Kinex Medical Company

Review: Kinex medical company LLC refuse to submit my bill to my insurance.This company claims that they submitted my bill to my insurance several times, and 10 months later they contact me by phone to pay the full amount, telling me that my insurance refuses to pay.I contacted my insurance with Blue Cross and Blue Shield, to find that they have never gotten any bills from Kinex.We were on a 3 way call with Kinex representative, My insurance representative, and my self. Kinex rep said that after a year they will not submit a claim to the insurance.The call ended.I called my insurance again letting them know that it has been 9 months not a year yet.Again, my insurance rep put us on a 3 way call with Kinex, telling them that it hasn't been a year yet. Encouraging them to go ahead and submit my bill.Kinex rep changed their words to " we don't submit any bills after 90 days"I requested to speak with a Kinex supervisor, which I was denied, while still on the 3 way phone call.I am disappointed with Kinex's services.Thank you[redacted]Desired Settlement: For Kinex to reconsider their decision and bill my insurance directly.

Business

Response:

After reviewing your account as well as all

notes and talking with our billing supervisor we are past timely filing for

your account and a claim will not be submitted. Below is a summary of our

actions relating to your account;12/29/14 - Our benefits department contacted your insurance to

obtain benefits and we were told that the insurance information we had on file

was not correct. A letter was sent as well as a phone call to you requesting

updated insurance information1/8/15 - A follow up call was made an a message was left

requesting a return call to provide updated insurance information1/9/15 - No reply was received from patient so a bill was sent to

the patient requesting full payment as we cannot submit to insurance as the

information we have is incorrect1/27/15 - Patient's husband called questioning the bill and he

provided the same incorrect insurance info we had on file. We had worked with

BCBS for several months from this point in order to get the correct ID for the

patient but we were still unsuccessful.8/13/15 - Another letter was sent to the patient requesting

updated insurance information and we indicated that the patient would have 30

days to respond with the correct insurance information or we would reach timely

filing with BCBS and the balance would become the patient's responsibility9/15/15 - We had not received any reply from the patient and so a

bill was sent with the full patient responsibility for the equipment10/13/15 - We received a voicemail to call the patient at the home

number. We called the home number and left a message for the patient to return

our call.10/14/15 - Received a return call from the patient at which time

the patient states she wanted an itemized bill. We did inform her that if we

had the correct insurance information she would not be responsible for the full

bill. Patient stated she already paid this and needs an itemized bill to go

over with her insurance before she pays us again. Patient then provided an

insurance policy number that started on 2/15 and what we were needing was the

policy that was held during 12/14 when services were rendered. Patient stated

she would call BCBS and get the number and call us back. After the call ended

our benefits team contacted BCBS and was able to verify that the new insurance

information provided was active and valid on 12/14. We are checking to see if

we are within timely filing of patient's insurance to file a claim. We found

out that per BCBS policy we are beyond timely filing and the claim will not be

able to be submitted.10/20/15 - Patient called and wanted to know if her insurance

paid, we explained that per her insurance policy we cannot submit the claim

because it was after their timely filing period and that the balance of $250

was now the patient's responsibility.10/28/15 - Patient called again and wanted to know if we would

submit the bill even though it was past timely filing and per our policy and

her insurance we would not be submitting it. Patient stated that she had never

received any phone calls or letters and she always answers her phone. We

apologized but informed her that we cannot submit a claim this late and that we

will be sending her another bill today.11/2/15 – Patient’s husband called, he wanted

to know the dates of service and the total billed, information was provided. He

stated he was calling the carrier and would call us back. Later that day a

3-way call from the Anthem provider service, Kinex and the patient occurred.

The situation was explained to the patient and Anthem. The patient’s husband

was very upset and continued to argue with us and insisted that the policy

numbers were given at the time of service and claims that they were valid and

Kinex was at fault. The dates and

information were then given for when calls and messages were left as well as

letters sent requesting the updated information. Patient’s husband was still

arguing that we should resubmit to Anthem and Kinex explained that we will not

submit untimely claims in this way. The Anthem rep interrupted and informed the

patient that he needs to either pay the bill or appeal with Anthem.11/3/15 – Another 3-way call with Anthem and

the patient’s husband occurred; the Anthem rep said that timely filing was 1

year however Kinex stated that in our contact is states 90 days. Kinex advised

that we will not submit the claim because we did not get the correct insurance

until October and the claim is now past timely filing. Patient kept stating

that he just doesn’t understand why we won’t submit the claim. Kinex advised

that it was due to a lack of response within the window for which we are

allowed to submit a claim. Kinex advised that if he wants to submit a claim to

Anthem for reimbursement he is welcome to do so. Patient’s husband requested

Kinex mail a letter explaining why we won’t file and what timely is the Anthem

rep also gave him instructions on how to file a member claim. Letter was mailed

to patient.After all of these documented incidents

including calls with Anthem the patient was never denied speaking to a

supervisor and we can gladly have one contact him if he prefers however, due to

the timely filing window being closed we will not submit a claim to Anthem but

the patient is more than welcome to do so. Instructions were provided on 11/3/15.

Consumer

Response:

[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.]

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that It wasn't satisfactory to me. Explanation followsi regret the decision Kinex reached. I would like to set the record straight.I have never been without insurance up until november 30,2014 my husband and I were on the same policy for so many years, when he qualified for Medicare my insurance issued me a new policy number starting on December 1st2014just for me.I received the new card toward the end of December.I was never contacted to be told that they had problems with my insurance until 10 months later.kinex claims that BCBS have a yearly policy that they do not accept a year old claims. My husband was on a three way phone call with Kinex rep and BCBS rep for the second time, BCBS agent requested that Kinex submits the claim since it hasn't been a year old case, then Kinex agent replied " it is our policy (Kinex) that we do not submit a claim after 90 days" yet in their letter dated August 13'2015 they requested from me an insurance update information before it reaching the timely filing with BCBS.I figured from December till August that would be 9 months and not 90 days, which contradicts everything Kinex said.also, at the end of their letter, they mentioned I was never denied speaking to a supervisor which is true, except that they were talking with my husband on the three way phone call with my BCBS rep. My husband requested during that call to speak with a supervisor and the Kinex agent replied : " we have discussed this issue with our supervisor and there is no need to talk to a supervisor "This was said with BCBS agent on the line, which he heard everything.I am sure that this conversation was recorded from BCBS since it was a conflict.I hope that Kinex would treat their customers with better courtesy than they have shown methank you

Regards,

Review: I received a cold therapy machine on 12/04/2015. At the time, I was given a pad to wrap around my ankle and a hose to connect it to the cold machine. There was another hose that didn't fit the pad and I was told by the Kinex rep to not worry about it because it was for compression and I wasn't receiving that therapy anyway. Now, I have received a bill from the company for the machine, which insurance paid for, and three pads (one for hot/cold, which I received, and one for an Ankle HL pad, which insurance paid, and for a stabilization orthotic, which insurance did not pay for). I did NOT use, nor receive an stabilization orthotic. I have questioned this with insurance and they said the stabilization orthotic was billed with a generic code and that they didn't know what it was but that they didn't pay for orthotics. I did NOT receive or use an orthotic device. Kinex says that they bill this way, and have no other explanation. I should not have to pay for an orthotic because I did not use one and did not need one and did not receive one. This appears to be a type of insurance fraud to me.Desired Settlement: Insurance has paid for the service I used. I should not continue to be billed for services I did not use. The $107 should be removed from my account, which should be marked paid in full.

Business

Response:

Hello Mr. [redacted],?

Review: I had a shoulder procedure done and I got a call from Kinex medical offering a CPM machine. I wasn't sure I wanted to do it but was ASSURED over the phone that the maximum out of pocket would be $250. ASSURED. When the gentlemen dropped off the devise he once again ASSURED me that no matter what insurance covered, they would only charge $250 maximum. I just received the bill and its for $340.76. I called customer service and they said that indeed all their sales people tell customers that and they are telling them not to anymore. Why is it my fault that their employees are promising pricing?Desired Settlement: I am willing to pay the $250 MAXIMUM out of pocket guaranteed by the company and not a dollar more.

Business

Response:

Patient is correct that they are receiving a bill for $340.76. Per the Assignment of Benefit form signed by Mr. [redacted] (attached) it stated that the Estimated Cost to patient is $250 if deducible has been met. The $340.76 was all applied to the patients in network insurance deductible. Also noting that per #10, the patient understood that if their specific insurance plan requires any co-pays, co-insurance, or deductibles, they would be financially responsible for paying said balances.Per our BCBS contract, we are obligated to bill deductibles to the patients as it affects all other claims processing after.Thanks,[redacted]Operations Manager

Consumer

Response:

Excellent products and very friendly representatives.

Review: I had rotator cuff surgery and they recommended Kinex for the post surgery equipment. The person came to my house and explained everything and said that as long as my deductible was met that it wouldn't cost me anything. Now I am getting billed for $200 and they are saying I signed a contract agreeing to pay them $200. I did sign a contract but didn't think I needed a lawyer to look at it and see if it matched what I was being told by the sales person. I believe this is a very deceitful practice and should not be allowed.Desired Settlement: That Kinex zeros my balance due and stops misleading customers who are expecting them to be truthful.

Business

Response:

Dear Mr. [redacted], I have reviewed your chart and our benefits department did in fact reach out to obtain pre-authorization for your medical equipment. Recently your insurance policy has changed and as of 2/27/15 when we were able to obtain the benefits, the durable medical equipment you received is no longer a covered benefit. Our service representative who provided the equipment to you has been with our company for many years and has received proper education in explaining all paperwork to the patient at the time of setup. There is no "contract" in which you enter in to and certainly does not require a lawyer to decipher the verbiage. The form is an Assignment of Benefits which is a 1 page sheet that explains that we will submit a claim to your insurance on your behalf and if your insurance does not pay for the equipment being prescribed you may be responsible for the $200 out of pocket. I would be happy to send you a copy of what was signed on 2/4/15 which explains the items listed above.With that being said we have also worked with your local service representative to make him aware of the changes with the insurance policy and that he should never be telling a patient that their equipment is 100% covered and that they will not receive a bill based on the situation you are describing. We are not trying to be deceitful in any way but trying to provide you with the most information regarding your coverage as we can. Thank you.

Consumer

Response:

[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.]

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.

Regards,