Surgi-Care, Inc.

Revdex.com:I spoke with *** this morningHe put the check in the mail today
I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #***I understand that by choosing to accept the business response that my complaint will be closed as resolved.
Regards,
*** ***

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ***Please add your rejection comments below.
I will not accept until Surgi-Care gets this straightened outLast week I received calls from the collections departmentThe first call was on Tuesday, February 6, the guy who called said he'd call me back in minutes once he had time to review my caseI didn't get a call until the next day, Wednesday, February when he started saying the same generic messageHe told me he would call back but has yet to, it is a week later.
Regards,
*** ***

(A copy of this letter and an updated invoice is being mailed to the customer today via ***.) Dear Ms***, We see that an invoice for the full amount was printed and mailed on August 22, The reason this printed with the full amount is that the bill was not finalized until the
CPM was returned, as we do not know how many days we will have to bill for until we have it returnedYour son’s CPM was picked up by *** on August 18th and was received by Surgi-Care on August 21stThe bill was printed and mailed by invoicing statement software before our cash application team could apply your $paymentUnfortunately because of the timing it was applied right after the invoice was sent The invoicing statement software automatically sends invoices for unpaid balances every days so you will most likely receive an invoice this week, which will include your applied paymentWe manually printed an updated invoice from the software today showing your payment of $170.00, which we have included with this letter If you have any additional questions please don’t hesitate to contact our billing department at ###-###-#### Sincerely, *** *** Compliance Officer Surgi-Care, Inc

Dear Ms***,We have reached out to our *** *** ** *** *** contracting representative for more clarification on this claimWe will be in touch shortly as soon as we hear back from the representativeThank you for your patience.Thank you,*** ***

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ***Please add your rejection comments below.
Your response confirms that it is common practice to overbill clientsSomehow surgi-care knows that we already paid $170, and it is not shown on the billIt is not clear how receiving the returned CPM has any connection to the amount already paid.
Regards,
*** ***

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted].  I spoke with [redacted] MA. The claims had been submitted by Surgi-care in September. On December 18 surgi-care cancelled these claims. My insurance had covered this. This claim needs to be resubmitted.
 
Regards,
[redacted]

Dear Ms. [redacted] spoke with you about your account on the phone earlier, but we wanted to submit a formal response. After speaking with our customer representative from [redacted] of Massachusetts, they have decided to make an exception and pay your claim. Since they are paying and since you met your out-of-pocket maximum for the year by the date of service we are refunding you the $174.39 you had previously paid for the CPM machine. If you do not receive the check between now and three weeks please contact [redacted] directly. We apologize for the inconvenience this caused, but we are glad that your claim has been resolved. Sincerely,[redacted]Compliance Officer

Hi Ms. [redacted], I’m sorry you are frustrated with the conflicting information you received from Surgi-Care and your insurance company; we are frustrated as well. We spoke with your insurance company and they informed us that the system they have in place for automatically denying claims that do...

not meet the medical necessity guidelines was manually overridden by an associate in their claims department. They have since educated the associate and assured us that this error will not occur again. Your insurance company let us know that their Member Services Department has contacted you to explain the error and to speak with you about it. Please let us know if you have not yet heard from them. Thank you, [redacted] Compliance Officer

Dear Mr. [redacted], We disagree with your claim that we overbill clients. You received a statement for the full amount invoiced. As we previously stated, the reason the statement did not show your payment was because it had not yet been applied to that particular invoice before the invoicing statement software automatically printed and sent a statement. The statements get printed and sent out every 30 days so the next statement you receive will show your payment. The payment was in your account, but the invoice has to be created before payment can be applied to it specifically. If you had paid the full amount, in addition to the $170.00 you already paid, you would have immediately received a refund for the overpayment of $170.00. You stated, “Your response confirms that it is common practice to overbill clients.” The definition of overbill is, “to send or give a bill for more than the correct amount.” The initial statement you received was the correct amount for the total CPM rental period; it just did not have your payment applied yet. However, we will reiterate that although your payment had not yet been applied on that particular statement that printed, every other statement printed after that one would show your payment, as well as any customer service representative would be able to confirm over the phone that your payment was in your account. You stated, “Somehow surgi-care knows that we already paid $170, and it is not shown on the bill.” The $170.00 payment was in your account, but had not yet been applied to your particular invoice because our cash application team has to wait until an invoice is created before applying any payments in a customer’s account to the invoice. Your initial statement printed before your payment had been applied. As previously explained, this is why your payment did not appear on your initial bill. You stated, “It is not clear how receiving the returned CPM has any connection to the amount already paid.” As we explained in our previous letter the invoice cannot be created until the CPM is returned because the final amount is determined by the number of days the CPM is rented. As mentioned above, the invoice must be created before the payment can be applied. Occasionally, the invoicing statement software will automatically print before this payment can be applied. We recognize your confusion with seeing the initial statement without your payment line-itemed on it, but we hope the above explanation has cleared your confusion. According to our records, the remaining balance on the account is $194.29 and we hope you honor your legal contract with Surgi-Care to pay your balance in full at your convenience.   Sincerely, [redacted] Compliance Officer Surgi-Care, Inc.

Dear Ms. [redacted], Thank you for reaching out to us about your concerns regarding the invoice you received for the CPM machine. As you are aware, the CPM does not meet the medical policy required by your insurance, [redacted]. Under the [redacted] of Massachusetts medical policy CPMs are only covered for...

total knee replacements or microfracture procedures, neither of which were a diagnosis in your chart. Since the CPM is not covered under your insurance policy, it is not related to your out-of-pocket maximum. An out-of-pocket maximum is only for covered services under your medical plan. I have included a print-out from the [redacted] of Massachusetts website. Due to this, our records indicate that you still owe the remaining $165.61 balance on your account for this non-covered service. This balance will not be sent to collections until 4/1/2018 so if you pay your balance before then it will not be transferred to collections. Please visit www.surgi-care.com or call any of our billing customer service representatives at [redacted] to pay your bill. If you have any additional questions please don’t hesitate to contact me at [redacted]. Sincerely, [redacted] Compliance Officer Surgi-Care, Inc.