ComplaintsforBreathe Easy Medical

• Initial Complaint

  11/28/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  On or about August 8, 2022 I received a call from Breathe Easy asking me if i wanted to get a new CPAP mask. I said yes but I had moved to Volusia County and have different insurance. i gave the person my insurance information and she put me on hold. When she came back she said I was covered and took my order and $22.91 which is my usual copay. In November 2022 I received a bill for $47.09. I call them and ask why they are charging me additional money. They are not very pleasant and have been difficult to work with in the past about overcharging. The billing person told me to ask my insurance. So I did, and was told that Breathe Easy was out of network for my new insurance. I called back to Breathe Easy and spoke with the billing person again and told her what my insurance said. And she "Oh, I thought you were in network, this is the first time i heard ****************** was out of network, I will but a note in the file." I told her that this was clearly their mistake and I don't owe the money. A week later I get another bill indicating I would be turned over to collections if i didn't pay immediately. I called today and spoke with the Manager ****. He said it was my responsibility and that I was supposed to check with my insurance to see if they were in network. I tried tried to explain what happened but he insisted I pay the remainder. Things got a little heated when he would not let me speak and he talked over me. He told me it was sad that I didn't take responsibility (for their mistake). He said they do billing only as a courtesy and I need to check my insurance before using his company. His staff told me I was covered but they are either incompetent or dishonest and gave me false information. I told him I would spread the word on the web about their business practices. He said he didn't care if I paid it or not he would turn it over to collections. I wonder how many other senior citizens they change the price on goods and demand payment.

  Business response

  12/02/2022

  This is the response for BBB case# ********. The patient was contacted by Breathe Easy Medical on August 8th, 2022 regarding his CPAP mask resupply order. At that time, the patient let us know that he did want his supplies and that he had moved to Volusia County. He also provided his credit card information for his co-insurance payment. At that time, we accessed the United Healthcare provider portal to verify eligibility and co-pays. Because we are an in-network provider for United, the co-insurance to be collected was listed as 20% in the portal. We proceeded to process his order and charged the co-insurance as provided by the United Healthcare website. The order was mailed out to him on August 10th, 2022.
  
  The payment from United Healthcare was received on November 1st, 2022. With this payment we learned that there were additional co-pays due. Our billing department followed up with United Healthcare and they said that since the patient now lives in Volusia County, we are considered out of network with his plan. We spoke with them about being under contract and the portal did not show us as out of network for his plan. They did some research and now found that his plan lists us as an out of network provider even though we are a United Healthcare provider. We let them know that we checked the provider portal prior to dispensing his supplies and there was nothing there about being out of network or the patient having higher co-pays. They did not understand why we were considered out of network with this plan and were looking into the situation. As of 12/2/2022, we have still not heard back from United on this situation.
  
  Regardless, when a patient is first taken on by our company, we let them know that we do the best we can with the information provided by the insurance provider. With over 900 different insurance companies and thousands of plans in the U.S. alone, it is impossible to always get the most accurate information. We encourage our patients to verify their own benefits since it is their insurance. Upon initial delivery, patients are made aware of our assignment of benefits clause. The patient signed an acknowledgement of this clause which states, "I request payment under my medical insurance to be made directly to the above named company for the products provided. In the event my medical insurance does not make payment, I (or my Agent, Parent, Guardian, Representative, or Estate) agree to be personally liable for all charges". This is a standard practice for any medical provider because co-pays and deductible can change and information from insurance companies can be unreliable at times. We try to do the best we can but ultimately it is the responsibility of a patient to know and understand their insurance, their benefits, and potential monies they will owe. We used the information provided to us from United Healthcare at the time to calculate the co-pays.
  
  The patient states that we overcharge. This statement is inaccurate. When a company works with an insurance company, the insurance company sets the price, we do not. The patient receives an explanation of benefits from his insurance that breaks down all the charges. The insurance company sets the price, we do not. If the patient looks at his explanation of benefits, he will see this. He can also call the insurance company and verify the prices, which sound like he already has. So, he is aware and knows that we have not over charged him.
  
  The statement about our billing person stating that we though he was in network is correct. When we verified his benefits prior to delivery through the United Healthcare portal the information we received was a 20% copay do. We did not look any further since we deal with United Healthcare frequently and are a certified contracted provider.
  Even thought this was all presented to the patient when he called in, he said it is our fault and that he is not liable for the monies. As I stated above, we do the best we can with the information that is provided to us. We are not asking the patient to pay a bill that he is not responsible for. Ultimately it is his insurance policy and his responsibility to verify his benefits. I looked over this situation and our staff followed our procedures correctly. We do the best we can with the information given.
  
  Our bills are sent out automatically and a second bill puts on the bottom that to avoid collections, please take care of this bill as soon as possible. We very rarely send people to collections. When the patient called up and spoke with me on 11/28/2022, I explained the situation and let him know that he was responsible for the additional copays. He became irate and kept saying it is our fault and our problem. I tried to work with the patient the best I could but without success.
  
  We service thousands of patients a year. You are always going to run into patients that feel they share no responsibility. With the patient's rudeness to my staff and myself, I did give him 2 options of either paying the bill or it would just go to collections. At that point in the conversation, I was not going tolerate and listen to his rudeness any longer and told him I did not care what he did. The patient told me that he has an 800-credit score so send it to collections. He also threatened my company by saying he would spread the word on the internet and report us to business organizations. All because he does not want to own up to his financial responsibility. I never mind when a complaint is brought against our company because in the end, when both sides are presented, people can see what is right and what is wrong. In this case, the patient not only does not want to take care of his financial responsibility but the way he treated my staff was unacceptable. We are in the business of helping people and should not have to endure nasty situations like the patient created.
  
  His last statement of, "he wonders how many other senior citizens they charge the price on goods and demand payment", is another attempt at making it look like he is the victim in this situation when he should do what is right and take care of his financial responsibility. As stated above, the insurance companies set the price and any deductible or co-pays that will be due. We have nothing to do with this. When we agree to accept a patient's insurance, we accept the prices set by the insurance company. I wish people would be honest when reporting or complaining about a company and just state the facts and not make things up.
  

  Customer response

  12/07/2022

  (The consumer indicated he/she DID NOT accept the response from the business.)
  The managers response is a valiant attempt to justify their mistake and wanting me to pay for their error. Their policies and procedures appear stellar without exception but unfortunately they are misleading and clearly are not practiced. Looks good on paper, lol. The manager spoke to me in a condescending manner which sounded like he does this spiel all the time. I was put on hold initially with staff for approximately 20 seconds and told I was covered because usually ****************** is in network. Unfortunately, they appeared to make that determination off hand without checking contrary to the mangers statement. Hopefully, others will read their actual business practices in this complaint opposed to how they like to describe them. I am done with Breathe Easy and their error is on them. They are unwilling to rectify it and then make it sound like they are above board in the dealings with customers. I am sending mask back and expect a full refund.

  Business response

  12/09/2022

  I feel that we responded to the consumer's complaint in a factual manner, not speculation like the consumer. We service thousands of patients a year and like any company, you will always have a few like the consumer who just feel wronged. We tried to discuss this and work with the patient without success. This whole complaint is over the consumers co-insurance of $47.09. If the consumer handled himself more professionally with my staff, we most likely would have written it off. This is not about the money, but the principle. It is unacceptable to treat anyone the way the consumer treated my customer service staff. I will not respond any further to this case since the consumer has proved that he is unwilling to accept any responsibility and appears to just want to speculate on this matter. I feel I have provided enough information for the BBB and anyone that reads the complaint to justify our position. Thank you for the opportunity to respond to this complaint.

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩