Although TriCore understands the Consumer’s frustration, there seems to be some miscommunication between the Consumer and his case manager [redacted] TriCore does not have a contractual arrangement with [redacted] to receive paymentsThe arrangement is between the consumer and [redacted] In spite of the Consumers extremely disparaging remarks and verbal abuse towards TriCore’s employees, TriCore contacted [redacted] of New Mexico on behalf of the ConsumerPer [redacted] , it is the patient’s responsibility to provide information to [redacted] to process the co-payments due [redacted] is waiting for the receipt of information from the patientThey are aware of both accounts and are waiting for the 6/15/Explanation of Medical Benefits (EOB) TriCore telephoned the Consumer and with the Consumer’s permission, faxed the 6/15/EOB to [redacted] for him Per [redacted] , payments for both outstanding accounts should be made by end of weekTriCore notified its third-party collection agency to place the patient’s accounts on a 30-day hold until payment is received TriCore’s billing practices are conducted in conformance with State and Federal laws and conform with industry standardsTriCore adamantly denies any of its business practices are predatory, lacking compassion or malicious
Account #1: Mr [redacted] obtained laboratory services in April after which there was an outstanding balance related to the patient’s insurance deductibleTriCore sent billing statements to Mr [redacted] on the following dates: 4/29/2014, 6/4/and 7/9/and received no response and no returned mail The account was sent to soft bad debt in August Additional statements were sent to Mr [redacted] on the following dates: 8/26/ and 10/10/and received no response and no returned mail The account was sent to bad-debt collections in November of Outbound telephone calls were made on the following dates: 5/07/at 4:15pm, 6/10/at 9:12am- message left, 6/27/at 12:32pm and 7/30/at 4:22pm Account #2: Mr [redacted] obtained laboratory services in May after which there was an outstanding balance related to the patient’s insurance deductibleTriCore sent billing statements to Mr [redacted] on the following dates: 5/28/2014, 6/4/and 7/9/and received no response and no returned mail The account was sent to soft bad debt in August Additional statements were sent on 8/26/and 10/10/and received no response and no returned mail, The account was sent to bad-debt collections in November Outbound calls were made on the following dates: 6/10/ at 9:12am- message left, 6/27/at 12:28pm message left and 7/30/at 4:22pm All statements were sent to the following address: [redacted] We have no record of patient ever calling TriCore or the soft bad debt agency concerning "missing" bills 1/27/4:29pm: A TriCore customer service rep received a call from the collection agency to inquiring about the balances The customer service rep informed the collection agency that the balances were due to patient’s deductibleThe collection agency was then going to inform the patient 3/23/10:18am: Another customer service rep received a call from patient wanted to know if make the payment on the original balance because he could not afford to pay the collection interest Patient was advised that TriCore no longer had the accounts and payment arrangements must be made directly with the collection agency 9/25/9:34am: A customer service rep received another call from Mr [redacted] stating that he is trying to buy a house and these two accounts are on his credit reportHe stated he had paid collection agencyHe stated that TriCore had an incorrect mailing addressThe customer service rep verified address confirming the current addressThe customer service rep told Mr [redacted] that the bills were all sent to the current address and TriCore never received return mail from this addressThe customer service rep called the collection agency and asked if the collection agency could send a letter to MrMr [redacted] stating the charges had been paid so he could show his mortgage companyThe collection agency agreed
11/25/$service performed There were several unfortunate factors that affected Ms [redacted] claimWe've outlined some below: 1/16/$BCBSNM processed the claim which denied as ‘not covered when performed for the reported diagnosis’ and indicated patient is responsible for the non-covered chargeBCBSNM notifies the patient by sending an Explanation of Medical Benefits letter 3/16/During an audit the charges re-billed to patient responsibility 4/25/Ms [redacted] called Customer Service to inquire about the bill she received She questioned what the lab test was for and was advised to contact her doctor to let TriCore know if there were corrected or additional diagnosis codes She stated that her doctor retired and would do some research 5/5/Ms [redacted] asked TriCore to resubmit the claimShe was advised by her insurance that the claim was past timely filing and the claim could not be submitted for reprocessing without corrections due to the denialShe stated her doctor was retired and revisions could not be made Patient stated she would have insurance call TriCore to inform us where to send corrected claim TriCore submitted the information that was received from the ordering provider when the lab test was performed TriCore relies on the provider to submit the correct information when lab tests are requested and/or submitted The diagnosis that the provider supplied was considered a non-covered diagnosis leaving the charge to patient responsibility by BCBSNM The situation was further complicated by the implementation of and transition to the revised ICDcoding systemThe transition created coding delays across all areas, including lab, health practitioners and insurance companiesDue to these and other factors, TriCore is willing to extend a discounted charge to Ms [redacted] TriCore has attempted to contact Ms [redacted] but has not yet been successfulWe will continue to attempt to contact herHowever, Ms [redacted] may also contact TriCore’s Business Office Manager and we would be happy to discuss a resolution
5/4/Laboratory services performed6/3/BCBSNM adjudicated the claim indicating patient responsibility of $ The implementation and transition to ICDin created coding delays across all areas of healthcare, including lab, healthcare providers and insurance companies Although TriCore did its best to manage the denials and resubmissions, it was not always possible to retrieve timely informationTriCore submitted the information that was received from the ordering provider when the lab test was performed TriCore relies on the provider to submit the correct information when lab tests are requested and/or submitted The information that the provider supplied resulted in claim adjudication as “Coverage/program guidelines were not met or were exceeded”, leaving the charges to patient responsibility by BCBSNM
After repeating the investigation into this account, we were unable to locate any incoming calls from Mr [redacted] All calls are recorded for quality purposesA representative was able to reach him on 03/23/and again on 09/25/using the same telephone number that was used previouslyIn addition, the requisition used to order the testing on the dates of services in question contain the current, correct contact informationThis information would have been the information used to create the bills We understand Mr [redacted] ’s position remains that he did not receive any communications from TriCore, and that TriCore must have erredHowever, our records indicate we currently have and had at the time, accurate informationThe debt was a valid debt
Complaint: ***
I am rejecting this response because:
Regards,
*** ***[To assist us in bringing this matter to a close, the consumer must give a reason why they are rejecting the responseIf the consumer does not provide a reason the complaint will be closed Answered]The issue here is the fact *** *** was turned into collections. *** *** called Tricore several (suspect times) to request time to address the payment system. Please access your records to show *** *** called time and again asking for time to address the co pays. Please do not use excuses in accessing your records. Umbrellas exist - customer name, customer id. The reason for *** *** contacting the Revdex.com is the Fact that Tricore will turn an HIV AIDS patient into collections for $dollars. The patient requested * how many times * for mercy in payment. Tricore - access your records for the number of times *** *** requested leniency to request payment via EOB for *** - HIV AIDS clinic. Please also request the phone call from your collections agency. The call from your collections bureau is the reason for this need of the Revdex.com. ***
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Regards,
*** ***
As of the date of this response, the payments from *** of New Mexico have been posted to the Consumer's accounts. TriCore will be sending the Consumer a statement showing $balances for the accounts that he was concerned about. However, TriCore is not sure what the Consumer is requesting from TriCoreEach date of service is processed as a separate accountThere is not one umbrella account for each patientAs is standard with all billing practices, there are multiple stages involved with collection effortsThe Consumer received multiple statements and telephone calls to inform him of the outstanding balance which was being classified as “patient responsibility” because *** had not received the information they needed from the Consumer in order to process their paymentThe delinquent account did not progress to hard collections or credit reporting TriCore hopes to resolve any outstanding concerns and encourages the Consumer to reach out to TriCore directly if additional information is needed
TriCore has investigated this situation and determined that
there was, in fact, a breakdown in communication between its collection
department and its accounting departmentWe sincerely regret that Mr***
had a negative experience and have taken action to correct the situation
Our
business office reached out to Mr*** and left voice messages on 06/14/
and again on 06/21/The refund has been ordered with the accounting office
and Mr*** can expect to receive it in the upcoming week
TriCore has policies and procedures in place to avoid such communication
breakdownsHowever, those processes failed in this circumstanceWe will
provide additional training where necessary and reinforce the current processes
with the applicable workforce members
Mr*** may contact our business office Manager with any
questions
In response to Ms***’s complaint, TriCore understands that her
account is currentTriCore accepts certified letters quite frequentlyWe
would need the address to which the letter was sent to understand why it might
not have been signed forHowever, in response to Ms*** notice “recind[ing]
agreement to pay for any test”, TriCore is not able to prevent future charges based
on a statement that a patient will not pay charges for which they are responsible
A Medicare patient will be informed of what tests TriCore believes will not be
covered because they will be presented an ABN before the sample is collectedProviding
an ABN is the mechanism by which TriCore provides Medicare patients this
information, which affords them opportunity to choose whether or not to have the
testing performed even though it might not be covered
In response to Ms***’s request to know what she must do to “regain
the status with which every Medicare patient starts: that I only have to pay
for what Medicare covers”, we reiterate the abovePatients do not have to pay
for what Medicare covers, only for their responsibility of what Medicare does
NOT cover if they choose to have the testing performed anywayWe hope this
clarifies TriCore’s response to Ms***’s complaint
Complaint: ***
I am rejecting this response because:years of business between *** ***, *** (HIV/AIDS clinic), *** *** (Doctors out of Santa Fe), and the medical agencies (like Tricore) have been the mainstay of my health care. Tricore - please provide all records you have on *** ***. It will be made very clear *** *** is WELL aware of the business end of health care. *** has asked *** ** ** for all payments to Tricore. *** has requested all records from ***.It is my intention to show conclusively Tricore was asked repeatedly (or more times) to NOT send *** to collections. There is no paperwork between *** and Tricore for the June work Tricore performed.*** and Tricore are responsible for the business end of the work for June 2017. The only notice *** received was the 3rd notice for the work dated June 2017.Tricore, please send ALL records pertaining to *** ***
Regards,
*** ***[To assist us in bringing this matter to a close, the consumer must give a reason why they are rejecting the responseIf the consumer does not provide a reason the complaint will be closed Answered]
TriCore understands how complicated and confusing medical billing can beTriCore’s billing office manager reached out to the Consumer’s provider to clarify discrepancies in the information TriCore receivedTriCore’s billing office manager also contacted the Consumer to explain some of the issues
that complicated the bills and communication between TriCore and the ConsumerTriCore and the Consumer were able to make the proper payment arrangements to bring the accounts current
TriCore is in the process of researching this complaint but will need more information in order to properly identify the correct patient. Ms. Martinez has a common name and we need to be sure to be sure we are looking at the correct information. Please provide a date of birth and an account number...
pertaining to this complaint. Thank you.TriCore Risk Management
Although TriCore understands the Consumer’s frustration, there seems to be some miscommunication between the Consumer and his case manager [redacted] TriCore does not have a contractual arrangement with [redacted] to receive payments. The arrangement is between the consumer and...
[redacted]. In spite of the Consumers extremely disparaging remarks and verbal abuse towards TriCore’s employees, TriCore contacted [redacted] of New Mexico on behalf of the Consumer. Per [redacted], it is the patient’s responsibility to provide information to [redacted] to process the co-payments due. [redacted] is waiting for the receipt of information from the patient. They are aware of both accounts and are waiting for the 6/15/17 Explanation of Medical Benefits (EOB). TriCore telephoned the Consumer and with the Consumer’s permission, faxed the 6/15/17 EOB to [redacted] for him. Per [redacted], payments for both outstanding accounts should be made by end of week. TriCore notified its third-party collection agency to place the patient’s accounts on a 30-day hold until payment is received. TriCore’s billing practices are conducted in conformance with State and Federal laws and conform with industry standards. TriCore adamantly denies any of its business practices are predatory, lacking compassion or malicious.
There were several unfortunate factors that affected Ms. [redacted] claim. We've outlined some below: 1/16/2015 $265.51 BCBSNM processed the claim which denied as
‘not covered when performed for the reported diagnosis’ and indicated...
patient
is responsible for the non-covered charge. BCBSNM notifies the patient by
sending an Explanation of Medical Benefits letter.
3/16/2017 During an audit the charges re-billed to patient
responsibility
4/25/2017 Ms. [redacted] called Customer Service to inquire
about the bill she received. She
questioned
what the lab test was for and was advised to contact her
doctor to let TriCore know if there were corrected or additional diagnosis
codes. She stated that her doctor
retired and would do some research.
5/5/2017 Ms. [redacted] asked TriCore to resubmit the claim. She
was advised by her insurance that the claim was past timely filing and the
claim could not be submitted for reprocessing without corrections due to the
denial. She stated her doctor was retired and revisions could not be made.
Patient stated she would have insurance call TriCore to inform us where to send
corrected claim.
TriCore submitted the information that was received from the
ordering provider when the lab test was performed. TriCore relies on the provider to submit the
correct information when lab tests are requested and/or submitted. The diagnosis that the provider supplied was
considered a non-covered diagnosis leaving the charge to patient responsibility
by BCBSNM.
The situation was further complicated by the implementation
of and transition to the revised ICD10 coding system. The transition created
coding delays across all areas, including lab, health practitioners and
insurance companies. Due to these and other factors, TriCore is willing to
extend a discounted charge to Ms. [redacted]. TriCore has attempted to contact Ms.
[redacted] but has not yet been successful. We
will continue to attempt to contact her. However, Ms. [redacted] may also contact
TriCore’s Business Office Manager and we would be happy to discuss a resolution.
Complaint: [redacted]I am rejecting this response because:Regards,[redacted]
[To assist us in bringing this matter to a close, the consumer must give a reason why they are rejecting the response. If the consumer does not provide a reason if he complaint will be closed Administratively Resolved]
My Response: Tricore can claim what they want to about placing telephone calls to me. I assured them I gave them correct contact information and no correspondence was ever received from them. I have never had a business (one whom which I still unfortunately had have to use) for blood work, battle back and forth on this so much. They say one thing, I say another. I am from the understanding that the customer is always right. Where is Tricore's compromise? I am asking for a deletion letter to get these 2 items off my credit report. Never in my experience has a company spent so much time fighting a paying customer. Pretty ironic isn't it?? These debts were satisfied. The time they spent sending this correspondence back and forth could have already been resolved. I am glad to see local businesses such as Tricore argue back and forth with current paying customers. They sound so professional. I wish Tricore spent this much time processing their bills in a timely manner and actually trained their staff to be courteous and professional while dealing with customers on the phone which is a whole other story. I request a deletion letter be created as I have stated my reasons time and time again.
Complaint: [redacted]
I am rejecting this response because: They did not respond to my complaint. I said explicitly in my complaint that I paid the bill. I said in the first line that my complaint is that they refused certified notice that I rescind my agreement to pay for any test, which I have the right to do. My last statement said I want proof that they have received this notice. They sent a stock answer to every complaint about not paying the bill. I can't afford an attorney to take them to court and make them revert my status to pay only for what Medicare approves. This is a common issue; they should have a mechanism for it, unless they are intentionally stonewalling. I would like to know what I have to do to regain the status with which every Medicare patient starts: that I only have to pay for what Medicare covers.
Regards,
[redacted] [To assist us in bringing this matter to a close, the consumer must give a reason why they are rejecting the response. If the consumer does not provide a reason if he complaint will be closed Administratively Resolved]
5/4/2015 Laboratory services performed6/3/2015 BCBSNM adjudicated the claim indicating patient responsibility of $436.67 The implementation and transition to ICD10 in 2015 created coding delays across all areas of healthcare, including lab, healthcare providers and insurance companies....
Although TriCore did its best to manage the denials and resubmissions, it was not always possible to retrieve timely information. TriCore submitted the information that was received from the ordering provider when the lab test was performed. TriCore relies on the provider to submit the correct information when lab tests are requested and/or submitted. The information that the provider supplied resulted in claim adjudication as “Coverage/program guidelines were not met or were exceeded”, leaving the charges to patient responsibility by BCBSNM.
Unfortunately, there is a misunderstanding regarding what
type of services TriCore performs. TriCore does not perform “brain MRI’s” and
is not able to speak to why MRI services may not have been covered by Ms. [redacted]'s insurance.
However, TriCore did perform the laboratory
blood testing ordered...
by her healthcare providers on 06/03/2015. TriCore did
not receive accurate insurance information from the ordering provider when the blood work was ordered. Some of the testing was denied coverage by the insurance carrier that was provided. Ms. [redacted] contacted TriCore upset
that she had received a bill for testing she believed should have been covered. TriCore explained that [redacted] was asking for an Explanation of
Benefits from her “primary carrier”. This is how TriCore was able to determine
that Ms. [redacted] had more than one eligible insurance policy. TriCore was subsequently
able to obtain updated insurance information directly from Ms. [redacted] and has
rebilled the appropriate payers for the blood work.
Although TriCore understands the Consumer’s frustration, there seems to be some miscommunication between the Consumer and his case manager [redacted] TriCore does not have a contractual arrangement with [redacted] to receive paymentsThe arrangement is between the consumer and [redacted] In spite of the Consumers extremely disparaging remarks and verbal abuse towards TriCore’s employees, TriCore contacted [redacted] of New Mexico on behalf of the ConsumerPer [redacted] , it is the patient’s responsibility to provide information to [redacted] to process the co-payments due [redacted] is waiting for the receipt of information from the patientThey are aware of both accounts and are waiting for the 6/15/Explanation of Medical Benefits (EOB) TriCore telephoned the Consumer and with the Consumer’s permission, faxed the 6/15/EOB to [redacted] for him Per [redacted] , payments for both outstanding accounts should be made by end of weekTriCore notified its third-party collection agency to place the patient’s accounts on a 30-day hold until payment is received TriCore’s billing practices are conducted in conformance with State and Federal laws and conform with industry standardsTriCore adamantly denies any of its business practices are predatory, lacking compassion or malicious
Account #1: Mr [redacted] obtained laboratory services in April after which there was an outstanding balance related to the patient’s insurance deductibleTriCore sent billing statements to Mr [redacted] on the following dates: 4/29/2014, 6/4/and 7/9/and received no response and no returned mail The account was sent to soft bad debt in August Additional statements were sent to Mr [redacted] on the following dates: 8/26/ and 10/10/and received no response and no returned mail The account was sent to bad-debt collections in November of Outbound telephone calls were made on the following dates: 5/07/at 4:15pm, 6/10/at 9:12am- message left, 6/27/at 12:32pm and 7/30/at 4:22pm Account #2: Mr [redacted] obtained laboratory services in May after which there was an outstanding balance related to the patient’s insurance deductibleTriCore sent billing statements to Mr [redacted] on the following dates: 5/28/2014, 6/4/and 7/9/and received no response and no returned mail The account was sent to soft bad debt in August Additional statements were sent on 8/26/and 10/10/and received no response and no returned mail, The account was sent to bad-debt collections in November Outbound calls were made on the following dates: 6/10/ at 9:12am- message left, 6/27/at 12:28pm message left and 7/30/at 4:22pm All statements were sent to the following address: [redacted] We have no record of patient ever calling TriCore or the soft bad debt agency concerning "missing" bills 1/27/4:29pm: A TriCore customer service rep received a call from the collection agency to inquiring about the balances The customer service rep informed the collection agency that the balances were due to patient’s deductibleThe collection agency was then going to inform the patient 3/23/10:18am: Another customer service rep received a call from patient wanted to know if make the payment on the original balance because he could not afford to pay the collection interest Patient was advised that TriCore no longer had the accounts and payment arrangements must be made directly with the collection agency 9/25/9:34am: A customer service rep received another call from Mr [redacted] stating that he is trying to buy a house and these two accounts are on his credit reportHe stated he had paid collection agencyHe stated that TriCore had an incorrect mailing addressThe customer service rep verified address confirming the current addressThe customer service rep told Mr [redacted] that the bills were all sent to the current address and TriCore never received return mail from this addressThe customer service rep called the collection agency and asked if the collection agency could send a letter to MrMr [redacted] stating the charges had been paid so he could show his mortgage companyThe collection agency agreed
11/25/$service performed There were several unfortunate factors that affected Ms [redacted] claimWe've outlined some below: 1/16/$BCBSNM processed the claim which denied as ‘not covered when performed for the reported diagnosis’ and indicated patient is responsible for the non-covered chargeBCBSNM notifies the patient by sending an Explanation of Medical Benefits letter 3/16/During an audit the charges re-billed to patient responsibility 4/25/Ms [redacted] called Customer Service to inquire about the bill she received She questioned what the lab test was for and was advised to contact her doctor to let TriCore know if there were corrected or additional diagnosis codes She stated that her doctor retired and would do some research 5/5/Ms [redacted] asked TriCore to resubmit the claimShe was advised by her insurance that the claim was past timely filing and the claim could not be submitted for reprocessing without corrections due to the denialShe stated her doctor was retired and revisions could not be made Patient stated she would have insurance call TriCore to inform us where to send corrected claim TriCore submitted the information that was received from the ordering provider when the lab test was performed TriCore relies on the provider to submit the correct information when lab tests are requested and/or submitted The diagnosis that the provider supplied was considered a non-covered diagnosis leaving the charge to patient responsibility by BCBSNM The situation was further complicated by the implementation of and transition to the revised ICDcoding systemThe transition created coding delays across all areas, including lab, health practitioners and insurance companiesDue to these and other factors, TriCore is willing to extend a discounted charge to Ms [redacted] TriCore has attempted to contact Ms [redacted] but has not yet been successfulWe will continue to attempt to contact herHowever, Ms [redacted] may also contact TriCore’s Business Office Manager and we would be happy to discuss a resolution
5/4/Laboratory services performed6/3/BCBSNM adjudicated the claim indicating patient responsibility of $ The implementation and transition to ICDin created coding delays across all areas of healthcare, including lab, healthcare providers and insurance companies Although TriCore did its best to manage the denials and resubmissions, it was not always possible to retrieve timely informationTriCore submitted the information that was received from the ordering provider when the lab test was performed TriCore relies on the provider to submit the correct information when lab tests are requested and/or submitted The information that the provider supplied resulted in claim adjudication as “Coverage/program guidelines were not met or were exceeded”, leaving the charges to patient responsibility by BCBSNM
After repeating the investigation into this account, we were unable to locate any incoming calls from Mr [redacted] All calls are recorded for quality purposesA representative was able to reach him on 03/23/and again on 09/25/using the same telephone number that was used previouslyIn addition, the requisition used to order the testing on the dates of services in question contain the current, correct contact informationThis information would have been the information used to create the bills We understand Mr [redacted] ’s position remains that he did not receive any communications from TriCore, and that TriCore must have erredHowever, our records indicate we currently have and had at the time, accurate informationThe debt was a valid debt
Complaint: ***
I am rejecting this response because:
Regards,
*** ***[To assist us in bringing this matter to a close, the consumer must give a reason why they are rejecting the responseIf the consumer does not provide a reason the complaint will be closed Answered]The issue here is the fact *** *** was turned into collections. *** *** called Tricore several (suspect times) to request time to address the payment system. Please access your records to show *** *** called time and again asking for time to address the co pays. Please do not use excuses in accessing your records. Umbrellas exist - customer name, customer id. The reason for *** *** contacting the Revdex.com is the Fact that Tricore will turn an HIV AIDS patient into collections for $dollars. The patient requested * how many times * for mercy in payment. Tricore - access your records for the number of times *** *** requested leniency to request payment via EOB for *** - HIV AIDS clinic. Please also request the phone call from your collections agency. The call from your collections bureau is the reason for this need of the Revdex.com. ***
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Regards,
*** ***
As of the date of this response, the payments from *** of New Mexico have been posted to the Consumer's accounts. TriCore will be sending the Consumer a statement showing $balances for the accounts that he was concerned about. However, TriCore is not sure what the Consumer is requesting from TriCoreEach date of service is processed as a separate accountThere is not one umbrella account for each patientAs is standard with all billing practices, there are multiple stages involved with collection effortsThe Consumer received multiple statements and telephone calls to inform him of the outstanding balance which was being classified as “patient responsibility” because *** had not received the information they needed from the Consumer in order to process their paymentThe delinquent account did not progress to hard collections or credit reporting TriCore hopes to resolve any outstanding concerns and encourages the Consumer to reach out to TriCore directly if additional information is needed
TriCore has investigated this situation and determined that
there was, in fact, a breakdown in communication between its collection
department and its accounting departmentWe sincerely regret that Mr***
had a negative experience and have taken action to correct the situation
Our
business office reached out to Mr*** and left voice messages on 06/14/
and again on 06/21/The refund has been ordered with the accounting office
and Mr*** can expect to receive it in the upcoming week
TriCore has policies and procedures in place to avoid such communication
breakdownsHowever, those processes failed in this circumstanceWe will
provide additional training where necessary and reinforce the current processes
with the applicable workforce members
Mr*** may contact our business office Manager with any
questions
In response to Ms***’s complaint, TriCore understands that her
account is currentTriCore accepts certified letters quite frequentlyWe
would need the address to which the letter was sent to understand why it might
not have been signed forHowever, in response to Ms*** notice “recind[ing]
agreement to pay for any test”, TriCore is not able to prevent future charges based
on a statement that a patient will not pay charges for which they are responsible
A Medicare patient will be informed of what tests TriCore believes will not be
covered because they will be presented an ABN before the sample is collectedProviding
an ABN is the mechanism by which TriCore provides Medicare patients this
information, which affords them opportunity to choose whether or not to have the
testing performed even though it might not be covered
In response to Ms***’s request to know what she must do to “regain
the status with which every Medicare patient starts: that I only have to pay
for what Medicare covers”, we reiterate the abovePatients do not have to pay
for what Medicare covers, only for their responsibility of what Medicare does
NOT cover if they choose to have the testing performed anywayWe hope this
clarifies TriCore’s response to Ms***’s complaint
Revdex.com:
As per the information requested by Tricore LabsAccount number is: *** Date of Birth ***Date of Service was: ***
Regards,
*** ***
Complaint: ***
I am rejecting this response because:years of business between *** ***, *** (HIV/AIDS clinic), *** *** (Doctors out of Santa Fe), and the medical agencies (like Tricore) have been the mainstay of my health care. Tricore - please provide all records you have on *** ***. It will be made very clear *** *** is WELL aware of the business end of health care. *** has asked *** ** ** for all payments to Tricore. *** has requested all records from ***.It is my intention to show conclusively Tricore was asked repeatedly (or more times) to NOT send *** to collections. There is no paperwork between *** and Tricore for the June work Tricore performed.*** and Tricore are responsible for the business end of the work for June 2017. The only notice *** received was the 3rd notice for the work dated June 2017.Tricore, please send ALL records pertaining to *** ***
Regards,
*** ***[To assist us in bringing this matter to a close, the consumer must give a reason why they are rejecting the responseIf the consumer does not provide a reason the complaint will be closed Answered]
TriCore understands how complicated and confusing medical billing can beTriCore’s billing office manager reached out to the Consumer’s provider to clarify discrepancies in the information TriCore receivedTriCore’s billing office manager also contacted the Consumer to explain some of the issues
that complicated the bills and communication between TriCore and the ConsumerTriCore and the Consumer were able to make the proper payment arrangements to bring the accounts current
TriCore is in the process of researching this complaint but will need more information in order to properly identify the correct patient. Ms. Martinez has a common name and we need to be sure to be sure we are looking at the correct information. Please provide a date of birth and an account number...
pertaining to this complaint. Thank you.TriCore Risk Management
Although TriCore understands the Consumer’s frustration, there seems to be some miscommunication between the Consumer and his case manager [redacted] TriCore does not have a contractual arrangement with [redacted] to receive payments. The arrangement is between the consumer and...
[redacted]. In spite of the Consumers extremely disparaging remarks and verbal abuse towards TriCore’s employees, TriCore contacted [redacted] of New Mexico on behalf of the Consumer. Per [redacted], it is the patient’s responsibility to provide information to [redacted] to process the co-payments due. [redacted] is waiting for the receipt of information from the patient. They are aware of both accounts and are waiting for the 6/15/17 Explanation of Medical Benefits (EOB). TriCore telephoned the Consumer and with the Consumer’s permission, faxed the 6/15/17 EOB to [redacted] for him. Per [redacted], payments for both outstanding accounts should be made by end of week. TriCore notified its third-party collection agency to place the patient’s accounts on a 30-day hold until payment is received. TriCore’s billing practices are conducted in conformance with State and Federal laws and conform with industry standards. TriCore adamantly denies any of its business practices are predatory, lacking compassion or malicious.
11/25/2014 $265.51 service performed
There were several unfortunate factors that affected Ms. [redacted] claim. We've outlined some below: 1/16/2015 $265.51 BCBSNM processed the claim which denied as
‘not covered when performed for the reported diagnosis’ and indicated...
patient
is responsible for the non-covered charge. BCBSNM notifies the patient by
sending an Explanation of Medical Benefits letter.
3/16/2017 During an audit the charges re-billed to patient
responsibility
4/25/2017 Ms. [redacted] called Customer Service to inquire
about the bill she received. She
questioned
what the lab test was for and was advised to contact her
doctor to let TriCore know if there were corrected or additional diagnosis
codes. She stated that her doctor
retired and would do some research.
5/5/2017 Ms. [redacted] asked TriCore to resubmit the claim. She
was advised by her insurance that the claim was past timely filing and the
claim could not be submitted for reprocessing without corrections due to the
denial. She stated her doctor was retired and revisions could not be made.
Patient stated she would have insurance call TriCore to inform us where to send
corrected claim.
TriCore submitted the information that was received from the
ordering provider when the lab test was performed. TriCore relies on the provider to submit the
correct information when lab tests are requested and/or submitted. The diagnosis that the provider supplied was
considered a non-covered diagnosis leaving the charge to patient responsibility
by BCBSNM.
The situation was further complicated by the implementation
of and transition to the revised ICD10 coding system. The transition created
coding delays across all areas, including lab, health practitioners and
insurance companies. Due to these and other factors, TriCore is willing to
extend a discounted charge to Ms. [redacted]. TriCore has attempted to contact Ms.
[redacted] but has not yet been successful. We
will continue to attempt to contact her. However, Ms. [redacted] may also contact
TriCore’s Business Office Manager and we would be happy to discuss a resolution.
Complaint: [redacted]I am rejecting this response because:Regards,[redacted]
[To assist us in bringing this matter to a close, the consumer must give a reason why they are rejecting the response. If the consumer does not provide a reason if he complaint will be closed Administratively Resolved]
My Response: Tricore can claim what they want to about placing telephone calls to me. I assured them I gave them correct contact information and no correspondence was ever received from them. I have never had a business (one whom which I still unfortunately had have to use) for blood work, battle back and forth on this so much. They say one thing, I say another. I am from the understanding that the customer is always right. Where is Tricore's compromise? I am asking for a deletion letter to get these 2 items off my credit report. Never in my experience has a company spent so much time fighting a paying customer. Pretty ironic isn't it?? These debts were satisfied. The time they spent sending this correspondence back and forth could have already been resolved. I am glad to see local businesses such as Tricore argue back and forth with current paying customers. They sound so professional. I wish Tricore spent this much time processing their bills in a timely manner and actually trained their staff to be courteous and professional while dealing with customers on the phone which is a whole other story. I request a deletion letter be created as I have stated my reasons time and time again.
[redacted]
Complaint: [redacted]
I am rejecting this response because: They did not respond to my complaint. I said explicitly in my complaint that I paid the bill. I said in the first line that my complaint is that they refused certified notice that I rescind my agreement to pay for any test, which I have the right to do. My last statement said I want proof that they have received this notice. They sent a stock answer to every complaint about not paying the bill. I can't afford an attorney to take them to court and make them revert my status to pay only for what Medicare approves. This is a common issue; they should have a mechanism for it, unless they are intentionally stonewalling. I would like to know what I have to do to regain the status with which every Medicare patient starts: that I only have to pay for what Medicare covers.
Regards,
[redacted] [To assist us in bringing this matter to a close, the consumer must give a reason why they are rejecting the response. If the consumer does not provide a reason if he complaint will be closed Administratively Resolved]
5/4/2015 Laboratory services performed6/3/2015 BCBSNM adjudicated the claim indicating patient responsibility of $436.67 The implementation and transition to ICD10 in 2015 created coding delays across all areas of healthcare, including lab, healthcare providers and insurance companies....
Although TriCore did its best to manage the denials and resubmissions, it was not always possible to retrieve timely information. TriCore submitted the information that was received from the ordering provider when the lab test was performed. TriCore relies on the provider to submit the correct information when lab tests are requested and/or submitted. The information that the provider supplied resulted in claim adjudication as “Coverage/program guidelines were not met or were exceeded”, leaving the charges to patient responsibility by BCBSNM.
Unfortunately, there is a misunderstanding regarding what
type of services TriCore performs. TriCore does not perform “brain MRI’s” and
is not able to speak to why MRI services may not have been covered by Ms. [redacted]'s insurance.
However, TriCore did perform the laboratory
blood testing ordered...
by her healthcare providers on 06/03/2015. TriCore did
not receive accurate insurance information from the ordering provider when the blood work was ordered. Some of the testing was denied coverage by the insurance carrier that was provided. Ms. [redacted] contacted TriCore upset
that she had received a bill for testing she believed should have been covered. TriCore explained that [redacted] was asking for an Explanation of
Benefits from her “primary carrier”. This is how TriCore was able to determine
that Ms. [redacted] had more than one eligible insurance policy. TriCore was subsequently
able to obtain updated insurance information directly from Ms. [redacted] and has
rebilled the appropriate payers for the blood work.