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This message and the attached documents are offered in response to and at the request of the AMR billing representative with whom I spoke during the afternoon of Wednesday, 16 October 2018. During the discussion the AMR representative stated that MEDICARE does not cover routine appointments to a physicianโ€™s office. It was at that point I stated โ€“ as I have in numerous pervious discussions โ€“ that my use of your services was for the purposes of post-surgical care at a medical center! Due to the restrictions placed on me, travel by stretcher was required for my safety. My physician, using Medical Center Letterhead, provided justification directly to AMR Billing. Repeated calls to AMR Customer Service indicates the whereabouts of these documents is unknown.

The attachments are copies of physician letters of medical necessity that were previously mailed directly to AMR billing from the medical center. These documents were to have been included by AMR with the AMR claims sent to MEDICARE and TRICARE.

In addition, excerpts from the MEDICARE patient guide are attached.

Please address and resolve my concerns with respect to costly errors in AMR coding and claims. Since January I have been engaged with your billing department with no success. I am put off with statements that the case will be put under review only to receive additional notices in the mail. MEDICARE and TRICARE denied payment for trips to the closest medical center able to provide the necessary care. Trips I made under the written advice of a physician.When I pursued the issue with the Medicare Contractor, First Coast Services, I was told that the claims were denied due to the way in which AMR had filed. In addition, the period to appeal has been allowed by AMR to expire on the first in a series of runs. AMR billing and insurance is now delaying corrective action on four additional service runs for which November appeal thresholds are fast approaching. Please see that this time the attached documents are include in the package and that you clearly indicate the trips were to and from the nearest medical facility able to provide the care needed!

Please acknowledge receipt of this email. Include whether or not the appropriate coding and coordination with MEDICARE and TRICARE have taken place such that these bills have been or will be resolved without further action or payment on my part.

END EXCERPT

Once again after weeks of delay they responded:

Per the notes, the billing department further reviewed your request. The trips are to and from doctor appointments; therefore, they are not a covered service under Medicareโ€™s guidelines. We are unable to change the coding just to satisfy Medicare billing. It is suggested that you appeal with Medicare directly with additional documentation as proof this was a medical emergency and a life threatening issue.

END RESPONSE

AMR customer service has led me to believe for months that THEY would file the claims appeal. And now they have delayed the process to a point outside the window that I can do it!

Michael Downey

Reason of review: Poor customer service.

American Medical Response Cons: Billing personnel.

Location: Kissimmee, Florida

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