollection. If Mr. [redacted] was still an employee, we would attempt to reconcile the situation. Since he is no longer employed by Pacific Medical, we cannot actively "correct" the problem.With that said, pursuant to the request in your letter, we are willing to waiver your obligation your second prosthetic ($883.75). As such, your outstanding balance will be $777.43. As you know, we have in the past agreed to allow you to make monthly payments on the amounts due. We will continue to honor that agreement, however, we requested that payment made be no less than $50.We hope this is an acceptable resolution to the situation and thank you in advance for your cooperation.Regards,[redacted] General CounselPacific Medical, Inc.

Review: My doctor recomended a Plantar Fasciitis Night splint for my right foot on 12/10/2014. After using the splint for about a month, I went back to the doctor for more pain relief because the splint did not help at all. I contacted the billing department for Pacific Medical Inc at [redacted] and I was advised I would not be able to return the equipment. I was not properly notified that I would not be able to return the equipment if I was not pleased with it. I feel this is unfair because the equipment did not work and it is useless for me. For these reasons, I want to return it.Desired Settlement: I was billed for the equipment and it has not yet been paid. I would like for Pacific Medical Inc to accept my return of the equipment and not charge me for it.

Business

Response:

The patient was provided a splint on 12/10/14 and did sign our form (copy attached) that states products that come in contact with the body cannot be returned. We billed the patients insurance and they applied $129.83 to her deductible. The patient did contact our office on 2/17/15 and left a message. We did contact the patient on 2/19/15 and she advised us that she did not expect such a large bill and we advised her it was applied to her deductible per her insurance. We also advised that we would accept monthly payments from her. She said she would think about it and call us back the next week. We have no documentation that she wanted to return the brace. The patient states that she was not properly notified that she could not return the item if she was not pleased with it. She states that the equipment did not work and is useless. Please note that she did sign the form stating she understood that the item could not be returned. She also did not let us know if her phone call that the item did not work for her. We are unable to accept the item back but we are willing to accept monthly payments as we indicated on our phone call with her last month.

Review: Grandson got a sling in 06/06/2015 he is on [redacted] health plan .pacific medical .was sending bills to a address my son who has brain damage doesn't know what to do with mail .so either he never checks it or gets rid of it .they had my address where all important mail comes to my address .when I finally received this bill in Nov .I called and asked why it wasn't billed to [redacted] health plan .the lady told me they offer us cash offer first .I told her why would we pay cash when he has insurance .so I asked her do you have the insurance info .she read me off the correct info and said she would bill them .okay figured done with this .but k

Nope I get a call Dec 4 or 5 telling me it's to late for m

Them to bill insurance have to pay cash .I requested to talk to her supervisor so she transfered me to [redacted] Left message on Dec 4 or 5 no response from her .I received another bill called again 12/18/2015 spoke to [redacted] I think her name was she put me through to [redacted] again .she was the rudest so called supervisor I have ever had the pleasure to talk with .so because they choose not to bill [redacted] health plan and want 35.00 plus 25.00 late fees for something they should of billed to insurance .they have quite the scam here .I asked to wave the 25.00 late fee she flat refused .this company needs to be investigated for there billing scamsDesired Settlement: Them to bill the insurance .and remove the 25.00 late fee account [redacted]

Business

Response:

It appears that we did bill the patient for this as at the time of service, they did not provide any insurance information and were billing the patient with the address provided to us. We received a phone call from the paitent's grandmother on 11/17/15 and she stated that we need to bill the insurance. However, after further review, we were unable to bill the insurance for this item as we only have 4 months after the date of service in order to bill them. According to [redacted] Medicaid guidelines, we are able to bill the patient if they do not provide us with insurance information. This bill in it's entirety has been written off as of 1/11/16. There is no balance due at this time.

Consumer

Response:

I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.

Review: Beginning 7/1/2015 I have received a monthly statement from this business stating that I have a passed due bill that, according to the statement started out at $200.39 with a late fee of $25.00. Then, with the billing of 10/01/2015 the balance stated $108.82 with late fee of $25.00. The most re4cent billing of 12/01/2015 stated the same. Not sure why the balance has changed but, regardless, this bill does not belong to me.With the very first notification, I contacted this business and spoke with an employee, [redacted], and assured her this bill was not mine. Accept for my address, which I do not know how they came by, NONE of the personal information connected with this bill matches mine. They have a different birthdate and social security number associated with this bill. I have assured them numerous times that I have NEVER been in this clinic or even visited this particular town and that I live several hundred miles away. I spoke with [redacted] on 7/14/2015 and again on 7/16/2015 and demanded that they discontinue sending me these past due notices but they continue to do so. I am filing this complaint because I have tried to resolve this with them with no success. I assure you this is NOT my bill, I would certainly pay it if it was.The account number listed on the billing is [redacted], for a service performed on 2/23/2015.Desired Settlement: I want this company to discontinue sending me these notices. I have an excellent credit history and should not have to be subjected to this when I have tried to resolve it personally, the response I get from Monique is, "I can't just take your word for it that this isn't you"...totally unacceptable.Please do not share my e-mail address with this company.Thank you very much with your assistance in this matter,Sincerely,[redacted]

Business

Response:

The customer is correct. We were billing them incorrect for a patient with a similar name. The account balance for this customer is now zero.

Consumer

Response:

I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.

Review: On September 30, 2015 my primary care provider supplied me with a wrist support from Pacific Medical, Inc. On December 10, 2015 a claim was filed against my insurance. The allowed amount was $161.25 and the insurance paid $7.33.

In mid-January I received a bill for $153.92.

At the time, my doctor's office assured me that the cost of this brace would be $50 or less.

On January 27, I called Pacific Medical with the part number for this brace and received a quote of $32.00 if purchased without insurance.Desired Settlement: I would like the charges reduced to $32.00 which is the cost of this brace when not covered by insurance.

I might add, there are numerous other models available on-line for as little as $20.00.

I would be willing to pay the $32.00 in addition to $10.00 for their time and expense in billing insurance.

Thank you

Business

Response:

Our Collection Manager spoke to the patient on 1/29/16 and they agreed that the patient would pay $50.00 as payment in full.

Consumer

Response:

I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.