World Wide Circulation, Inc.

Complaint: ***
I am rejecting this response because: as stated on the certified letter I sent on January 9, to I indicated that Farmers Insurance has indicated if no response is not received by September 22, a denial of Personal Injury Protection benefits will be issued My wife and I spoke with you, Brian and Amber and your attending physician to get this matter resolve in a timely manner before September 22, Keep in mind your physician and office kept scheduling me for my neck and back pain and assuring me everything is fine with my account. You stated we did not give you enough time to submit the claims from September 1, to December 17, Why didn’t Manakai O Malama file the claims when you got a letter from Farmers Insurance dated October 20, 2017? Claims have already been filed by me to my health insurance.As you stated your office spoke to me throughout my medical care Your physician continue to schedule me for my medical treatments and your staff assure me everything is alright Didn’t you once wonder why we kept on calling your office to follow up the letters sent by Farmers Insurance? I have letters dated May 26, to request medical information by June 30, 3017, 2nd letter dated June 12, still waiting for response and information needed by
June 40, 2017June 30, 2017, 3rd letter dated August 16, need more information to continue treatments and need response by September 22, 2017, 4th attempt went to Manakai O Malama spoke to Amber to get information to Farmers Insurance, 5th attempt letter dated September 7, still waiting for medical information and need request by September 22, As stated in that letter if a response is not received a denial of Personal Injury Protection benefits will be issued With no response by the deadline on September 22, Farmers Insurance had independent medical review my records As he stated any medical treatment s after September 1, to December 10, would not be considered for paymentsYes, it is much sadder that this issue cannot be solved in a timely manner I made this complaint to assure other patients with automobile accident beware of your medical doctors and office staff When letters were sent to you, how come no action were taken immediately and discuss with me After all of, I still continue have neck and back pain and with much added stress that could have been avoided Is this fair?
Sincerely,
*** ***

I am the Practice Administrator here at Manakai O Malama. I have looked into Mr***’ claim thoroughly. Of note, the insurance company requested an Independent Medical Review (IMR) of Mr***’ claim on 10/24/2017. This is common among insurance companies as they are
looking for another opinion other than the treating medical provider about the patient’s condition. Based on this study and NOT on any supposed missed records to the insurance company was the basis for Mr***’ denial of care. Our medical providers did not dispute the findings of the IMR once we finally received the report. By this time however, the patient did have several services. We spoke with both Mrand Mrs*** several times during this whole process to let them know what steps would be taken if either outcome came to pass. Currently we have billed any denied claims to his medical insurance and anything they do not pay we will work with Mr*** on the balance.They have not given us time to submit the claims to his medical insurance and receive payment to see what his balance will be, if any. We have spoken with the patient throughout this entire process and have provided what we deemed at the time as appropriate and necessary care. We are saddened that Mr*** felt he had to launch this complaint as we are not at the end of processing his claims and have not exhausted all solutions.Please feel free to contact me at the number below if you wish to further discuss.Thank you,Evette S*Practice AdministratorAccountingManakai O MalamaIntegrative Healthcare Group & Rehabilitation Center