ComplaintsforPrism Health Care Services, Inc.

• Initial Complaint

  01/29/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  A representative of Prism Health Care Services, *** telephoned me on 01/25/24 and attempted to pressure and manipulate me into ordering supplies I may not have needed. They wanted me to give them authorization to bill my insurance without properly explaining what supplies they wanted to order on my behalf and why I would need such supplies and whether or not my provider had ordered a resupply and even if allowed by my insurance, whether such supplies were needed given my health circumstances. The representative who did not claim to be medically trained, told me I would get infections. I asked for an estimate of what my insurance coinsurance would be but was refused. Prism's representative said they would determine the amount of my coinsurance responsibility and contact me before filling the supply order. I did not receive a phone call providing me with an estimate nor did authorize purchase of medical supplies. Prism sent me an email on 01/29/24 falsely claiming that I approved the resupply on 01/25/24 and that the order #******* was being shipped. When I called the number provided, a representative named ******* or *************** or similar yelled and blamed a third party they had contracted with. She refused to let me speak to a supervisor and refused to look up my name or account and refused to notate my account then hung up. When I called back, I had to wait on hold for an unreasonable amount of time. When I called back a third time, I reached ******* who said she was in contact with her supervisor **** but refused to let me speak to her supervisor or to any supervisor to resolve this issue. Prism Health Services deliberately frustrates the customer service process so that a customer has no venue to complain or to reach a supervisor. In addition, they are potentially committing insurance fraud by pressuring customers to order unnecessary or unneeded supplies and then processing the order with authorization causing a bill to the insurance company..

  Business response

  02/06/2024

  Upon receiving notifications from both our Resupply Fulfillment Provider and the Better Business Bureau (BBB), I conducted a thorough review of the order timeline. It has been confirmed that you were not contacted to confirm your financial responsibility and allowed to approve the resupply order.  In light of this oversight, I have taken immediate action to rectify the situation. The total balance of the order has been adjusted, and I want to assure you that we will not be submitting any claims to your insurance or billing you for any balance related to this order.

  
  Additionally, I have made a note in your account to ensure that you will not be contacted for any future resupply orders.

  There are recordings of the calls with ********************, but I am not able to upload due to the document type.  ******************** was informed at the start of the first call that the call was being recorded.  

  Customer response

  02/07/2024

  Complaint: 21218426
  
  I am rejecting this response because:
  
  Prism states in their response that they reviewed the recorded call and found no evidence of their representative pressuring or manipulating me into ordering supplies and that the call was routine.  I reject Prisms response.  Prism, as the subject of my complaint and a profit-motivated entity, is not in an arms-length independent position to fairly evaluate their own response to my complaint.  Their representative used excessive pressure and aggressive manipulation to secure approval of an potentially unnecessary resupply order.  I hadnt needed to use my medical device for several weeks.  After the one night that I used, it, I received a resupply call immediately the next day from Prism.  They are using my private medical device usage information which is electronically submitted to my provider for their own profit-motivated purposes.  The representatives phone call was an unsolicited cold call commonly used by industries who employ high pressure sales tactics.  I never asked to be contacted to re-order supplies.  The representative immediately dived right into a corporate script narrative framing the discussion with an unstated assumption at the onset that my medical provider said I needed these supplies and then quickly moving on to blind side me into quickly getting my authorization without giving me an opportunity to object or to clarify whether she was calling on behalf of my provider or on behalf of the resupply company.  Her tactics were brazen and unethical and were a deliberate attempt to confuse and frighten me, a vulnerable patient, into authorizing supplies I may have not needed on.  Previous representatives asked if any of the parts to my medical device were damaged such as holes in hoses.  This representative did not make any inquiries as to the current state of my equipment. I was told by Prism at the onset that if I regularly cleaned my equipment, they wouldnt need constant replacement. If that wasnt bad enough, the representative ignored my stated concerns, did not actively listen to my concerns of being pressured to make an uninformed decision, then brazenly tried to upsell my by wanting to use my phone number so that Prism could send ******* me with constant unsolicited texts to further pressure me into ordering unnecessary supplies.  Her tone of voice and her attitude conveyed techniques such as guilt-tripping, fear mongering Lack of trust and damage to reputation.
  Prism apologized for their lack of explanation of supplies being ordered but pointed out that the provided had ordered a resupply and that the insurance consistently paid for the resupply.  I reject this response.  As I attempted to explaine to the representative, just because a provider and insurance approves a resupply doesnt mean it is necessary.  Employing high pressure tactics to blind side a patient into approving unnecessary supplies drives up insurance costs and allows Prism to profit at the expense of vulnerable patients receiving medical care.
  Prism stated that any representatives statement on possible infections I could get were likely intended to convey the importance of hygiene.  I reject this response.  The representative spoke in an angry and hurried voice typical of a high pressured sales person who is only interested in securing authorization to secure profit for Prism.  The representative did not ask even minimal information of the state of my equipment, whether I performed regular cleaning, or whether any of the hoses or filters showed signs of wear or tear. 
  Prism admits their representative did not follow up with me to provide an estimate and to get authorization to order supplies but they claim it was an error.  I agree that I was not contacted but I doubt it was an error. The representatives tactics, tone of voice, impatience, and her brazen attempt to scare me and to upsale all indicate a potential deliberate attempt to push the authorization through hoping I would not take any action after the fact.
  Prism apologized for the difficulties I experience in not being to reach a supervisor but claimed my calls were forwarded to a medical provider in *****, a closed branch location, and that staff at their main office had left for the day at %:00pm CST. I reject his response because %:00pm is not a time of day.  In addition, a representative of Prism told me there were speaking with a supervisor on the other line who had not left for the day but refused to let me speak to that supervisor.  In addition, Prism made no mention of how they planned to improve their process so that a customer with a complaint can bring it to the attention of a supervisor.  
  Prism states they take allegation of insurance fraud very seriously and that they operate with the highest ethical standards. Insurance fraud affects vulnerable patients who have medical needs.   I reject their response for all the reasons I have already mentioned above. Prism admitted that a claim for the supplies that I did not authorize was with its accounting department and practically on its way to my insurance company and had to be manually stopped.  In addition, Prism did not state specifically how they are committed to operating with high ethical standards or what actions they would not take to improve their operations, be more transparent, how they plan to rebuild credibility with me, or how they could improve their operations so that they focus on my specific medical supply needs as opposed to profit.  
  
  Except for their admission that I was not contacted to authorize a resupply, I reject Prisms response.
  
  Sincerely,
  
  *******************************

  Business response

  02/19/2024

  Please see the attached response.  

  Customer response

  02/24/2024

   
  Complaint: 21218426
  
  I am rejecting this response because the business in its concluding statement still denies that its representative pressured me into ordering supplies or that they engaged in any potential insurance fraud.  I have forwarded a complaint to the state department of professional regulation for their review in the interest of protecting people with medical conditions from unscrupulous profit-motivated businesses.  The business by its very own admission said the recorded call was clear that I did not authorize order of the supplies yet I received the supplies with a packing slip that contained an invoice number, order number, and order date.  The fact that the bill had not yet reached the insurance company for payment is irrelevant because had I not intervened, it would have eventually reached the insurance company for payment for supplies that were not needed nor authorized.  Someone had to have hit the approve authorization button or field in the business' ordering system with full knowledge on a recorded call that I did not authorize the order.  The business does not admit that I attempted several calls to them to speak to a supervisor but was continually transferred or deliberately hanged up on so as to frustrate the process so that I would be intimidated and fearful into just letting the order go through.  I called from several phones where associates failed to notate our conversation or to connect me with a supervisor.  I have asked my provider to remove the referral to this business and to refer me for medical supplies to another business that is more responsive to my medical needs and choices and does not attempt to manipulate me into ordering unnecessary supplies for profit-motivated reasons.  This is my final response.

• Initial Complaint

  12/16/2021

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  They seem to be spamming or just calling .12/16 /2021 @ 11:58 from ************.I answer then they hang up call back to tell them to grow up then are scared to talk as well and goes into a strange VM

  Business response

  12/22/2021

  This is in response to a complaint filed with the Better Business Bureau on December 16th, 2021. 
  The complaint was regarding a call that was made to ***************** place of business.  During this call the Prism Representative misdialed a number and as soon as they realized the number dialed was incorrect, they disconnected the call without apologizing to the receiving party.    
  ****************** then called Prism Health Care and left the following message in the general mailbox:   
  Yeah um, you must have children there or immature people that work for you. Um, I see that youre listed here with the Better Business Bureau, so I probably should not put that there. Oh, you have been in business since oh well ok, oh you just went on to the Better Business Bureau looks like what, 3/17/21. Um, tell your children to stop calling professional companies and then when you answer they hang up. If they are scared to talk to people, then just dont have them bother other people and you should probably not let them make the calls representing your company. 
  I have reviewed our call records for dates 12/1 to 12/17/2021 and verified that ****************** was only contacted on 12/16/2021 at 11:58am.    
  As a result of this complaint, re-education in proper phone etiquette has been reviewed with our customer service staff.  I apologize for this inconvenience and for the disruption to your day. 

  Customer response

  12/29/2021

   
  Complaint: 16372123
  
  I am rejecting this response because:  Only reason is first try to make iy seem that he felt a need to publicy post as if its my fault.I would guess as a business they would want to squash with a phone call..

   If they did I would have actually withdrawn I have noticed not the first time for them with others 
  
  Sincerely,
  
  *************************

  Business response

  01/05/2022

  Good morning ******************,
  
  Again, I apologize for the inconvenience caused by our phone call made in error on December 16, 2021 at 11:57am.  This was a misdialed call on the part of our customer service representative and no further calls had been placed to your place of business. 
  In your rejection response this morning you stated, I would guess as a business they would want to squash with a phone call.  However, when you filed the original complaint you indicated, No further contact by the business as the Desired Outcome/Settlement.  We respected your request and responded via the Better Business Bureau Complaint Hub. 
  Again, I apologize, and I hope you have a Healthy and Prosperous New Year. 

   

  *******************

  Quality Control Director 

  Prism Health Care Services, Inc.  

*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. ↩