ComplaintsforAmramp

• Initial Complaint

  02/02/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  The company AM Ramp, ******** ******** location, came out to take measurements and file a claim to my mothers health insurance to get a wheelchair ramp installed. I am my mothers daughter and ***** of ******** due to her health decline. **** is the manager of this AM Ramp location. He came out to do the measurements. He then told me he sent a claim to my *****************. This conversation/measurements for the ramp took place Tues Nov. 28th. I called him weeks afterwards for a follow up. He stated he had not started the claim yet because he did not know how to do it and asked if I knew an email or fax number for him to send it to. I recommended he call the insurance company to get help as I could not assist. I then called him weeks later again because my mothers secondary insurance ***************** called me and said they sent a claim to them first, when the claim should have gone to he rprimary insurance ********** to deny (because ******** does not cover wheelchair ramp) so that her secondary insurance ***************** would pick it up. I called **** and he stated he did not know he had to send a claim to her primary first but he would. He told me he sent a claim at the end of Dec. 2023. Mid Jan **** I called him to follow up. He said he had not heard anything but he would call ******** to see if they could rush the denial. I did not hear from him again. Today, Feb 1st I called ******** myself to see what was taking so long for the denied. After being transferred 3 times I was told the claim was never submitted. This company and **** lied about a claim ever being submitted. This is an unethical company that is lying about submitting claims to insurance companies and leaning clients struggling with their day to day life without these mobility assistance.

  Business response

  02/08/2024

  Hello. I have communicated with the family member regarding this request and clarified the facts with her. Most importantly, that we did submit (by fax) the request for authorization and I do have confirmation that our fax service successfully completed the fax transmission. It is unfortunate that this complaint was filed without even asking us because the facts are not accurate. Further to this point, after hearing from the family that ******** did not have a request in their system we called ******** and the plan administrator for DME pre-authorization, CGS. We were able to confirm with them that we did in fact send the correct documents to the correct fax number so it is unclear why they wouldnt have processed anything for this request. Additionally, after hearing of this situation, we again faxed the files on Feb 2 (the ************ to submit are by fax or mail). We again received confirmation of successful transmission. We were told at the time by CGS that we could call back 48 hours later and inquire about the status. I called earlier this week and CGS then stated they couldnt provide any details. The family called ******** today (2/8)and again, ******** says they do not have a request for the patient. It is clear that the issue was with GCS and/or them transmitting the request to ********.The last I have heard from the family this morning, the issue is being escalated to the ******** supervisor and a resolution team at ******** to try and resolve the problem.
  
  I certainly do not believe this is a fair complaint against our company. We have submitted requests for this ramp as instructed by *************** and ********. As the provider, I do not get confirmation until they send out a letter of approval or denial so it is just a waiting game on our end. We have attempted and are still attempting to help this family with a ramp knowing that historically, ramps have not been covered by these government insurance programs. Of note, case managers for Anthem have been reaching out to us because we are the only ones even willing to attempt to work with ******** and ********. We are not an in-network provider and are not contracted with either program to provide routine service. We are doing this, or at least attempting to, because we recognize there is a need that isnt being filled for these families. We agreed to try to assist this family because the case manager stressed the need and that no other company was willing to help. I feel we have gone out of our way to attempt to help the family with this need while trying to navigate what has turned out to be a very dysfunctional insurance process. It is regrettable that is taking this long and still not resolved and that it has now tarnished our reputation as a result of us trying to help a family where other providers werent willing to even try. As a company and individual we are in the business of helping individuals and families with their accessibility needs and this particular case hurts as weve been unable to do that due to insurance hold-*** and legalities.  
  
  Additionally, I know the family member does not see it, but we have spent hours upon hours talking with ******** and ******** over the last couple months to try to figure out what is going on with this request. Even after spending several more hours talking with the ******** durable medical equipment administrator and confirming that on multiple occasions, we have sent the pre-authorization request to the appropriate fax number that provider still is not able to process the request. We pride ourselves in being able to provide and install ramps in only a couple days once we receive approval (which is typically from the paying homeowner not insurance). Obviously getting approval from the insurance company has been a long and painful process for all of us involved and at the expense of the family not still not having a ramp.
  
  I fully understand the frustrations of the family but to say that we lied, are unethical and are intentionally leaving families to suffer is just wrong. 

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