ComplaintsforCare N' Care

• Initial Complaint

  12/16/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have been getting medical supplies from ************************** since 2022. I recently received a bill in the mail for $182.58 for (3) different dates of services. I discovered that the co-********** amount was for 30% and not for 20%. This problem was filed with ***********, the grievance department, and as of 12/15/23 this problem has not been fixed at ***********. My concern is that this bill could be turned over to a collection agency for non-payment. This is a careless mistake that was made with ***********. They cant tell me how long it will take to correct the problem, but has been close to 30 days, and nothing has been done.

  Business response

  01/11/2024

  Problem Report ID: ******
  Policy Number: CC0030681
  Policy Holder: *****************************
  
  Dear Sir or Madam:
  
  In response to the consumer complaint, you forward to *********** on December 18, 2023,
  Below is a timeline of the Grievances *********** has received from ************** related to the Medical Supply Company claim.
  10/20/2023 *********** received a Grievances from ************** this Grievance was closed on 11/1/2023 with the following resolution:
  o Grievance reason: ************** disagreed with the way the Evidence of Coverage described Durable Medical Equipment (DME) and stating that equipment and supplies are different and should be noted that way in the Evidence of Coverage. ************** compared the *********** Evidence of Coverage with the Human book and noted that they read differently. In addition, ************** wanted to know why the definition of DME includes equipment and supplies when they are different.
  o A Pharmacy Programs Manager for *********** advised that our 2024 Evidence of Coverage has blood glucose monitors listed as diabetic self-management training, diabetic services, and supplies that are covered, which is different than the *************************************************************************************************** that same section, it lists our preferred blood glucose monitors (Freestyle, Precision, and OneTouch) that are covered at $0 copay. However, the Dexcom G7 continuous blood glucose monitor that ************** is using is not preferred but covered at 20% coinsurance. They stated that our wording for this has been re-phrased in our 2024 Evidence of Coverage.
  11/6/2023 *********** received a Grievance from ************** this Grievance was closed on 11/29/2023 with the following resolution:
  o ************** filed another Grievance related to the issue outlined above. ************** was informed that ********************** had communicated that Diabetic Supplies benefit was unclear and that they have not sent any bills as they believed supplies
  
  
  should be separated from equipment.
  o ************ Provider Concierge team contacted and spoke with **** at the providers office and provided education related to the benefit, the benefit customer service phone number, and how to locate the benefits on the *********** website. In addition, they were also advised that the providers representative was unaware of any issue with their understanding of ************ benefits on your account.
  11/28/2023 *********** received an Appeal from ************** which was resolved on 12/19/2023. The resolution was follows:
  o Upon review of the appeal filed, *********** has approved the request.
  o *********** took all appropriate steps to ensure claims were reprocessed and payment issued to the provider within 7 to 14 days.
  o The Appeals Coordinator verified the claims below were reprocessed to pay in-network for ************************.
  o Claim number. New Claim number Date of Service
  ************ ************ 1/10/2023
  ************ ************ 2/10/2023
  ************ ************ 10/2/2023
  o All claims were re-processed with the member responsibility of $0
  o Upon inquiry of ************************** on 12/21/2023, they confirmed that the claims had been reprocessed and paid and that ************** had a credit on his account of $46.92
  The *********** Plan is issued in the ************** and is a PPO member.
  
  

  Customer response

  01/14/2024

  I am rejecting this response because:   

  i have not received a check in the mail from *********** for $46.92.

  I paid co-copays last year for the copay.

  I was told that the claims were processed at 70/30 copay.

  Again no check was received for the credit.

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