ComplaintsforABF/ROMCare
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Complaint Details
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Initial Complaint
02/15/2023
- Complaint Type:
- Billing Issues
- Status:
- Answered
On 12/19/2022 my daughter had knee surgery, and as part of her recovery program, her surgeon required that she use a Continuous Passive Motion (CPM) machine. The machine was delivered by ABF ROM Care 12/19/22 and picked up on 2/14/23. When ABF set up delivery of the machine, they told me my health insurance would not cover it and and asked for a credit card number for payment, but they did not plan to bill until after the machine was returned. I then contacted my health insurance provider (*****) to find out if the machine was covered, and they said it was covered under certain circumstances and directed me to a policy on their website. My daughter's surgery is covered under the policy, so I worked with the surgeon's office to ensure that the order for the machine accurately described the surgical procedure she had so insurance would cover it. Despite getting the revised order and my instructions to bill insurance, ABF has resisted submitting the order to my insurance and keeps trying to bill me directly at a "reduced rate," and is trying to insist that I pay for it and then work with my insurance for reimbursement. Despite the revised order and my request to bill the insurance before billing me, the company still tried to process the payment on the credit card I provided. The payment did not go through because I had the card replaced after reporting it lost. My insurance provider is listed as "in-network" on their website, but they keep trying to tell me the machine isn't covered by my insurance when they haven't even tried to submit the claim. I suspect ABF tries to save themselves time, paperwork, and possibly earn more money by billing patients directly instead of submitting claims through insurance.Business response
02/17/2023
When we received the initail order it had stated a Right Hip Arthroscopy on 12/19/22. Due to *****(her health insurance provider) criteria they will not cover for a Continuous Passive Motion Device for that procedure. Therefore, we negotaite with patients as cash cases so we can provide a lower cost to patients since the patient has to pay out of pocket. Not having to go through all the technicalities with our billing and the insurance providers processes it allows our company to reduce cost to help the patient when enduring the out of pocket for items that are not covered. On February 15, 2023 we received a new order dated February 1, 2023 as you show in the complaint. We have been in contact with doctors office in regards to the new order, conversation is still in the works with the doctors office. Once conversations are completed with the doctors office we will determine what information should be sent to ***** for claim submittal on behalf of the patient. We still can't guarantee that insurance will pay, even though they have told the insured that it will. All insurances have disclaimers subject to review, no guarntee off benefits. Even if we obtain a authorization they still can deny claims that have had orinigal approval once claims are submitted. We strive in making this the best possible experience for our patients. Please see original order attached and ***** criteria for the Continuous Passive Motion Device. Please let me know if there are any further questions.
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Contact Information
12984 Maurer Industrial Dr Ste A
Saint Louis, MO 63127-1554
Customer Complaints Summary
1 total complaints in the last 3 years.
0 complaints closed in the last 12 months.