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] MAThe claims had been submitted by Surgi-care in SeptemberOn December surgi-care cancelled these claimsMy insurance had covered thisThis claim needs to be resubmitted Regards, [redacted]
Dear Ms [redacted] , [redacted] spoke with you about your account on the phone earlier, but we wanted to submit a formal responseAfter speaking with our customer representative from [redacted] of Massachusetts, they have decided to make an exception and pay your claimSince 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 $you had previously paid for the CPM machineIf you do not receive the check between now and three weeks please contact [redacted] directlyWe apologize for the inconvenience this caused, but we are glad that your claim has been resolvedSincerely, [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 wellWe 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 departmentThey have since educated the associate and assured us that this error will not occur againYour insurance company let us know that their Member Services Department has contacted you to explain the error and to speak with you about itPlease let us know if you have not yet heard from themThank you, [redacted] Compliance Officer
Dear Ms [redacted] , Thank you for reaching out to us about your concerns regarding the invoice you received for the CPM machineAs you are aware, the CPM does not meet the medical policy required by your insurance, ***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 chartSince the CPM is not covered under your insurance policy, it is not related to your out-of-pocket maximumAn out-of-pocket maximum is only for covered services under your medical planI have included a print-out from the [redacted] of Massachusetts websiteDue to this, our records indicate that you still owe the remaining $balance on your account for this non-covered serviceThis balance will not be sent to collections until 4/1/so if you pay your balance before then it will not be transferred to collectionsPlease visit www.surgi-care.com or call any of our billing customer service representatives at [redacted] to pay your billIf you have any additional questions please don’t hesitate to contact me at [redacted] Sincerely, [redacted] Compliance Officer Surgi-Care, Inc
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] MAThe claims had been submitted by Surgi-care in SeptemberOn December surgi-care cancelled these claimsMy insurance had covered thisThis claim needs to be resubmitted Regards, [redacted]
Dear Ms [redacted] , [redacted] spoke with you about your account on the phone earlier, but we wanted to submit a formal responseAfter speaking with our customer representative from [redacted] of Massachusetts, they have decided to make an exception and pay your claimSince 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 $you had previously paid for the CPM machineIf you do not receive the check between now and three weeks please contact [redacted] directlyWe apologize for the inconvenience this caused, but we are glad that your claim has been resolvedSincerely, [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 wellWe 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 departmentThey have since educated the associate and assured us that this error will not occur againYour insurance company let us know that their Member Services Department has contacted you to explain the error and to speak with you about itPlease let us know if you have not yet heard from themThank you, [redacted] Compliance Officer
Dear Ms [redacted] , Thank you for reaching out to us about your concerns regarding the invoice you received for the CPM machineAs you are aware, the CPM does not meet the medical policy required by your insurance, ***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 chartSince the CPM is not covered under your insurance policy, it is not related to your out-of-pocket maximumAn out-of-pocket maximum is only for covered services under your medical planI have included a print-out from the [redacted] of Massachusetts websiteDue to this, our records indicate that you still owe the remaining $balance on your account for this non-covered serviceThis balance will not be sent to collections until 4/1/so if you pay your balance before then it will not be transferred to collectionsPlease visit www.surgi-care.com or call any of our billing customer service representatives at [redacted] to pay your billIf you have any additional questions please don’t hesitate to contact me at [redacted] Sincerely, [redacted] Compliance Officer Surgi-Care, Inc