The Dukester, LLC

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this proposed action would not resolve my complaint For your reference, details of the offer I reviewed appear below.They refuse to acknowledge the rude and demeaning behavior of their representative and they did not address as to why they refused to let us speak to a supervisorThe lack of response or any research into the complaint shows me that this is not a concern for themIn business there may be disputes and miscommunications but refusing to discuss a matter and to try and find a resolution is not an acceptable business practiceThis place seems to think it is per their response to the complaintI did some more research and I noticed this is not the first complaint filed with the Revdex.com about this billing discrepancy issue, there were several more complaints about the bill not being as quoted for this exact same testTo date we have not received any calls from this business to try and resolve the disputeWe would prefer to find a solution so this issue is no longer a disputed matter, but that would require this business to make an attempt to resolveIf they are not willing to try and resolve this issue I will be forced to file my next complaints with the Attorney General, CFPB and The Medical Board of California (since the main office is located there) Regards, [redacted]

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this case, the patient was covered by private health insurance We received the processed claim from the patient’s insurance company on December 31, As the patient had not yet met her in-network deductible, $was applied to the patient’s deductible and billed to the patient as governed by her insurance plan The patient should have received the explanation of benefits from the insurer which clearly identifies the patient’s responsibility of $Sequenom Laboratories invoiced the patient in accordance with the explanation of benefits from her insurer, which we are obligated to do pursuant to our contract with the insurer Sequenom Laboratories has no record of the patient or her spouse contacting us prior to the test We maintain call logs of all calls with patients and we show only one call from the patient’s spouse which was received on January 11, During that call, our representative explained the charge and offered a discount if the patient was willing to pay promptly which the spouse refused Again, our records do not reflect any conversations with the patient or her spouse other than the call on January We would also not quote a self-pay cash price of “around $400.” The self-pay cash price at the time was $and is not quoted by us as an estimate For a patient with private insurance, the amount for which the patient is responsible is dependent on the patient’s applicable co-pays and the balance of the patient’s deductible obligations Sequenom Laboratories is confident that its billing practices are compliant with its contractual obligations to healthcare insurance providers and with proper healthcare billing practices In addition, we are confident that our customer service representatives explain billing maters thoroughly and transparently Very truly yours, [redacted] Senior VP, General Counsel & Secretary

I received an email today from the company about my credit being fixedI did notice it's been fixed as well.Thank you for your enormous assistance in helping to resolve this issue

Sequenom Laboratories provided a detailed and complete response to the consumer's complaint. The consumer's response is a recitation of the initial complaint. As such, Sequenom Laboratories has no further response

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" type="#_x0000_t202" o:spid="_x0000_s1026">
 January 18, 2016
 
 
VIA ONLINE SUBMISSION
 
Revdex.com of San Diego & Imperial Counties
 
Re: ID # [redacted]
 
Ladies and Gentlemen:
 
Please accept this response to the above referenced matter involving a question regarding Sequenom Laboratories’ billing of a patient for its MaterniT21® PLUS non-invasive prenatal screening test. 
 
In this case, the patient was covered by private health insurance.  We received the processed claim from the patient’s insurance company on December 31, 2015.  As the patient had not yet met her in-network deductible, $823.50 was applied to the patient’s deductible and billed to the patient as governed by her insurance plan.  The patient should have received the explanation of benefits from the insurer which clearly identifies the patient’s responsibility of $823.50. Sequenom Laboratories invoiced the patient in accordance with the explanation of benefits from her insurer, which we are obligated to do pursuant to our contract with the insurer.
 
Sequenom Laboratories has no record of the patient or her spouse contacting us prior to the test.  We maintain call logs of all calls with patients and we show only one call from the patient’s spouse which was received on January 11, 2016.  During that call, our representative explained the charge and offered a discount if the patient was willing to pay promptly which the spouse refused.  Again, our records do not reflect any conversations with the patient or her spouse other than the call on January 11.  We would also not quote a self-pay cash price of “around $400.”  The self-pay cash price at the time was $995 and is not quoted by us as an estimate.   For a patient with private insurance, the amount for which the patient is responsible is dependent on the patient’s applicable co-pays and the balance of the patient’s deductible obligations.
 
 
Sequenom Laboratories is confident that its billing practices are compliant with its contractual obligations to healthcare insurance providers and with proper healthcare billing practices.  In addition, we are confident that our customer service representatives explain billing maters thoroughly and transparently.
 
Very truly yours,
 
[redacted]
Senior VP, General Counsel & Secretary

July 17, 2015
 
Roman","serif";
color:windowtext"> 
VIA
ONLINE SUBMISSION
 
Revdex.com of San Diego & Imperial Counties
 
Re: ID # [redacted]
 
Ladies and Gentlemen:
 
Please
accept this response to the above referenced matter involving a question
regarding Sequenom Laboratories’ billing of a patient for its MaterniT21®
PLUS non-invasive prenatal screening test. 
In sum, there appears to be a misunderstanding on the part of the
patient as to her financial obligation and she has omitted several key facts.  We also dispute the patient’s
characterization of communications with us regarding the matter.
 
In
this case, the patient was covered by private health insurance.  In accordance with our contract with that
insurer, it allowed $820.00 to be eligible for payment to Sequenom Laboratories
for its test.  As the patient had not yet
met her in-network deductible, the entire amount was applied to the patient’s
deductible and billed to the patient as governed by her insurance plan.  The attached (redacted) explanation of
benefits from the insurance company outlines the above information.  The patient would have received the
explanation of benefits from the insurer which clearly identifies the patient’s
responsibility of $820.00. Sequenom Laboratories invoiced the patient in
accordance with the explanation of benefits from her insurer, which we are
obligated to do pursuant to our contract with the insurer.
 
Sequenom
Laboratories sent invoices to the patient on March 19, 2015, April 18, 2015,
May 9, 2015 and May 30, 2015 and never received a payment, inquiry or response
from the patient.  In order to fulfill
our obligation to the insurance company to collect the patient’s deductible,
the account was sent to a collection agency on June 22, 2015 – more than three
months after the initial invoice was sent to the patient.  On July 6, 2015, we were contacted for the
first time by the patient’s spouse who was upset that the account was with a
collection agency.  Our representative
explained to him that, once the account has been turned over to a collection
agency, we are no longer able to discuss the account and that all communication
must be with the agency.  We dispute that
our representative was unprofessional or demeaning.
 
The
patient states that the test “should have cost $200.00.” Sequenom Laboratories,
of course, does not know what information was conveyed to the patient by her
healthcare provider.  However, it appears
that the patient’s belief could be based upon Sequenom Laboratories’ Patient’s
Guide (copy attached). 
 
The
Patient’s Guide clearly explains the billing process and the allocations of the
amounts of the charges.  In describing
the explanation of benefits, the guide states: “After your insurance claim has
been processed by your insurer, if your Explanation of Benefits (EOB) indicates
you are to pay a co-pay or deductible, we will send you a bill for the amount
specified.”  This is, in fact, precisely
what was done by Sequenom Laboratories. 
It billed the patient for the amount of her deductible as directed by
her health insurer.  Pursuant to our
contractual arrangement with insurance companies and proper healthcare billing
practices, we are obligated to bill and collect these amounts from patients.
 
The Patient’s Guide also contains a box that describes
typical out-of-pocket costs for in-network HMO and PPO patients (as was the
case here) and does state that “Co-payment for in-network plans is typically $200
or less, after your private insurance deductible is met” (emphasis
added). In fact, in this case, the
patient had no co-payment as the patient’s remaining deductible exceeded $820.00
which is why the patient is responsible for the full amount.  Importantly, the patient’s insurance company
credited this amount to the patient’s deductible which served to reduce the
remaining amount of the deductible applicable to subsequent healthcare costs.
It would be inappropriate for the patient to not pay what she is responsible to
pay under her insurance plan.
 
In
summary, Sequenom Laboratories is confident that its billing practices are
compliant with its contractual obligations to healthcare insurance providers
and with proper healthcare billing practices. 
In addition, our Patient’s Guide is clear and accurate as to how we bill
patients and what charges they should expect and our practice in this case, as
in all cases, was appropriate and entirely consistent with our written
communications.
 
Very truly yours,
 
 
[redacted] D. [redacted]
Senior VP, General Counsel & Secretary
 
[redacted]
Enclosures

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.They refuse to acknowledge the rude and demeaning behavior of their representative and they did not address as to why they refused to let us speak to a supervisor. The lack of response or any research into the complaint shows me that this is not a concern for them. In business there may be disputes and miscommunications but refusing to discuss a matter and to try and find a resolution is not an acceptable business practice. This place seems to think it is per their response to the complaint. I did some more research and I noticed this is not the first complaint filed with the Revdex.com about this billing discrepancy issue, there were several more complaints about the bill not being as quoted for this exact same test. To date we have not received any calls from this business to try and resolve the dispute. We would prefer to find a solution so this issue is no longer a disputed matter, but that would require this business to make an attempt to resolve. If they are not willing to try and resolve this issue I will be forced to file my next complaints with the Attorney General, CFPB and The Medical Board of California (since the main office is located there).
Regards,
[redacted]