Rocky Mountain Medical

This client did present in our office in May of 2015 requesting a mobility device and at that time we informed her of what is required by the insurance company in order to supply this piece of equipment (attached).  On June 19th, we received a basic prescription for an electric scooter. ...

We contacted client to explain insurance requirements and scheduled to meet client at her physical therapy appointment on 8/4/2015.  We received an incomplete seven element rx and chart notes from the physical therapy visit that did not indicate any need for the power operated vehicle (scooter).  We contacted client to discuss needs for scooter as initial indication for the use of equipment is for long distance use or primarily for outdoor activities which is non-covered by insurance (see attached).  There was a request by the client for a larger battery to allow for longer distance between charging which confirmed that this would be used outside the home and would require additional information to provide medical necessity to the insurance.  We explained that we required additional information to support use within the home to determine if insurance is going to cover.  We reached out several times to the physical therapist and finally received contact on 9/25/2015.  The therapist indicated that the client would benefit from use of a scooter for outdoor/community activities and was seeing the client that day and would discuss additional use.  We received notes from that evaluation on 10/1/2015 which further discussed need for community ambulation and did mention possibility of use in the home but did not detail the insurance requirements 1-5 (attached).  We contacted client on 10/1/15, gave information, she indicated that she had an appointment with her physician that day and would discuss the face to face requirements.  We called on 10/11/15 to follow up on appointment, left message requesting a return call.  Called again 10/20/15, left message on machine requesting a return call.  Called on 11/4/15, spoke to client, she did see her physician and stated that she wanted us to send the authorization request to her insurance and skip the additional information request from her physician.  We require the completion of the detailed product description signed by the physician so we faxed to the office for completion.  On 11/17/15, we called physicians office for status and l/m for medical assistant to return call.  We called ordering physician again on 11/24/2015 and were told by MA that client had not been seen since the initial prescription was written in June and that they could not complete any additional paperwork until the patient was seen.  We called client and was told that she saw her orthopedic physician for the face to face evaluation, we obtained that contact information.  We called the orthopedic physician on the same day and left a message requesting a return call.  We were able to discuss necessary paperwork with MA at that office and on 12/4/2015 we received a call from the orthopedic physicians office stating that there was no documentation in the chart from that visit stating that the client needed the equipment so she would have to make an appointment to discuss with the physician.  We called client the same day and left a message with a gentleman requesting a return call.  On 12/18/2015 we left a message with a gentleman that we cannot proceed until we receive a call back from client and we will be canceling the order if we don't hear back.  We did not hear from customer until February 22, 2016 stating that she contacted her insurance company and was told that nothing other than a prescription is required to obtain a scooter.  Our general manager discussed that with client and was told to proceed without the information that [redacted] publishes as required documentation for payment of a scooter.  The order was re-instated that day.   Sent DPD to physician as this was never received from either PCP or Orthopedic physician prior to inactivation of order previously.  Insurance was re-verified to confirm eligibility on the policy, customer was contacted regarding copay that was necessary and after several conflicting phone calls to insurance (twice being told that authorization was not required and once that it was), we confirmed that prior authorization was not needed.  Customer declined a pre-determination and in order to proceed with ordering the piece of equipment, we had to obtain an Advanced Beneficiary Notice to disclose to customer that we do not believe that we have the medical necessity on file to support the need for the equipment and that in the event that the insurance denies, she would be financially responsible.  We received signed ABN and copay from client and received the DPD from physician on 4/6/2016.  At which time the scooter was ordered and client notified that the scooter was ordered.  On 4/12/16 our General Manager spoke to client again with status and that scooter was expected to arrive on 4/15/16 or at the latest by 4/18/2016.  The scooter was received in our office on 4/14/2016 and the client was contacted to schedule delivery on 4/15/2016.  RMME attempts to obtain and communicate all necessary documentation requirements from an insurance company to prevent a situation where a client is billed for services that could have been prevented.  In this scenario, we attempted to collect all documentation to support the need for this scooter and assist this client in receiving coverage.  At no time did we intend to upset this client or prevent services from being provided, we were simply following the requirements set forth by the insurance company according to our contract requirements.  We pride ourselves on going above and beyond to assist the client and are saddened that this client feels that our attempts are unsatisfactory.  If there is any additional information that is necessary, please feel free to contact me at ###-###-#### Ext. [redacted].  Kind Regards,  [redacted]