ComplaintsforPRC- Saltillo

• Initial Complaint

  10/11/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  My wife and I have been trying to get our daughter a much-needed speech device from PRC Saltillo for over six months. Our daughter has been awarded several grants that are ready to be used. We have been consistently engaged with the PRC Saltillo Funding agent that handles this particular situation, providing her with everything she needed to process the order for the speech device. However, the Funding agent from the company continues to not complete forms necessary to complete the order for the speech device. The agent claimed that she processed one of the grants, when in fact, she has processed none. We are simply asking for the agent to complete the forms needed so our daughter can get her speech device. I want to also add that these grants have to be used by a certain date, or they will expire; which one, possibly, already has. The agent was also asked to provide a claim to our health insurance, so an Explanation of Benefits can be obtained; again, she did not provide the claim to our insurance so we can get the Explanation of Benefits

  Business response

  10/19/2023

  At PRC-Saltillo our mission is to enable individuals with speech and language impairments to successfully communicate and interact in their environment.  To fulfill this mission, we manufacture, sell and support augmentative and alternative communication (AAC) devices for individuals who are unable to speak.  The equipment is classified as Durable Medical Equipment, and our processes are heavily regulated based on insurance, Medicaid and Medicare guidelines.  We take our commitment to compliance seriously.
  
  A speech-language pathologist (SLP) at a local clinic recommended a NovaChat AAC device for this customer’s daughter.  This customer's daughter has a commercial insurance plan with a high deductible that does not cover the cost of the device.  PRC-Saltillo staff, a funding specialist, working with this family, let them know on March 3, 2023, that their request for an AAC device was approved, but due to the high deductible, the family would be responsible for the entire cost of the device.  At this time, the family indicated that they would pursue grants to cover the cost of the device.  Per our policy, a family must secure the cost of the device prior to the device being shipped.  In most cases, this is covered by insurance companies/ Medicare/Medicaid, and we receive prior approval and commitment of coverage.  In cases where there is no insurance coverage or a situation that requires a family to pay the full amount even with insurance coverage, we require either written commitment from a third party (e.g., grant foundation) to pay after the device has shipped or that the family commit to pay for the device prior to shipping.
  
  Ultimately, this family worked with three foundations to secure grant funding for the device.
  
  The first grant in the amount of two thousand dollars ($2000.00) was approved starting on April 29, 2023,but our funding specialist was not notified of this until July 31, 2023.  The funding specialist asked the family to request commitment of this grant in writing, and the family did so on July 31, 2023.  This written commitment simply said “Congratulations! The [FOUNDATION] has approved a medical grant for your child.”  This was sufficient to document their commitment to pay after the device was shipped.
  
  The second grant was secured on October 12, 2023, in the amount of seven hundred and ninety dollars ($790.00).  The funding specialist asked the granting foundation to commit to the grant in writing, and that was completed on October 12, 2023.  
  
  The information about the third grant (from HealthWell Foundation) was provided by the customer to the funding specialist on August 14, 2023.  After initially thinking that PRC-Saltillo should fill out the application form, the customer noted on August 22, 2023, that it was the customer’s responsibility to fill out the form and submit it to the organization.  The funding specialist communicated with HealthWell via email on September 14, 18, and 22, 2023 to ensure that PRC-Saltillo was providing the necessary information. Based on HealthWell’s response, on September 22, 2023, the funding specialist sent a quote with the estimated out of pocket remaining cost for the family and HealthWell responded on September 26, 2023, that it would take 10-14 business days for them to review the quote and provide confirmation of the grant.  HealthWell noted to the customer (presumably on 10/6) that they required the completed form, an Explanation of Benefits (EOB) and an invoice for the equipment prior to noting anything in writing.  This request caused several obstacles for our team:
  
  An EOB can only be obtained from the medical insurance company and only once a device is shipped. Because payment must be secured prior to shipment of the device, we had no way to ask the insurance company to provide an EOB or an invoice as those are only issued at the date of service (in this case, the shipping of the device). 
  The Grant Application Form that the family provided us to fill out was sent to our team on Friday, October 6, 2023, at 4:52 pm with a due date of Tuesday, October 10, 2023.  Our funding specialist called HealthWell on Monday, October 9 to discuss the inability to provide an EOB/ Invoice, but the company was closed for Columbus Day.  On October 10, 2023, our funding specialist called HealthWell to ask what we needed to do to ensure that this family received the grant. HealthWell noted that they had incorrect insurance information for the family and that the family could call them to request both a grant extension as well as correct their insurance information.  The Funding Specialist called and relayed this information to the family on October 10, 2023.
  
  
  The customer filed the complaint with the BBB on 10/11/23 and PRC-Saltillo received the complaint by mail on 10/17/23.  Since that date, the following has happened in this situation:
  The customer has called HealthWell and provided them with the correct insurance information.
  A team member from the speech therapy clinic that the customer has been working with is filling out the Grant Application form required by HealthWell, and our funding specialist has provided the information needed to fill out that form.  The clinic team member is working directly with HealthWell on securing written approval without an invoice/ EOB (as those cannot be provided since the device has not been shipped).
  
  At this point, there are two possible scenarios for how the customer could ultimately receive the AAC device.  These scenarios have been provided to the family verbally on October 18, 2023, by ***** ***** (Chief Operating Officer) and via an email to the family, PRC-Saltillo funding specialist, and PRC-Saltillo regional manager on October 19, 2023.
  Scenario 1: Wait for HealthWell to approve the amount requested and put that approval in writing to PRC-Saltillo.  Once that has happened, we can ship the device as the full amount of payment will have been documented.  This is still a possibility as all forms are still in progress with the clinic.
  Scenario 2: There may be an option for the customer to take full responsibility for the payment of the balance of the device if HealthWell is unable to provide written confirmation of intent to pay; however, this may have implications for how we bill their insurance company and have unintended consequences.  If this is the course that the family wishes to pursue, they will need to work closely with our billing and funding teams to explore how this happens in a way that does not violate our relationship with the insurance company or any of the grant providers.   
  I (***** *****, Chief Operating Officer of PRC-Saltillo) have been in contact with the customer via email on October 17, 2023 and via phone conversation on October 18, 2023.  The work to secure the HealthWell grant is ongoing, and it will likely be a decision that is made after the deadline to submit this response to BBB.  The decision on which way to proceed is one that can be made by the family through communication with our funding specialist, who is intent on ensuring that this family receives their device as soon as possible.
  
  Summary: Unfortunately, the process to obtain this type of durable medical equipment is laborious due to the high cost of the equipment, which involves complex technology, and the reliance on a third-party insurance company dictating coverage.  For this customer, there were multiple parties involved – an insurance company that had a high deductible plan requiring the family to be responsible or find other funding to cover full payment of the needed equipment,  an evaluating clinic that recommended the device, three separate grant entities that needed to indicate payment approval in writing, and a family  intent on ensuring that their daughter have a means to communicate.  PRC-Saltillo is the manufacturer and sole supplier of the equipment requested. As such we have a responsibility to ensure confirmation of payment, either by an insurance company, grant providers or through private payment plan, prior to shipping the equipment.   In this case, we have responded timely to requests, and successfully obtained promise of payment from two grant providers. Unfortunately, we have had consistent roadblocks with the third grant provider (HealthWell).  At the time of this writing, we are working with the clinic to obtain the written intent to pay from HealthWell, and have provided the family with an alternative to receiving the device by committing to financial responsibility if the third grant does not come through.  We have communicated consistently with the family throughout the process, ensuring they are included on all email conversations. We are committed to ensuring that this family receives their communication device and have helped to remove funding barriers to do so. Like the family, we understand the power that communication has for a child and will continue to work to assist this family with obtaining the communication equipment needed for their child.

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