Subject: ID# [redacted] To Whom It May Concern The letter that was sent to you and forwarded to me from BioConcepts contains multiple fallacies. I will provide the accurate information. First, as background my son was diagnosed with a very large and unusual Venous Malformation, for which he is followed at the Children's Hospital of Pennsylvania. It extends from his fingertips onto his chest on the right side, and up to the base of his neck. (He is not being treated for lymphatic retention-a much less urgent issue- as stated in their letter). The internationally renowned team at the Vascular Malformation Clinic there follows him, and has stressed how essential it is that he have well fitted custom garments to prevent development of clots which could embolize and be life threatening for him. Because there is no manufacturer of custom garments for small children in network with Blue Cross Blue Shield, the team said our only recourse was to use BioConcepts, and that they would be able to create the very necessary custom garment for my baby. They said that the garments were expensive but because it was medically necessary it would be covered by my insurance. For the measurements for each garment I have to take off of work and travel an hour each way so that the specially trained OT professional in the Vascular Malformation Clinic can measure my son (they do multiple points of measurement because the correct fit of the garment is very important). These measurements are then sent to BioConcepts in Arizona where two garments for each order were to be created to these exact measurements. He was to wear them 2417 except for bathing and peri-operatively when he experiences massive swelling and partial thickness tissue loss due to the embolization procedures. It was a struggle to obtain authorization from Blue Cross despite providing medical necessity documentation. Blue Cross continually told me that the claim had been authorized and the vendor had been paid, and then told the vendor that it wasn't authorized, and that I had been paid long before I was. Eventually Blue Cross would send me a check that I would use to pay BioConcepts. or use to pay off the large charge on my credit card, (minus months of interest), that BioConcepts insisted I make before they began to create it. There was a lot of miscommunication, but I have a perfect credit score and never leave anything unpaid. Out of the three sets of compression gloves that BioConcepts has created, two of the three sets were not made to measurements. The first error resulted in a glove that was far too long on the arm and could not be worn by my baby. This is not something that could be rolled or folded or cut. it would create a tourniquet This is not my impression as a parent, this was the professional assessment of the OT garment specialist who sent it back to them to be remade. The statement that "Mom was unhappy with the length of the sleeve" is completely false, it was far longer than my baby's arm, and could not be used. It was not shortened to accommodate "Mom", but at the direction of the OT professional who retumed it to them. Also erroneous is the claim that I demanded "professional courtesy" which I have never requested or expected in my life. I have no idea where they would come up with something like that. I did stress the medical urgency ofthe gam1ent, because it was frightening to think that because of paper work delays and miscommunications that my baby could possibly die, and I am sure that I became upset while banging my head against the walls ofthe insurance and this company. I did request that they communicate with Blue Cross manager who was telling me it was already authorized, and repeatedly providing their contact info, because there was clearly miscommunication between the two agencies. Instead they both kept insisting on making me the middle man, and delaying the creation of a garment and putting my son at risk. I did not have the option of going to another company, the OT therapist was only aware of this group. I spent so much time calling back and forth between the two companies that it affected my ability to work tull time (80+ hours/week) and care for my 5 children. I will absolutely admit that a company that is so callous and heartless that they wi II refuse to even make a phone call to confirm that insurance has authorized the garment, and makes a helpless baby wait for a necessary medical device that only they could provide, putting him at significant risk did absolutely upset me· and I challenge any parent who has a child in danger to feel differently. For the most recent set of garments they demanded full payment ahead of time for two gloves, and then made only one, and then comp/etelv not to measurements, it could not even be placed on my son again. Again I had to take time to travel to show OT and have him re-mcasured, the OT therapist confirmed that the measurements she provided to BioConcepts were still correct, and that the garment was not made to these measurements. My son then underwent another surgical procedure and the garment could not be worn until the massive swelling and soft tissue loss had resolved. In the meantime they were supposed to correct the incorrectly made garment. In their letter they state "Garment was shipped on May 25, Mom refused to take the garments to the therapist to have them evaluated". This again is completely incorrect, I saw the OT therapist on the next available appointment after receiving the "altered" garment, on June 14, 2016 again at the OT department at CHOP, The latest "alteration" was still completely wrong and could not be worn. The therapist was frustrated because after contacting BioConcepts again, they told her they would do no further alterations. Q At this point both the OT therapist and I were beyond frustrated with their lack of ability to provide the necessary garment (after paying over 600$ and receiving nothing he could wear, even temporarily). The therapist admitted that they have had increasing difficulty in their dealing with BioConcepts in general. as well as receiving more and more poorly made garments. The same OT therapist tried to lind some other avenue to obtain some type of compression that might work for my son, because we had no choice. She enlisted the help of another area that had worked with a company that created a new type of garment for lymphedema (a different medical condition that she thought might cross over to be able to help my son, but the application was experimental). Because BioConcepts had failed twice to provide a tilting garment. Imailed it back to them and requested my payment returned. I would be happy to obtain and provide documentation of my appointments at the OT department, in both May, June, and July, all because of the malfitting garment from BioForm. each time missing work and traveling over an hour each way. I have since met with OT in July twice and in September still working on the staging process for the new garment system. My son has been placed at medical risk because of lack of compression t()[ such long periods of time. and this company has still kept the 600+ dollars they were paid for a garment that was not made to measurements and was never able to be used. I have certainly never received reimbursement from them for the garment Ireturned, arld guarantee that they cannot provide evidence that they did. Their statement ''Mom is most difficult to deal with and only values her own opinion, further she has already been reimbursed for the garments" is ridiculous. The reimbursement that I am requesting will be immediately paid back to my Blue Cross carrier. as the product that was paid for was never provided, and this is fraud. None of this is my personal opinion, as they repeatedly state, but the assessment of the OT therapist who measured and requested the garments from this company. They also fail to mention that BioConcepts put me into collection for a garment that l had paid for month.\ before. and which they apologized for doing so at the time. I can provide third party documentation for each time the garment that they made did not fit, and could not be worn. Ea h time it was evaluated by a trained OT professionaL This is not a He-said-she-said issue. I can document that they did not provide the product, did not provide reimbursement, and that the statements they made about my not seeking a professional fitting are all incorrect. They are making blatantly false statements, and attempting to keep payment tor a product that they did not provide.
Revdex.com
1010 E. Missouri Avenue
Phoenix, AZ 85014
Conciliation & Engagement Dept.
Subject: ID# [redacted]
To Whom It May Concern
Thank you for bringing this to our attention. Let me bring out the history so there is a clearer picture of this situation. This child was treated for a vascular anomaly. He required custom compression garments and the mom was advised that as they would fit snuggly, the child would need to be re-measured at least every 3 months to allow for either growth of the child or reduction in the lymphatic retention. Bio-Concepts designs and manufactures custom compression garments.
On November 21, 2014, Bio-Concepts received the first order for this child from the ordering facility. Insurance information was provided and the mom was contacted. She had a Blue Cross/Blue Shield policy (BC/BS) that we are not contracted with. Understand, BC/BS has a national policy that they will not pay to providers that are not contracted. They will pay to the family, if they pay. Because of this, it is our policy to be paid upfront and file a courtesy claim for the policy holder. We would work on a prior authorization, if needed, but she would need to pay upfront. The mom was furious and refused to consider this. She demanded professional courtesy, as a physician, and insisted she would have the insurance pay to Bio-Concepts. Bio-Concepts worked with her BC/BS insurance and they provided an “Out of Network Exception” for the garments [2 sets]. The order shipped within 10 days of receiving the authorization. No returns or complaints at this time came from the mom or the therapist. A claim was filed the day the order shipped, December 22, 2014.
In March, 2015, Bio-Concepts received an order to make 2 new sets of custom compression garments for the child with new measurements. However, we had still not been paid for the original 2 sets. We contacted the mom and advised these would be out of pocket and she still owed for the original 2 garments. She again balked and insisted her insurance would cover. She eventually got a case manager to work with for her child. It was through the case manager that we finally got the BC/BS claims department to tell us that they in fact had paid the claim – to the mom. She had not sent payment on to Bio-Concepts. We left several messages and were finally paid April 15, 2015. The case manager also helped to obtain another prior authorization. The new sets were provided and a claim was filed. This time the insurance sent an EOB stating that in spite of the prior authorization, it was not a covered benefit and therefore, the patient’s responsibility. Mom eventually got her insurance to pay to her in May 2015. However, she didn’t pay to Bio-Concepts until August 19, 2015.
In August 2016 another 2 sets were ordered with new measurements and the same argument ensued. Mom refused to pay up front. A prior authorization was obtained and the garments were provided. Mom was unhappy with the length of the sleeve even though it match matched the length of the previous garments. The garments were shortened 1 inch to accommodate the mother. Mom received payment from the insurance and again Bio-Concepts had to prove she received payment and we were not paid until November 2015.
In March, 2016 Bio-Concepts received an order for 2 new sets and mom was sternly advised she would need to pay for them up front. It was not acceptable that we should have to work so hard to be paid for a service. It was her insurance and it is now her fight with them. As a medical practitioner and a policy holder, she has more weight with her insurance to pay promptly and to the vendor, than we do. She relented and paid. The garments were provided March 29, 2016. A claim was filed and mom has been reimbursed from her insurance. It paid to her April 14, 2016, Check# [redacted] in full.
Our warranty period is 30 days from day of receipt by the patient. It covers alterations or replacement resulting from defects in workmanship, materials or design. Mom returned these garments to Bio-Concepts in mid-may (out of warranty) for no charge alteration. Bio-concepts, wanting to keep peace, allowed the alteration per the therapist’s instructions for changes. All was done and shipped May 25, 2016. On June 17, 2016 Bio-Concepts received the garments back from the mom demanding a refund, stating they didn’t fit. She refused to take the garments to the therapist to have them evaluated.
We do not believe that Bio-Concepts is at fault for any errors with the final garments. Mom is most difficult to deal with and only values her own opinion. Further, she has already been reimbursed for the garments.
I hope this sheds some other light on this.
Sincerely,
Lari-Ann C. R[redacted]
Corporate Secretary
Subject: ID# [redacted] To Whom It May Concern The letter that was sent to you and forwarded to me from BioConcepts contains multiple fallacies. I will provide the accurate information. First, as background my son was diagnosed with a very large and unusual Venous Malformation, for which he is followed at the Children's Hospital of Pennsylvania. It extends from his fingertips onto his chest on the right side, and up to the base of his neck. (He is not being treated for lymphatic retention-a much less urgent issue- as stated in their letter). The internationally renowned team at the Vascular Malformation Clinic there follows him, and has stressed how essential it is that he have well fitted custom garments to prevent development of clots which could embolize and be life threatening for him. Because there is no manufacturer of custom garments for small children in network with Blue Cross Blue Shield, the team said our only recourse was to use BioConcepts, and that they would be able to create the very necessary custom garment for my baby. They said that the garments were expensive but because it was medically necessary it would be covered by my insurance. For the measurements for each garment I have to take off of work and travel an hour each way so that the specially trained OT professional in the Vascular Malformation Clinic can measure my son (they do multiple points of measurement because the correct fit of the garment is very important). These measurements are then sent to BioConcepts in Arizona where two garments for each order were to be created to these exact measurements. He was to wear them 2417 except for bathing and peri-operatively when he experiences massive swelling and partial thickness tissue loss due to the embolization procedures. It was a struggle to obtain authorization from Blue Cross despite providing medical necessity documentation. Blue Cross continually told me that the claim had been authorized and the vendor had been paid, and then told the vendor that it wasn't authorized, and that I had been paid long before I was. Eventually Blue Cross would send me a check that I would use to pay BioConcepts. or use to pay off the large charge on my credit card, (minus months of interest), that BioConcepts insisted I make before they began to create it. There was a lot of miscommunication, but I have a perfect credit score and never leave anything unpaid. Out of the three sets of compression gloves that BioConcepts has created, two of the three sets were not made to measurements. The first error resulted in a glove that was far too long on the arm and could not be worn by my baby. This is not something that could be rolled or folded or cut. it would create a tourniquet This is not my impression as a parent, this was the professional assessment of the OT garment specialist who sent it back to them to be remade. The statement that "Mom was unhappy with the length of the sleeve" is completely false, it was far longer than my baby's arm, and could not be used. It was not shortened to accommodate "Mom", but at the direction of the OT professional who retumed it to them. Also erroneous is the claim that I demanded "professional courtesy" which I have never requested or expected in my life. I have no idea where they would come up with something like that. I did stress the medical urgency ofthe gam1ent, because it was frightening to think that because of paper work delays and miscommunications that my baby could possibly die, and I am sure that I became upset while banging my head against the walls ofthe insurance and this company. I did request that they communicate with Blue Cross manager who was telling me it was already authorized, and repeatedly providing their contact info, because there was clearly miscommunication between the two agencies. Instead they both kept insisting on making me the middle man, and delaying the creation of a garment and putting my son at risk. I did not have the option of going to another company, the OT therapist was only aware of this group. I spent so much time calling back and forth between the two companies that it affected my ability to work tull time (80+ hours/week) and care for my 5 children. I will absolutely admit that a company that is so callous and heartless that they wi II refuse to even make a phone call to confirm that insurance has authorized the garment, and makes a helpless baby wait for a necessary medical device that only they could provide, putting him at significant risk did absolutely upset me· and I challenge any parent who has a child in danger to feel differently. For the most recent set of garments they demanded full payment ahead of time for two gloves, and then made only one, and then comp/etelv not to measurements, it could not even be placed on my son again. Again I had to take time to travel to show OT and have him re-mcasured, the OT therapist confirmed that the measurements she provided to BioConcepts were still correct, and that the garment was not made to these measurements. My son then underwent another surgical procedure and the garment could not be worn until the massive swelling and soft tissue loss had resolved. In the meantime they were supposed to correct the incorrectly made garment. In their letter they state "Garment was shipped on May 25, Mom refused to take the garments to the therapist to have them evaluated". This again is completely incorrect, I saw the OT therapist on the next available appointment after receiving the "altered" garment, on June 14, 2016 again at the OT department at CHOP, The latest "alteration" was still completely wrong and could not be worn. The therapist was frustrated because after contacting BioConcepts again, they told her they would do no further alterations. Q At this point both the OT therapist and I were beyond frustrated with their lack of ability to provide the necessary garment (after paying over 600$ and receiving nothing he could wear, even temporarily). The therapist admitted that they have had increasing difficulty in their dealing with BioConcepts in general. as well as receiving more and more poorly made garments. The same OT therapist tried to lind some other avenue to obtain some type of compression that might work for my son, because we had no choice. She enlisted the help of another area that had worked with a company that created a new type of garment for lymphedema (a different medical condition that she thought might cross over to be able to help my son, but the application was experimental). Because BioConcepts had failed twice to provide a tilting garment. Imailed it back to them and requested my payment returned. I would be happy to obtain and provide documentation of my appointments at the OT department, in both May, June, and July, all because of the malfitting garment from BioForm. each time missing work and traveling over an hour each way. I have since met with OT in July twice and in September still working on the staging process for the new garment system. My son has been placed at medical risk because of lack of compression t()[ such long periods of time. and this company has still kept the 600+ dollars they were paid for a garment that was not made to measurements and was never able to be used. I have certainly never received reimbursement from them for the garment Ireturned, arld guarantee that they cannot provide evidence that they did. Their statement ''Mom is most difficult to deal with and only values her own opinion, further she has already been reimbursed for the garments" is ridiculous. The reimbursement that I am requesting will be immediately paid back to my Blue Cross carrier. as the product that was paid for was never provided, and this is fraud. None of this is my personal opinion, as they repeatedly state, but the assessment of the OT therapist who measured and requested the garments from this company. They also fail to mention that BioConcepts put me into collection for a garment that l had paid for month.\ before. and which they apologized for doing so at the time. I can provide third party documentation for each time the garment that they made did not fit, and could not be worn. Ea h time it was evaluated by a trained OT professionaL This is not a He-said-she-said issue. I can document that they did not provide the product, did not provide reimbursement, and that the statements they made about my not seeking a professional fitting are all incorrect. They are making blatantly false statements, and attempting to keep payment tor a product that they did not provide.
inherit; background-clip: inherit; background-color: transparent; border-right: inherit; font-size: 17.6px; margin: 12px 1px 9px 0px; padding: 0px 0px 0px 8px;">October 4, 2016
Revdex.com
1010 E. Missouri Avenue
Phoenix, AZ 85014
Conciliation & Engagement Dept.
Subject: ID# [redacted]
To Whom It May Concern
Thank you for bringing this to our attention. Let me bring out the history so there is a clearer picture of this situation. This child was treated for a vascular anomaly. He required custom compression garments and the mom was advised that as they would fit snuggly, the child would need to be re-measured at least every 3 months to allow for either growth of the child or reduction in the lymphatic retention. Bio-Concepts designs and manufactures custom compression garments.
On November 21, 2014, Bio-Concepts received the first order for this child from the ordering facility. Insurance information was provided and the mom was contacted. She had a Blue Cross/Blue Shield policy (BC/BS) that we are not contracted with. Understand, BC/BS has a national policy that they will not pay to providers that are not contracted. They will pay to the family, if they pay. Because of this, it is our policy to be paid upfront and file a courtesy claim for the policy holder. We would work on a prior authorization, if needed, but she would need to pay upfront. The mom was furious and refused to consider this. She demanded professional courtesy, as a physician, and insisted she would have the insurance pay to Bio-Concepts. Bio-Concepts worked with her BC/BS insurance and they provided an “Out of Network Exception” for the garments [2 sets]. The order shipped within 10 days of receiving the authorization. No returns or complaints at this time came from the mom or the therapist. A claim was filed the day the order shipped, December 22, 2014.
In March, 2015, Bio-Concepts received an order to make 2 new sets of custom compression garments for the child with new measurements. However, we had still not been paid for the original 2 sets. We contacted the mom and advised these would be out of pocket and she still owed for the original 2 garments. She again balked and insisted her insurance would cover. She eventually got a case manager to work with for her child. It was through the case manager that we finally got the BC/BS claims department to tell us that they in fact had paid the claim – to the mom. She had not sent payment on to Bio-Concepts. We left several messages and were finally paid April 15, 2015. The case manager also helped to obtain another prior authorization. The new sets were provided and a claim was filed. This time the insurance sent an EOB stating that in spite of the prior authorization, it was not a covered benefit and therefore, the patient’s responsibility. Mom eventually got her insurance to pay to her in May 2015. However, she didn’t pay to Bio-Concepts until August 19, 2015.
In August 2016 another 2 sets were ordered with new measurements and the same argument ensued. Mom refused to pay up front. A prior authorization was obtained and the garments were provided. Mom was unhappy with the length of the sleeve even though it match matched the length of the previous garments. The garments were shortened 1 inch to accommodate the mother. Mom received payment from the insurance and again Bio-Concepts had to prove she received payment and we were not paid until November 2015.
In March, 2016 Bio-Concepts received an order for 2 new sets and mom was sternly advised she would need to pay for them up front. It was not acceptable that we should have to work so hard to be paid for a service. It was her insurance and it is now her fight with them. As a medical practitioner and a policy holder, she has more weight with her insurance to pay promptly and to the vendor, than we do. She relented and paid. The garments were provided March 29, 2016. A claim was filed and mom has been reimbursed from her insurance. It paid to her April 14, 2016, Check# [redacted] in full.
Our warranty period is 30 days from day of receipt by the patient. It covers alterations or replacement resulting from defects in workmanship, materials or design. Mom returned these garments to Bio-Concepts in mid-may (out of warranty) for no charge alteration. Bio-concepts, wanting to keep peace, allowed the alteration per the therapist’s instructions for changes. All was done and shipped May 25, 2016. On June 17, 2016 Bio-Concepts received the garments back from the mom demanding a refund, stating they didn’t fit. She refused to take the garments to the therapist to have them evaluated.
We do not believe that Bio-Concepts is at fault for any errors with the final garments. Mom is most difficult to deal with and only values her own opinion. Further, she has already been reimbursed for the garments.
I hope this sheds some other light on this.
Sincerely,
Lari-Ann C. R[redacted]
Corporate Secretary