Complaints

The complaint text that is displayed might not represent all complaints filed with BBB. 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.

• Initial Complaint

  Date:09/29/2022

  Type:Customer Service Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  My son's due for an upgrade on his cochlear implants every 5yrs. through insurance. All we have to do is see the Audiologist & ENT then Medel files the proper ppwk to Ins. His upgrade was due July 2021 The appointment with the audiologist was rescheduled due to the doctor having something come up. We were pushed to 1/22. Late October his left cochlear hook came off, but it's no longer covered under his warranty. We planned to have it replaced. On 12/21 our home burnt to the ground including ALL EQUIPMENT & 5 processesors. The day before his appt with the audiologist. in Jan. We got a call to reschedule the appt because the doctor wasn't in again. I threw a fit, my son's been without a left cochlear since late October & we have zero equipment to maintain his right cochlear. I got ahold of someone who assured me they'd get this ratified. Audi.'s office submitted a letter of medical nessesity (LMN) to Medel & Ins trying to bypass going in. I kept being told by Medel "it's processing." Received a denial letter in March so I rescheduled him to the Audi's first available 6/17 we saw the Audi & ENT that week. Both submitted ppwk to Medel. Waited until Aug to reach out & see what the hold up was & told by **** ****** with Medel that an appeal was submitted on 8/25 to request reconsideration. I called Ins, no record of an appeal or current claim pending. Also, the appeal time limit had already been reached for the 3/22 claim. I emailed **** letting her know what ins said. She claimed she had a ref# & name of who she filed with. I thought maybe it just needed more time to reflect in the acct. So I gave her more time but then **** kept requesting the same ppwk she'd already received from the Audi for LMN. So his audi and myself re-sent them several more times via email. I called Ins again. This time they had a record of an appeal but no current claims. **** stated several times via emails she filed an appeal on 8/25, ins said she filed on 8/29 which was not only two months-

  

  Business Response

  Date: 10/05/2022

  MED-EL’s goal is to provide prompt and efficient service, and we appreciate the opportunity to rectify any customer concern that is brought to our attention as soon as possible.  We have investigated the incident to determine the factors involved in causing this unfortunate delay. Unfortunately, there were delays in their being seen by their local clinical Providers (which is a necessary step to initiate the medical documentation required for insurance approval of a new system). We worked with the local clinical team to submit the request for coverage (despite their not having been able to be seen), but this resulted in an insurance denial of coverage (since they typically require the User to be seen and require documentation from the medical record to support this).  MED-EL Reimbursement staff requested the required medical documentation on 3/23/22.  The Insurer’s request for a peer-to-peer call with the User’s Physician was sent to clinic on 4/08/22. There was a change in Audiologist during this time, and their new Audiologist wasn’t sure which system to order until they consulted with the family (after which they promised to send the medical documentation that we are required to submit to insurance with our request/appeal, including Clinical Notes from the Clinic’s medical record. We did not receive the clinical notes required for the submission until 8/25/2022 (and did follow up with the local clinic during this time to try to obtain them).  We submitted the appeal to User’s Insurer on 8/25/2022.  We were informed on 9/8/22 that appeal was closed by the insurer because the original Prior Authorization (for the equipment this user needs) submitted on 3/17/22 did not contain the medical records from the local clinic supporting the medical necessity to replace the original equipment and the date of purchase of that original equipment. On the same date, 9/08/22, Insurance advised we needed to resend our appeal, and it was re-submitted that day.  In response to follow-up calls to insurer to check status of appeal, MED-EL was advised that they had classified the case as “peer to peer”, which this insurer defines as their assignment of one of their internal medical directors to review and determine if a formal review between insurer medical director and patient’s surgeon is required to overturn their authorization denial.  Insurer also advised MED-EL that they require completion of the Title XIX forms by referring surgeon before they will review case further.  MED-EL requested the patient’s referring physician to complete and sign the Title XIX forms on 9/21/22 (after receiving the forms from Amerigroup).  We updated the family on the same day (of the Insurer’s response and what was required to proceed with the appeal).  We received the Title XIX forms signed by the Physician on Friday evening (9/30/22) and submitted those to the Insurer on Monday 10/3/22. MED-EL Reimbursement staff have been in contact with the family to update them on the progress of this appeal.  We received an email Friday (9/30/22) from the family requesting to change the order from ***** to ****** (Speech Processors), and this change will be honored upon resolution of the insurance approval and order completion. The next step is for Amerigroup to process the appeal that the patient’s mother filed by phone on Thu, Sep 29th.  MED-EL was advised by phone follow- up to insurer on Monday, Oct 3rd that they would not consider the member’s appeal until member returns insurer’s forms. Insurer estimated processing of appeal to take 30 days after forms received from member. The insurer may determine that a formal peer-to-peer review is necessary at the conclusion of their review of the appeal.  
  
  We understand the frustrations of this User and family. They have been through a horrendous year, and all the delays are understandably frustrating.  We provided a quote (for the equipment) for FEMA, after the family’s fire last December, but never received confirmation of coverage by FEMA (which I’m sure added to the family’s frustration). [I think this sentence is confusing – MED-EL was not involved with the FEMA situation beyond providing a quote to family should they need it to submit to FEMA. Our staff have worked to obtain the information necessary from the User’s local medical Providers to file a Prior Authorization request for coverage; followed up regularly when there were delays in obtaining additional documentation requested/required by the Insurer; have tried to facilitate the steps necessary for the Insurer to consider our appeal of their denial of coverage and will keep the family updated as this progresses.  If Insurance approves coverage, we are ready to ship the equipment ordered by the User’s Audiologist.  If insurance coverage is denied, we will reach out to the family and their local medical Providers to discuss options and see how they want to proceed.
  
  We do not consider this situation resolved but are doing all we can to try to get approval from their health Insurer. We will continue to follow up, keep the family and local Providers updated as to the status of our appeal of the Insurer’s denial of coverage, and based on their Insurer’s response, work with them to find a solution so that this User can obtain the equipment they need. 

• Initial Complaint

  Date:06/21/2022

  Type:Delivery Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  My daughter has been waiting for a hearing device since August 2021 when the order process was started. We were told it would take approximately 6-8 weeks to receive. It has been almost a year and we have not received the device. I have reached out to the company multiple times and am given minimal information and told someone will call back and I have not heard any response from the company. To my knowledge Med El is the sole provider of this specific device and we are not able to get the device from another provider. My daughter has been waiting for a hearing aide that she needs to use daily. She went all school year without it. The company has not offered any resolution other than they will follow up and call me back. I have reached out to medical providers to ensure the company has all the information they need.

  

  Business Response

  Date: 06/22/2022

  The company’s goal is to provide prompt and efficient service, and we appreciate the opportunity to rectify any customer concern that is brought to our attention as soon as possible.  We have investigated the incident in accordance with our Quality System Complaint process to determine where the gap or gaps occurred that resulted in this delay.   In this case, staff were unable to obtain documentation from the customer’s healthcare provider (a referral from the Primary Care Physician) required by the user’s health insurer, leading to delays in getting insurance approval for this order.  The customer and their clinician (Audiologist) were informed of the reason for the delay and that we were still awaiting a referral from their PCP.   The company has authorized shipping the system at no charge, given the extraordinary delay involved. The new ADHEAR Kit was shipped on 6/21/2022.  We have verification of delivery from Fed-Ex and the user’s clinic (who received the shipment). MED-EL staff has reached out to let the customer know that the new ADHEAR kit is at their local center, so they can schedule an appointment. The device comes with a new Manufacturer’s warranty, just as it would if it had been approved by their insurer.  Staff have been trained/reminded that if there are delays in getting documentation necessary for insurance approval, they should ensure the customer is informed not only of the reason for the delay but also of all efforts MED-EL staff are making to try to obtain the information. Staff were also reminded to escalate this up to Management if there are continued delays, after having notified the customer and their local center (for any assistance they may be able to provide in getting the information needed).  We believe we have resolved the customer’s concern, but if not, we ask that they reach out to us directly.