NOVA Health

The complaint is being investigated. We are awaiting a response from the 3rd party that supplies the DME; as we dispense on their behalf.

Mr.,

If you would like to return the brace I will deal with *** regarding the costs on behalf of our facility; I have no disagreement with the statements that you are making in regards to transparency of cost for the durable medical equipment that is dispensed by the clinic for a third party. I apologize for the inconvenience to you as staff should have referred the situation to me as Provider Liaison directly rather than attempt to rectify it on a clinical level.

Your complaint has had the benefit of an internal review as to the adherence of staff to the processes expected to be followed in the clinic during the dispensing of DME, and for that we are grateful; we cannot have eyes and ears everywhere as hard as we try. It has been our companies practice to utilize a price sheet provided by the supplier to disclose the costs billed to the carrier for an item and if requested further discussion with the provider as to the medical necessity of the item and it's benefits. When followed, this process allows for our patients to make an informed decision as to whether they would like to take the item. If a patient wishes to proceed then proper paperwork and signs the disclosures of payment responsibility, etc.; it will end with the patient leaving with the item. Once the item leaves the clinic it is a final purchase. Durable medical equipment in most all cases is unreturnable due to health regulations; one exception I am aware of is when there is a defect in the item and then it is exchanged. Once signed the paperwork is sent back to Pacific Medical and they bill the individuals carrier. On a side note from what I can ascertain, Pacific Medical themselves apparently has made a change in how they handle outside accounts and has removed the benefit of a local representative for our location (and others); this has added to my difficulty in getting clear information as to why the cost sheet was removed from the clinic (as when completing a walk-thru upon receipt of this complaint it was no longer in the binder, nor in the area of the clinic for which we store the DME). Regardless I also do not know why staff did not question the lack of the information to properly dispense according to our own procedure when dispensing to you.

Secondly, we will be meeting with the practitioners to ensure they are aware of the costs for our DME. Our staff are trained on the proper steps for dispensing and this includes disclosure of costs; providers are not aware as for any of our patients care, we want the recommendation for treatment options to be advised to the patient without bias. This is also why once staff review the billed cost for DME we want the practitioner to be available to answer any additional questions for our patients and it is always a patients right to refuse. Pacific Medical has advised me that the costs for DME are not set by them; they are regulated by Medicare, and coverage is per the contract they have with your carrier. I assure you that often times I am equally baffled by the costs.

All of these are answers that I will be seeking; however, we want to resolve this on your behalf as quickly as possible. I have notified Megan with Pacific Medical that we are planning to accept the brace back and we will deal with them directly as to the expense of the brace. If you would like to drop the brace and any packaging that may have been provided to you, to the Junction City Medical Clinic & Urgent Care location, please ask for it to be given to Michelle the Practice Manager; we will take care of it from there. Or if you would like me to pick up the brace, please contact me to arrange it at 541-799-4535, it is a protected voicemail should you need to leave me a message. I am also happy to contact you directly after obtaining more information from Pacific Medical as to how a hinged knee brace can cost over $600; and I will also be reviewing the DME inventory with our Medical Director to ensure that *** is stocking appropriate items.

Thank you for your time and response regarding this matter, hope to hear from you soon.

Apryl J - Provider Liaison