RediMed/Business Health Services

Initial Business Response /* (1000, 5, 2017/05/15) */
RediMed billed Humana with the correct codes for the service Mrs*** had providedHumana Medicare may pay for one TDAP per year under preventative but not when performed in an Urgent Care settingWe contacted Humana and confirmed the
reason for non-payment is due to the place of serviceTherefore the balance is Mrs***'s responsibilityWe *** provide Mrs*** with a claim form that she can submit to Part D for reimbursement
Initial Consumer Rebuttal /* (3000, 7, 2017/05/25) */
RE: CASE# (Ref# XX-XXXXXXX-XXXXXXXX-X-XXXX)
My REJECTION RESPONSE to RediMed's May 15, 2017, answer is within the contractual time period of days and the reasons for refusal are noted below:
The balance of *** is NOT my responsibility per Hurnana's Smart Summary (included with this letter) states: This is one of the preventive services that is covered AT NO COST UNDER ORIGINAL MEDICARE, and the plan covers this service at NO COST TaY0iarner TE: "YOU ARE (I am) NOT RESPONSIBLE FOR PAYING THE BILLED AMOUNT because you received this service from a Humana provider..." (Again, Humana should cover the balance to RediMed, not me)
Apparently, all Humana Insurance needs RediMed to do to pay the *** is submit an accurate claim with corrected information including the appropriate service code(s) and the correct place of urgent care service (RediMed SW, *** W *** *** Ft Wayne, IN XXXXX-XXXX phone: XXX XXX-XXXX), NOTE: I CALLED HUMANA BEFORE GOING TO REDIMED AND HUMANA DIRECTED ME TO GET THE SHOT AT REDIMED DUE TO LESS COST
Since Original Medicare covers this treatment and Humana Insurance accepts this medical procedure, it is unacceptable that RediMed expects me to pay the *** balance to RediMed directly and then submit a claim to Part D Medicare for "possible but not probable" reimbursement when I do not know the code(s) necessary nor any of the other applicable related medical claim detailsMedicare also states that the service provider (RediMed) should submit the claim to insurance (not me)
REDIMED'S May 15, 2017, RESPONSE TO THIS COMPLAINT IS NOT SATISFACTORY DUE TO THE ABOVE INFORMATION
Adamantly yours,
*** ***, Insurer

Initial Business Response /* (1000, 5, 2017/05/15) */
RediMed billed Humana with the correct codes for the service Mrs*** had providedHumana Medicare may pay for one TDAP per year under preventative but not when performed in an Urgent Care settingWe contacted Humana and confirmed the
reason for non-payment is due to the place of serviceTherefore the balance is Mrs***'s responsibilityWe *** provide Mrs*** with a claim form that she can submit to Part D for reimbursement
Initial Consumer Rebuttal /* (3000, 7, 2017/05/25) */
RE: CASE# (Ref# XX-XXXXXXX-XXXXXXXX-X-XXXX)
My REJECTION RESPONSE to RediMed's May 15, 2017, answer is within the contractual time period of days and the reasons for refusal are noted below:
The balance of *** is NOT my responsibility per Hurnana's Smart Summary (included with this letter) states: This is one of the preventive services that is covered AT NO COST UNDER ORIGINAL MEDICARE, and the plan covers this service at NO COST TaY0iarner TE: "YOU ARE (I am) NOT RESPONSIBLE FOR PAYING THE BILLED AMOUNT because you received this service from a Humana provider..." (Again, Humana should cover the balance to RediMed, not me)
Apparently, all Humana Insurance needs RediMed to do to pay the *** is submit an accurate claim with corrected information including the appropriate service code(s) and the correct place of urgent care service (RediMed SW, *** W *** *** Ft Wayne, IN XXXXX-XXXX phone: XXX XXX-XXXX), NOTE: I CALLED HUMANA BEFORE GOING TO REDIMED AND HUMANA DIRECTED ME TO GET THE SHOT AT REDIMED DUE TO LESS COST
Since Original Medicare covers this treatment and Humana Insurance accepts this medical procedure, it is unacceptable that RediMed expects me to pay the *** balance to RediMed directly and then submit a claim to Part D Medicare for "possible but not probable" reimbursement when I do not know the code(s) necessary nor any of the other applicable related medical claim detailsMedicare also states that the service provider (RediMed) should submit the claim to insurance (not me)
REDIMED'S May 15, 2017, RESPONSE TO THIS COMPLAINT IS NOT SATISFACTORY DUE TO THE ABOVE INFORMATION
Adamantly yours,
*** ***, Insurer