Posted on: by ForbinBlogger in VGM News

Jameson of Bellevue Healthcare shares how People for Quality Care helped his company deliver a difficult message so a happy ending could be reached for patient, Ken.


My name is Jameson and I work for a DME company in Washington State.  We have been dealing with the mess that is competitive bid for a few years now.  There are many problems with the new process, and I’m sure they are detailed elsewhere in a very articulate way.  Suffice it to say it has been very hard for all DME companies to continue to grow and provide equipment to beneficiaries who have paid into Medicare their entire life. 

In an attempt to try and speed the process up my company created a new department that I work in.  We deal almost exclusively with Medicare orders for our company.  We are charged with obtaining proper chart notes and paperwork from doctors and patients alike.  In this particular situation, Cinde was working as a patient advocate for her father Ken.  They were trying to get him a group II support surface.  Cinde came to us because she felt as though she was getting the run around from another company.  When we got her chart it was clear to me that the need for the LAL mattress was real, but unfortunately the doctor and Ken’s care team hadn’t written the notes in a way that lead us to believe Medicare would pay for it.  The notes were not detailed enough, and they were lacking key phrases that Medicare keys in on during audits. 

I called Cinde and let her know that the notes did not meet the Medicare guidelines for a LAL Mattress.  I let her know that I would work with her father’s doctor to try and get them up to par.  Unfortunately the Doctor’s and Ken’s care team weere unable or unwilling or possibly they didn’t understand the necessary changes that needed to be made to Ken’s medical chart.  After a week or two, I contacted Cinde and let her know the troubles we were having.  

I believe she thought I was giving her the run around just like the company before us had. 

That is when she found People for Quality Care. Lalaina Rabary was able to do what would have sounded like trickery or a sales pitch from me. 

She discussed the situation with the changes Medicare had made, and all of the options at Ken and Cinde’s disposal, including an ABN form and the options on that form.  It would have been very difficult conversation for me to tell Cinde that “No your father doesn’t meet the medical criteria that Medicare has put in place, but sign this form and we will bill Medicare for you.  Per Medicare guidelines by signing this form we reserve the right to bill you privately while we pursue a determination from Medicare.”

That is a hard sell no matter the situation, and considering Cinde had already felt betrayed by the companies and programs put in place to help her care for her father, the outcome was never going to be favorable to the patient.  

After talking with Lalaina, Cinde gave me a call, and we were able to set up the necessary equipment and get the LAL mattress delivered the next day.  We are going to bill Medicare and revisit the situation after Medicare makes a determination.  It is my opinion that without the help of People For Quality Care explaining the process and the options to Cinde, Ken would still be without the LAL that he needs.  It is my hope that in the near future Medicare will realize/care about the harm they are causing, and we won’t need places like People for Quality Care, but until then I’m glad to be able to have a place to send people whom the process has hurt, and neglected. 

Sincerely,
Jameson

Bellevue Healthcare


What does this mean to you?

People for Quality Care helps supplement the important work that your business does.  With your VGM membership, our organization provides you with more hands on deck to provide your patients with the support they need at no cost.  Our organization is able to clearly explain to patients why accessing their equipment is difficult and provide them with solutions. As highlighted in the testimonial above, working with patients can be difficult and our organization is able to alleviate the time and stress that comes with providing quality customer service. We are a trusted organization with many patient partners and have a solid understanding of the DME industry.

If you would like to partner with People for Quality Care contact Kelly Turner or Lalaina Rabary at 800-404-8702.