Care Medical Supplies

Initial Business Response /* (1000, 6, 2016/01/08) */
Contact Name and Title: TON*** C.F.O
Contact Phone: ***
Contact Email: [email protected]
PATIENT CALLED US 12/22/AND WANTED ELECTRODES FROM USSHE SAID SHE HAD MEDICARE AND MINNESOTA MA AND WANTED THEM BILLED TO
HER INSSHE TOLD US SHE HAD BEEN GETTING THE ELECTRODES FROM EMPI PREVIOUSLYEMPI IS NO LONGER IN BUSINESSWE ASKED HER WHAT HER DIAGNOSIS WASTHE DIAGNOSIS SHE GAVE US DOES NOT MEET THE MEDICARE OR THE MINNESOTA MA CRITERIA FOR ANY COVERAGESHE WAS ANGRY WITH US BECAUSE HER ELECTRODES HAD BEEN PAID FOR THROUGH EMPIWE EXPLAINED THAT MEDICARE HAD CHANGED THE RULES FOR COVERAGE A COUPLE YEARS AGOSHE MAY HAVE MET THE CRITERIA THEN, BUT NO LONGER DOESSHE SAID THAT SHE WOULD GO ELSEWHERE THEN
LATER THAT SAME DAY, SHE CALLED BACKSHE SPOKE WITH A SECOND PERSON THAT WENT OVER ALL OF THESE SAME ISSUES WITH HERSHE WAS STILL UNSATISFIED WITH OUR EXPLANATION SO THE PHONE CALL WAS TRANSFERRED TO MYSELFI AM THE MANAGER AND I HAVE DONE ALL OF THE MEDICARE BILLING FOR THE LAST YEARS
PLEASE UNDERSTAND THAT OUR STAFF MUST KNOW VOLUMES OF MEDICARE AND MA RULES AND GUIDELINES SO THAT WE CAN ADVISE MEDICARE/MA PATIENTS OF THE COVERAGE CRITERIA AND DOCUMENTATION REQUIREMENTSMEDICARE HOLDS US ACCOUNTABLE FINANCIALLY IF WE GIVE OUT A PRODUCT AND THEY DENY IT UNLESS WE INFORMED THE PATIENT OF THE PROBABLE DENIAL AT THE TIME OF ISSUEWE ARE EVEN REQUIRED TO OBTAIN AN "ADVANCED BENEFICIARY NOTICE" WHICH REQUIRES THE PATIENT TO SIGN THAT WE HAVE EXPLAINED WHY IT WOULD NOT BE COVERED
I THEN WENT OVER ALL OF THESE SAME ISSUES WITH HER A THIRD TIMEDURING OUR CONVERSATION SHE SAID THAT SHE CALLED THE MEDICARE BENEFICIARY LINE AND THEY TOLD HER THAT THE ELECTRODES SHOULD BE COVERED BECAUSE SHE HAD BEEN GETTING THEM THROUGH EMPI AND MEDICARE WAS PAYING FOR THEMI EXPLAINED THAT AS A NEW SUPPLIER FOR HER, WE WOULD NEED TO OBTAIN OUR OWN DOCUMENTATION WITH HER DIAGNOSIS TO BILL MEDICAREWE HAD RECEIVED A PRESCRIPTION FROM HER DOCTOR AND IT CLEARLY STATED ONE DIAGNOSISTHE DIAGNOSIS ON THE SCRIPT DOES NOT QUALIFY FOR COVERAGE UNDER MEDICARE OR MASHE TOLD ME THAT SHE WAS GOING TO COME IN TO THE STORE TOMORROW AND STRAIGHTEN US OUTAFTER SHE HUNG UP, I DECIDED TO CALL HER DOCTOR TO VERIFY THE DIAGNOSIS AND FIND OUT IF THERE WAS ANY OTHER DIAGNOSISTHEY CONFIRMED THAT WAS THE ONLY DIAGNOSIS FOR THE TENS ELECTRODES(SHE DOES NOT QUALIFY) THEN, I CALLED THE MEDICARE PROVIDER CENTERTHEY RE-CONFIRMED THAT HER DIAGNOSIS DOES NOT QUALIFY FOR COVERAGEI EXPLAINED THAT THE PATIENT HAD CALLED THE BENEFICIARY LINE AND BEEN GIVEN DIFFERENT INFORMATIONSHE SAID THAT THEY ONLY HAVE LIMITED INFO REGARDING COVERAGETHEY DO NOT ACCESS THE MEDICAL POLICIES WITH THE VERY SPECIFIC DETAILED CRITERIA AND DOCUMENTATION REQUIREMENTSI ASKED THAT THEY PLEASE RECORD THIS INFORMATION AND WHAT WE HAD DISCUSSED
THE NEXT DAY SHE CAME IN TO OUR STORE WITH TWO OTHER PEOPLEI WAS OFF THAT DAYTHE FOLLOWING IS OUR RESPONSE TO HER COMPLAINT:
WE ARE VERY SORRY THAT YOU FOUND US TO BE RUDEWE TRY VERY HARD TO EXPLAIN THESE COMPLEX MEDICARE RULES TO OUR CUSTOMERS IN A MANNER IN WHICH THEY CAN UNDERSTAND
YES WE DID HAVE A DOCTORS ORDER, BUT WE CAN NOT "RUN THE PRESCRIPTION THROUGH THE INSURANCE"UNLIKE A PHARMACY WHICH CAN "RUN PRESCRIPTIONS" MEDICARE REQUIRES US TO (1)GET THE REQUIRED DOCUMENTATION (2)PROVIDE THE PRODUCT AND (3)SUBMIT A CLAIM TO THEMIT TAKES SEVERAL WEEKS BEFORE WE RECEIVE A CLAIM DETERMINATION WITH THE PAYMENT OR DENIAL
WHEN THEY CAME IN AND SAT DOWN THE OTHER LADY WITH HER SAID SHE WANTED ELECTRODES AND BLOOD TESTING SUPPLIESWE DISCUSSED WITH THEM THAT WE DO NOT DO BLOOD GLUCOSE SUPPLIES AND MEDICARE ONLY COVERS THEM THROUGH NATIONAL MAIL ORDER NOWWE ADVISED THEM TO CALL MEDIARE TO FIND OUT WHO CAN SUPPLY THEMWE THEN DISCUSSED ELECTRODES AND MEDICARE COVERAGE OF THEMWE WENT THROUGH ALL OF THE SAME THINGS THAT WERE DISCUSSED DURING THE THREE PREVIOUS CONVERSATIONSWE HAD WRITTEN DOCUMENTATION OF MY CONVERSATION WITH THE DOCTORS OFFICE AND MEDICARE PROVIDER SERVICES AND HAD COPIED THE MEDICARE COVERAGE CRITERIA FOR HERBECAUSE THE LADY WITH HER WAS DOING ALL OF THE INQUIRY AND SHE HAD NOT SAID ANYTHING, WE OFFERED ALL OF THE DOCUMENTATION WE HAD COLLECTED FOR HER, ALONG WITH THE ORDER TO THE LADY WITH HERWE GAVE IT TO HER ALL FOLDED TOGETHER WITH NOTHING SHOWING AND SHE PUT IT IN HER PURSETHAT IS WHEN THE CONSUMER SAID "I'M CALLING MEDICARE" WE SAID THAT WAS FINESHE CALLED THE MEDICARE BENEFICIARY LINE AND WAS ON SPEAKER PHONESHE SPOKE WITH ANOTHER PERSON THAT INFORMED HER THEY SHOULD BE COVEREDDURING THE CONVERSATION AND BEFORE THEY HUNG UP, WE DID INTERRUPT TO INFORM THEM THAT SHE HAS A DIAGNOSIS THAT DOES NOT MEET THE MEDICARE CRITERIAWE DID NOT INTEND TO BE RUDEWE WANTED HIM TO HAVE ALL THE CORRECT INFORMATION TO EDUCATE HER APPROPRIATELYSHE TOLD US WE WERE NOT ALLOWED TO SPEAKHE PUT US ON HOLDAT THAT TIME WE ASKED FOR THE PRESCRIPTION AND DOCUMENTATION BACK AND THE OTHER LADY GAVE IT TO US WITHOUT EVER OPENING ITWHEN HE CAME BACK ON THE PHONE, HE INFORMED US THAT WE SHOULD CALL PROVIDER SERVICESWE ASKED HER IF WE COULD SPEAK NOWWE THEN TOLD HIM THAT WE HAD ALREADY CALLED PROVIDER SERVICE AND HER DOCTORHE THEN TOLD THE CONSUMER THAT UNFORTUNATELY IT SOUNDS LIKE SHE DOES NOT MEET THE MEDICARE CRITERIA
WE KNOW THAT WE HAVE TO BILL MEDICARE TO GET A CLAIM PROCESSED TO PAY OR DENYWE ARE RESPONSIBLE FOR KNOWING AND UNDERSTANDING THE MEDICARE COVERAGE CRITERIAIF WE BELIEVE THAT, ACCORDING TO THE POLICY, A PATIENT DOES NOT MEET THE CRITERIA, WE MUST HAVE AN ADVANCED BENEFICIARY NOTICE SIGNED AND DATED AT THE TIME WE PROVIDE THE PRODUCT
WE WOULD PROVIDE THE PRODUCT GET THE ABN SIGNED AND HAVE THE PATIENT PAY IN FULL FOR THE ITEMWE COULD THEN SUBMIT A CLAIM TO MEDICARE FOR DETERMINATIONWE WOULD BE HAPPY TO DO THIS FOR HER
Initial Consumer Rebuttal /* (2000, 8, 2016/01/21) */