Pacific Pulmonary

Initial Business Response /* (1000, 7, 2015/12/08) */
Thank you for notifying us on November 25, that Mr*** *** reported that he believed his account balance was inaccurate
Because this inquiry involves medical records, subject to Federal Privacy Laws, please note that no portion of
this letter may be posted publiclyThe patient's protected health information must remain private
Our research indicated that sleep equipment (CPAP and sleep supplies) was dispensed to Mr*** in accordance with an order from Dr*** *** on July 30, Mr***'s insurer, Colorado Access Medicare Advantage, was billed for the rental of the sleep equipment and sleep supplies, for the August 5, through October 8, dates of service
During the investigation, we carefully reviewed Mr***'s accountWe agree that the billing statement was inadvertently inaccurate because the initial insurance verification was inaccurateMr*** was incorrectly informed that the insurer would pay 100%Instead, however, Mr***'s insurance pays only 80% for the insurer's mandated allowable, with a 20% coinsurance obligationCo-insurance, basically, is an agreement between the insured and the insurer (under a health insurance policy) which provides that the insured will pay for a set percentage of the covered costsOnce we learned an error occurred, we immediately processed a $refund to Colorado Access Medicare Advantage for August 5, through October 8, dates of serviceWe also removed the $out-of-pocket charge for the same dates of serviceAs of December 7, Mr***'s account indicated a zero balanceAny future services provided to Mr*** would be charged in accordance with his insurer's correct benefits structure
Thank you for notifying us of Mr***'s experience with our companyWe very much appreciated you alerting us to his concerns, and allowing us to correct our records
Sincerely