Performance Home Medical

Complaint: [redacted] I am rejecting this response because: They kept changing the amount and date due every time I came into the office, from of 2015; to and from 2014; then to from? I never received a bill from when I returned with new prescription in Novthe amount was I paid this because I am having surgery not because I believed it was valid

Thank you for sending this patient complaint to us for resolution Performance Home Medical takes pride in being a very ethical and regulatory compliant medical equipment supplier We regret that this family believes that PHMl has been fraudulently billing them for the rental of the Nebulizer used for their son’s breathing treatments Our records indicate that the family of the patient received the nebulizer & supplies on 11/5/through their physician’s office Upon receipt of the signed paperwork, Performance contacted the patient’s insurance and found that the insurance’s policy required “rent to purchase” rather than an outright purchase We obtain the authorization for billing from the insurance, the prescription and then started billing for the rental equipment in their possession On 1/29/we received a denial from their insurance of record stating that the patient's insurance had terminated on 12/10/ Subsequently we left a message with the parents that the claim and been denied because the insurance coverage had terminated and they needed to call us We gave them till 2/9/to notify us of any new insurance or we would bill them privately for the rental equipment in their possession After no response, on 2/12/we transferred the billing to the family On 4/28/the patient’s mother called in about being billed for the rental of the nebulizer and that she was not going to pay " one more dime" to us and that they expected to get their $back that she had already paid We tried to explain to her that the insurance company determines the payment terms under their policy, therefore the item was still on rental At that time she stated she wanted to return the equipment and we told her we would send out a “prepaid” box for equipment return We explained that they were still responsible for the rentals until the machine was returned A box was sent to them on 4/29/15, and a second box was sent out on 5/6/as they stated they had not received the first On 4/30/the family & PHM agreed to a payment plan of $per month until the balance due was paid On 5/8/the mother called again stating that she did not believe we sent out the boxes as we were trying to continue the rental longer, and we tried to explain that it took a few days to get to Florida where they now residedIn good faith of their commitment we wrote off the April charges On 5/11/we received the equipment back from them via certified mail as the address we sent the boxes to was not deliverable by the post office Initially we did not show return of the equipment, however there was a mix up in our office but the the father provided us with the tracking number on 6/2/showing the return of the equipment received by PHM on 5/11/ On 11/27/we called the father about the missed payments and he said he couldn’t take care of the balance and we needed to call him back on Tuesday afternoon We reminded him that we had not received payment since MayWith no payment received in response to our calls, on 12/4/we sent this account to collections for $ On 5/16/we received notification from their previous insurance requesting a refund of the $they had previously paid, stating that the patient had another insurance that was primary and we needed to bill them On 8/31/we spoke with the mother and we explained that their insurance had requested a refund as they believed there was another insurance during that time We refunded the $to the previous insurance and we requested the mother provide us the information on the insurance that was primary so we could bill them We did not received information on another insurance, but the mother said she understood the issue now and payed the bill The payment was posted and the account was cleared We notified the collection agency and they removed the account from collection Unfortunately, the collection agency then made an error and re-set them up in their system for collections On 10/4/we found this out when the mother called and we contacted the collection agency to get this resolved The account has once again been removed from collections and we notified the mother that the collection agency had reopened this account by mistake We have requested a letter from the collection agency confirming their error for our records and we have apologized to the family for the collection agency error We do understand how confusing and frustrating insurance rules and reimbursement standards are to the patient/family It is unfortunate that this family did not understand and as a result felt we were tying to take advantage of them, which is not the case At this time we have verified that the account has a $dollar balance and the equipment has been returned This family has no additional liability for the nebulizer rental in

Thank you for bringing this problem to our attention We have found that this patient is absolutely correct We have contacted the credit agency and advised them to remove all reference to a collection from the patient's credit report Their account has been updated within our systems and we have documented this concern in our patient notes Additionally, it will be included in our system quality review report In the meantime, we will investigate this situation internally to determine why management was not aware of this problem until we received this complaintand how we can avoid this type of situation again We have contacted the patient and advised them of our action WE HAVE APOLOGIZED PROFUSELY for our error and they have graciously accepted our apology Again, thank you for bringing this problem to our attention

I spoke with this gentleman last week and apologized for the unprofessional and inappropriate way he was treated by our Billing Manager and staff Additionally after review of his account and all of our patient notes, we find that this patient is absolutely correct and based upon his
situation, should not be responsible for the disputed monthly rental charge since Performance staff did not follow through on resolution as promised and he returned the equipment just a few days into the next monthly rental period The $monthly rental fee has been written off and this patient now has a $balance with Performance This patient graciously accepted our apology and was pleased to know we acknowledge our error and have now written off the balance on his account Thank you for bringing this matter to the administration for resolution

Thank you for forwarding this patient complaint to us In response to this complaint, we have reviewed our notes on this account that explain why this patient was unable to obtain additional supplies for her CPAP from Performance
On 11/4/*** *** came into our Seattle Office
requesting supplies for her CPAP, which we provided at that time and advised her that we would bill her insurance and any co-pays or deductibles remaining after insurance payment would be her responsibility Her responsibility was $after insurance paid and we billed that amount to her numerous times with no response On 6/22/her account was sent to collections *** *** did not respond to collections and therefore her balance of $was still outstanding when she came to our Seattle office on 1/11/2016, again requesting new supplies We explained that she needed to pay her past due balance from prior to us providing any additional supplies for her and that since it had been over one year since we had a valid prescription we would need a new prescription from her physician to verify continued need and ongoing care management She left our office without paying her bill or obtaining additional supplies On 10/25/the patient came to our Seattle office again providing us with information about her new insurance and again requesting supplies We again explained that until she paid her past due balance we would not provide her any new supplies At that time she asked us to call her doctor to explain why we would not give her supplies as she was frustrated On 11/8/the patient again called our office to order supplies We again reminder her that until she paid her balance we would not dispense any supplies On 11/19/the patient came to our Seattle office again, this time she paid her bill from and we dispensed supplies to her We waived all past due penalties and accepted the original amount due of $from At that time we reminded her that after her insurance pays their portion of the new supplies she received that day, she will again be responsible for any remaining deductibles and co-insurance per her policy
At this point we are awaiting payment from her insurance and hopefully she will pay her billing prior to needing additional supplies Should this not be the case, this patient will be discharged from our service Please let us know if you have questions or we can be of further assistance

With the affordable care act many people are purchasing insurance with very high deductibles to reduce their premiums.  In this case the patient's deductible is $10,500 which has not yet been met, therefore he is responsible for the "allowed" amount determined by his insurance plan.  Since...

most every insurance plan has different "allowables", the equipment supplier routinely bills the insurance plan at their retail rate and then the insurance plan determines coverage and what they will pay/apply to the deductible and what the patients financial responsibility is.  Any difference between "allowable" and "billed" is written off as required by our insurance contract.  As a contracted supplier we are required to met extensive regulatory guidelines and then train the patient on use, care and maintenance of the equipment.  Additionally we must gather all the required documentation for coverage (i.e. sleep study, chart notes, written prescription, and other documentation that may be required based upon the individuals situation), set the pressure prescribed by the physician, fit the mask/interface to the patient, train them on the use and care of the equipment, answer questions the patient has, provide "tips" on use and provide ongoing support during the full 3 month rental period required before the insurance will make a determination to purchase the item (discounting the 3 months previously allowed) based upon the physicians belief that the patient is benefiting from this treatment.  While it is true that you can purchase this equipment at a less expensive rate on the internet, there is no training, fitting, rental or insurance billing.  There is no support or compliance help, what you purchase without being "fitted" is not returnable once used and therefore most insurance plans generally do not pay for equipment that is obtained by a "non-contracted" supplier who understands the guidelines and the value of fitting, training and support.  Additionally, I would like to mention that in this case the patient is comparing the internet companies rate for the CPAP only to the "billed" rate by Performance for the same equipment and all the supplies that are priced and billed separately.  I will also note that the CPAP internet price is $923 and the insurance allowable is $940.  PHM is a very reputable company that works hard to help our patients benefit from this equipment and service rather than just "selling" a product.  We take a risk every time we supply a patient with equipment, because if the insurance disallows coverage for the equipment/supplies, our only recourse is to take back the equipment and write off the rentals.  We have provided this patient with an itemized billing previously and explained the insurance payment to him, however it appears he did not fully understand and for that we certainly apologize.  In the next few days we will contact this patient again and try to clarify the billing and why he has a remaining balance. It is our hope that he will understand that we have not tried to take advantage of him or his insurance.  Thank you for bringing this issue to our attention.

Thank you for sending this patient complaint to us for resolution. 
Performance Home Medical takes pride in being a very ethical and regulatory compliant medical equipment supplier.  We regret that this family believes that PHMl has been fraudulently billing them for the rental of the...

Nebulizer used for their son’s breathing treatments.
Our records indicate that the family of the patient received the nebulizer & supplies on 11/5/2014 through their physician’s office.  Upon receipt of the signed paperwork, Performance contacted the patient’s insurance and found that the insurance’s policy required “rent to purchase” rather than an outright purchase.  We obtain the authorization for billing from the insurance, the prescription and then started billing for the rental equipment in their possession. 
On 1/29/15 we received a denial from their insurance of record stating that the patient's insurance had terminated on 12/10/14.  Subsequently we left a message with the parents that the claim and been denied because the insurance coverage had terminated and they needed to call us..  We gave them till 2/9/15 to notify us of any new insurance or we would bill them privately for the rental equipment in their possession.  After no response, on 2/12/2015 we transferred the billing to the family.
On 4/28/15 the patient’s mother called in about being billed for the rental of the nebulizer and that she was not going to pay " one more dime" to us and that they expected to get their $40.00 back that she had already paid.  We tried to explain to her that the insurance company determines the payment terms under their policy, therefore the item was still on rental.  At that time she stated she wanted to return the equipment and we told her we would send out a “prepaid” box for equipment return.  We explained that they were still responsible for the rentals until the machine was returned.  A box was sent to them on 4/29/15, and a second box was sent out on 5/6/15 as they stated they had not received the first.
On 4/30/15 the family & PHM agreed to a payment plan of $20.00 per month until the balance due was paid.  
On 5/8/15 the mother called again stating that she did not believe we sent out the boxes as we were trying to continue the rental longer, and we tried to explain that it took a few days to get to Florida where they now resided. In good faith of their commitment we wrote off the April charges.  On 5/11/15 we received the equipment back from them via certified mail as the address we sent the boxes to was not deliverable by the post office.  
Initially we did not show return of the equipment, however there was a mix up in our office but the the father provided us with the tracking number on 6/2/15 showing the return of the equipment received by PHM on 5/11/15.    
On 11/27/15 we called the father about the missed payments and he said he couldn’t take care of the balance and we needed to call him back on Tuesday afternoon.  We reminded him that we had not received payment since May. With no payment received in response to our calls, on 12/4/2015 we sent this account to collections for $68.41. 
On 5/16/2016 we received notification from their previous insurance requesting a refund of the $41.74 they had previously paid, stating that the patient had another insurance that was primary and we needed to bill them.  On 8/31/16 we spoke with the mother and we explained that their insurance had requested a refund as they believed there was another insurance during that time.  We refunded the $41.74 to the previous insurance and we requested the mother provide us the information on the insurance that was primary so we could bill them.  We did not received information on another insurance, but the mother said she understood the issue now and payed the bill.  The payment was posted and the account was cleared.  We notified the collection agency and they removed the account from collection.  
Unfortunately, the collection agency then made an error and re-set them up in their system for collections.  On 10/4/16 we found this out when the mother called and we contacted the collection agency to get this resolved.  The account has once again been removed from collections and we notified the mother that the collection agency had reopened this account by mistake.  We have requested a letter from the collection agency confirming their error for our records and we have apologized to the family for the collection agency error.   
We do understand how confusing and frustrating insurance rules and reimbursement standards are to the patient/family.  It is unfortunate that this family did not understand and as a result felt we were tying to take advantage of them, which is not the case.  
At this time we have verified that the account has a $0 dollar balance and the equipment has been returned.  This family has no additional liability for the nebulizer rental in 2014.

Thank you for bringing this problem to our attention.  We have found that this patient is absolutely correct.  We have contacted the credit agency and advised them to remove all reference to a collection from the patient's credit report.  Their account has been updated within our...

systems and we have documented this concern in our patient notes.  Additionally, it will be included in our system quality review report.   
In the meantime, we will investigate this situation internally to determine why management was not aware of this problem until we received this complaint. and how we can avoid this type of situation again.  We have contacted the patient and advised them of our action.  WE HAVE APOLOGIZED PROFUSELY for our error and they have graciously accepted our apology.  Again, thank you for bringing this problem to our attention.

Complaint: [redacted]I am rejecting this response because:
 
My choice of insurance providers, my deductible amount and whether my deductible has been met for this year have no bearing on this compliant against PHM Performance Home Medical.
 
On August 15, 2014 on saw my sleep apnea doctor for my annual checkup.  During my visit it was discovered that my CPAP machine was broken and could not be repaired.  My doctor wrote me a prescription for a new CPAP machine and on my way home from Seattle I stopped by the Kent, WA office of PHM.  I handed the prescription to the receptionist along with my insurance card.  She photo copied my card and said I would hear from someone in a few days.  On August 26th I received a call from the Tacoma PHM office, saying that my prescription had been processed and I could pick up my new CPAP machine.  I made and appointment and on August 28th I received my new CPAP machine from PHM.  I checked in at the Tacoma office and the technician showed me how to operate the machine and then he said he was required by PHM to show and test fit me with a generic head gear.  He opened a sealed package and had me try the head gear on; I did not like the fit and handed it back to him.  I then selected a ResMed Airfit P10 Nasal pillow mask since I had used this head gear with my previous CPAP machines.   I was in the PHM office for less than a half hour.
Per PHM response to my complaint, their insurance allowable rate for a ResMed S9 AutoSet CPAP machine is $940.00.  I believe that PHM has overcharged my insurance company ([redacted] and I for their products. 
 
The attached Delivery Ticket from PHM shows the charges applied the day I picked up my new ResMed S9 AutoSet CPAP machine.  The charges total $904.00, yet you will notice that the first insurance billing to [redacted] was $954.00.  I would also like to point out that line item 12 on the delivery ticket is the generic head gear item # S303005 that the technician was required by PHM have me try on, yet I handed it back to him.  I would also like to make you aware that the balance of the items billed out on the delivery ticket are standard items that come with the ResMed S9 AutoSet CPAP machine.  The only exception is the ResMed Airfit mask that I selected which I was $200.00 for, an item that regularly sells for $100.00-$115.00.
 
[redacted] Billing:
 
Here are the statements I have received from [redacted].
 
Date                      Amount Billed                   [redacted] Discount            Patient Responsibility
 
Sept 13, 2014     $954.00                 $290.63                 $663.37
Oct 17, 2014        $160.00                 $66.00                                   $94.00
Nov 08, 2014      $160.00                 $66.00                                   $94.00
Jan 24, 2015        $1500.00                              Claim Pending
 
To date I have paid PHM                                      �...⇄ $851.37
When I received the $1500.00 charge in January, I called the PHM billing department.  They told me that they would send me a detail report of my charges and that I owed them a balance of $940.00.  When I received the detailed statement it show’s my previous charges paid in full and a new invoice for $1500.00 and an amount due of $940.00, then I received another statement showing an amended amount $940.00 with an adjustment of -$282.00 for the three months of rental charges and a balance due of $658.00.  Although I received and amended invoice from PHM,  to my knowledge [redacted] has not received and amended invoice only the original %1500.00 billing.
 
Again, PHM has stated their insurance allowable rate for a ResMed S9 AutoSet CPAP machine is $940.00. 
 
I would like to offer the following for resolution in this matter:
 
I will agree to send PHM a check in the amount of $38.63.  Allowable rate for a ResMed S9 AutoSet CPAP machine is $940.00, less the $851.37 I have paid, less the $50.00 that both [redacted] and I were charged for the generic head gear that I did not receive.
 
PHM also stated in their response to this claim that “their only recourse would be to take back the equipment and write off the rentals” .
I would be happy to return their equipment upon my recipe of the $851.37 that I have paid.
 
 Sincerely,

Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. Sincerely, [redacted]

Complaint: [redacted]I am rejecting this response because:
They kept changing the amount and date due every time I came into the office, from 43.88 of 2015; to 60.10  and 10.44 from 2014; then to 43.88 from? I never received a bill from 2015. when I returned with new prescription in Nov. the amount was 35.88. I paid this because I am having surgery not because I believed it was valid.