B van

Tim,

Ah. This is always the awkward part where a simple “thank you” seems so woefully inadequate. Yes, I realize you’re not donating labor for the praise, but it’s always comforting to see kindness appreciated. Kindness is becoming almost extinct it seems so we aren’t sure how to respond to it when we do encounter it.

Of course, I will probably still have to pay off the parts bill in installments, but that will be a far smaller mountain to summit. Labor is always at least half of the cost when it comes to tearing down something as complicated as an automatic transmission (I still don’t really understand how they worked long before electronics). Hopefully, I will be able to pay off the parts bill without having to suspend training for my service dog as I would have to to pay off the full bill. Believe me, Leia, my dog, was not going to appreciate that at all!

One other thing, while you have Bessy up on the rack to drop the transmission, would you please check the differential for signs of wear? No, I’m unaware of any issues there, but that’s an area I suspect your techs don’t even think about during the semi-annuals. Let’s face it, my van is nearly as old as some of your techs, and comments are occasionally made that suggest to me that a few haven’t been totally comfortable examining a vehicle that doesn’t have a CAMBus port they can simply plug into. Put another way, it’s comforting knowing my transportation is currently in hands experienced enough to remember life before the mad proliferation of the CAMBus and ECUs with dubious software. J

Scott

From: Caleb Greissman [mailto:caleb.greissman@helfmandodge.com]
Sent: Monday, December 26, 2016 11:05
To: ‘Scott Royall’ <royall@conchbbs.com>
Subject: RE: B van

Scott,

Tim has the job approved and you will only pay for parts (Helfman will donate the labor) and we will overhaul it. I will let you know more as soon as we get the trans torn down. This is excellent news.

Kind Regards,

Caleb Greissman

Helfman DCJR Service Advisor

7720 Katy Freeway

Houston, TX 77024

From: Scott Royall [mailto:royall]
Sent: Sunday, December 25, 2016 2:51 PM
To: ‘Tim McLean’
Cc: caleb.greissman
Subject: RE: B van

Tim,

First, a couple of questions and a request. Does this particular transmission have a PCM? If so, what diagnostic codes is it giving? Also, would Caleb please prepare two estimates, one for replacing the transmission, and one for its overhaul. The final numbers will probably be what determines which course is more feasible.

On one hand, you have a right to know why my payment options are so limited at this point. Yet, one the other, I refuse to use the emotionally manipulative tactics employed by organizations like the ASPCA use in their minute-long commercials featuring animals freezing in the snow. Such blatant manipulation just galls me. Helfman is a business, and businesses have to be paid for services provided. I understand that, but my payment options are going to be severely limited from here on out. There was a time when I could count on financial assistance from the maternal side of my family, but nowadays they struggle to pay for their own caregivers and bills. In a way, I am more fortunate than they are, because my caregivers are paid for from a long-term care insurance policy I was able to enroll in a few years before Shell Oil decided to shift the bulk of its information technology operations to Malaysia. However, that LTC policy runs out of funds in mid-2019 (which tells you why I won’t be needing my van after that point).

The only personal income I have left is Social Security Disability, and that’s under $2K a month. So I can forget the possibility of a bank loan. The van has no resale value left, and I don’t have any other unencumbered collateral. The IRS has a lien on my house because I owe them around $100K in employer taxes (the LTC policy pays for my caregivers, but not the associated employer taxes). About the best I can do is pay Helfman in installments of $400-500 a month, and neither one of us probably has any influence over whether or not they will accept that. Even if they do, it will take me about a year to pay off the bill and interest. We will have to pray that nothing else major breaks in the meantime.

The only other option Helfman has is probably to scrap the van, and I couldn’t really blame them for doing it. I would only ask that the junkyard grant it a quick end in the crusher rather than make it endure a slow demise rusting in a stack of vehicles. Machines aren’t alive, but they sometimes do take on certain traits. This one has served me to the best of its ability for over two decades, enduring far more than you know, so I can’t help the sense that it has earned a quick death.

Hopefully, things won’t come to that for a while, because I really need the van back ASAP. There aren’t any other reasonable options around Houston for a somewhat active disabled person who still needs transportation on short notice.

It is what it is.

Scott

From: Tim McLean [mailto:tmclean]
Sent: Thursday, December 22, 2016 13:58
To: ‘Scott Royall’ <royall>
Cc: caleb.greissman
Subject: RE: B van

Yes of course .

It looks like KD band material delaminated. There is also a metallic slurry in the fluid.

From: Scott Royall [mailto:royall]
Sent: Thursday, December 22, 2016 1:00 PM
To: ‘Tim McLean’ <tmclean>
Cc: caleb.greissman
Subject: RE: B van

Yes, I see the debris. I hope you don’t mind if I use the images to get a second opinion.

I assume the cost of an overhaul is comparable to replacement, right?

From: Tim McLean [mailto:tmclean]
Sent: Thursday, December 22, 2016 12:14
To: Scott Royall <royall>
Subject: Fwd: B van

Scott I’m sorry for the bad news it’s worse than I expected there’s nothing we can do either has to be overhauled or replaced

B van

Tim,

First, a couple of questions and a request. Does this particular transmission have a PCM? If so, what diagnostic codes is it giving? Also, would Caleb please prepare two estimates, one for replacing the transmission, and one for its overhaul. The final numbers will probably be what determines which course is more feasible.

On one hand, you have a right to know why my payment options are so limited at this point. Yet, one the other, I refuse to use the emotionally manipulative tactics employed by organizations like the ASPCA use in their minute-long commercials featuring animals freezing in the snow. Such blatant manipulation just galls me. Helfman is a business, and businesses have to be paid for services provided. I understand that, but my payment options are going to be severely limited from here on out. There was a time when I could count on financial assistance from the maternal side of my family, but nowadays they struggle to pay for their own caregivers and bills. In a way, I am more fortunate than they are, because my caregivers are paid for from a long-term care insurance policy I was able to enroll in a few years before Shell Oil decided to shift the bulk of its information technology operations to Malaysia. However, that LTC policy runs out of funds in mid-2019 (which tells you why I won’t be needing my van after that point).

The only personal income I have left is Social Security Disability, and that’s under $2K a month. So I can forget the possibility of a bank loan. The van has no resale value left, and I don’t have any other unencumbered collateral. The IRS has a lien on my house because I owe them around $100K in employer taxes (the LTC policy pays for my caregivers, but not the associated employer taxes). About the best I can do is pay Helfman in installments of $400-500 a month, and neither one of us probably has any influence over whether or not they will accept that. Even if they do, it will take me about a year to pay off the bill and interest. We will have to pray that nothing else major breaks in the meantime.

The only other option Helfman has is probably to scrap the van, and I couldn’t really blame them for doing it. I would only ask that the junkyard grant it a quick end in the crusher rather than make it endure a slow demise rusting in a stack of vehicles. Machines aren’t alive, but they sometimes do take on certain traits. This one has served me to the best of its ability for over two decades, enduring far more than you know, so I can’t help the sense that it has earned a quick death.

Hopefully, things won’t come to that for a while, because I really need the van back ASAP. There aren’t any other reasonable options around Houston for a somewhat active disabled person who still needs transportation on short notice.

It is what it is.

Scott

From: Tim McLean [mailto:tmclean@helfmandodge.com]
Sent: Thursday, December 22, 2016 13:58
To: ‘Scott Royall’ <royall@conchbbs.com>
Cc: caleb.greissman@helfmandodge.com
Subject: RE: B van

Yes of course .

It looks like KD band material delaminated. There is also a metallic slurry in the fluid.

From: Scott Royall [mailto:royall]
Sent: Thursday, December 22, 2016 1:00 PM
To: ‘Tim McLean’ <tmclean>
Cc: caleb.greissman
Subject: RE: B van

Yes, I see the debris. I hope you don’t mind if I use the images to get a second opinion.

I assume the cost of an overhaul is comparable to replacement, right?

From: Tim McLean [mailto:tmclean]
Sent: Thursday, December 22, 2016 12:14
To: Scott Royall <royall>
Subject: Fwd: B van

Scott I’m sorry for the bad news it’s worse than I expected there’s nothing we can do either has to be overhauled or replaced

Wheelchair

From: Jonathan Crisman [mailto:jonathanc@txmobility.com]
Sent: Wednesday, December 7, 2016 16:38
To: ‘Scott Royall’ <royall@conchbbs.com>
Cc: troyl@txmobility.com; davidw@txmobility.com; mikem@txmobility.com
Subject: RE: Wheelchair

Mr. Royall-

We have you on the schedule for Friday at 1pm.

Thank you

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Wednesday, December 7, 2016 3:19 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Poor Jonathan, you’re trying. It’s not your fault the entire industry considers its end users to be “patients.” That encourages the perception that we’re all invalids with diminished capacity.

Ahmm, no.

My 80-year-old mother unfortunately has less mental capacity than I do, and I don’t let my employees use my card over the phone. Therefore, the only remaining option is for the mountain to go to Mohammed. I’ll see you around 1:00 pm. Friday, and you’ll only get to charge me $85. This is strictly an one-time event too.

Bye.

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc]
Sent: Wednesday, December 7, 2016 7:18
To: ‘Scott Royall’ <royall>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Mr. Royall-

You can have your caregiver or family member call in your payment information and then I can schedule the service call.

Thank you

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Tuesday, December 6, 2016 3:53 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

My my, you’re a greedy little cuss, eh? What’s the problem, are people “forgetting” to pay? J (Sorry, that was just too juicy to pass up. Besides, it is a valid point. Not even my doctors are demanding immediate gratification, despite what their signs say. It comes down to respect and trust.)

What information are you needing? Surely you’re not asking for credit card data in email, right? That would unencrypted plain text, readable by anyone along the route it travels. Your billing department should have the rest of my information. In any case, what good does a receipt do me when my personal income is below the minimum taxable level? I owe the IRS only because I hire my own caregivers.

From: Jonathan Crisman [mailto:jonathanc]
Sent: Tuesday, December 6, 2016 13:50
To: ‘Scott Royall’ <royall>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

We can take a credit card. Send me the info and we can bring a receipt.

Thanks

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Tuesday, December 6, 2016 1:17 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Jonathan,

Seems reasonable. I’ll let you pick a day that’s best for you. Make the appointment for after 10:00 (preferably after 11:00). I don’t carry cash so I’ll have to owe GASMH.

Scott Royall

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc]
Sent: Tuesday, December 6, 2016 7:33
To: ‘Scott Royall’ <royall>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Mr. Royall-

It will only be a onetime charge for the diagnosis due at the time of appointment.

If available, I would be more than happy to attend.

Please let me know if you would like to schedule and I will get with service to schedule.

Thank you

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Monday, December 5, 2016 2:30 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Jonathan,

You’re apparently saying that GASMH needs to make two visits, one to diagnose, and another to actually perform the maintenance. Will I be charged $170 for each visit? Or is it the case that the $170 is for the diagnostic visit? If the latter, then Mike’s calling it a “diagnostic” charge seems much less farcical. A diagnostic visit is probably prudent with most power wheelchair users as few are thoroughly aware of how their machine functions.

If the $170 is for the diagnostic visit, I have only one firm requirement. I understand that it isn’t your job to go on diagnostic visits, but I must insist that you come on this one because I think it’s essential that you and I meet. I believe Troy would agree on that also. I am not your typical “patient,” and I think it necessary that you develop your own sense of my abilities and limitations. Please plan on spending an hour with me as I unfortunately communicate slowly, and it’s important we not be rushed. Of course I know you’re going to balk at this whole idea, but please remember this is a requirement I have of any DME supplier.

I would also ask that, as part of your preparation for our meeting, you please review the history of part orders for this chair. In particular, notice the long string of casters, and how it suddenly stopped last year. Yes, there’s a story there about who is the best diagnostician when it comes to my equipment, and it will serve nicely as an example. I wonder if Troy still has copies of the relevant email.

Scott Royall

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc]
Sent: Monday, December 5, 2016 9:48
To: ‘Scott Royall’ <royall>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Mr. Royal-

We will be more than happy to submit for authorization once we come out and diagnose the chair for repairs.

Please let me know if this is agreeable and we can schedule.

Thanks

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Saturday, December 3, 2016 7:04 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Jonathan,

Well, thank you for the information. I note that it appears to have come from a PDF that’s not publicly available. As to my supposed rights as a MSP subscriber, I have your word, and I have Healthspring’s. In any case, the issue is academic because of the number of suppliers on the list. I simply don’t have the weeks required to contact each of them to determine if they have out-of-pocket trip charges; my batteries likely won’t wait patiently so a little more help would be appreciated.

Of course, I could point out that, if the suppliers are being squeezed as you say, then it was a miracle that GASMH could afford to hire you, right? Teasing aside, I am aware that GASMH has had difficulty getting paid by Healthspring. I also know Medicare pays less than what the industry considers to be the going rate. My personal viewpoint is the whole medical industry has been high on seemingly unlimited government and insurance money for so long that it has become a very dysfunctional market. I honestly don’t know what it will take to reset the mess, but my instincts tell me it can’t be done without pain, suffering, and a boatload of natural selection. Not what liberals want to hear. Thing is, though, the standard American business practice of passing cost increases on to the consumer might come back to bite those businesses that do too much of it, because the demand for durable medical equipment may be more elastic than currently thought. Poor people may start trying to do without more than they already do if they can’t find affordable solutions. Just keep that cautionary thought in mind.

Oh, one other thing: Although I understand why you would think my “rehab” chair is customized, it isn’t. In fact, avoiding customization of the basic wheelchair itself has been a core rule in building everything added. About the only modifications that have been done to the wheelchair are three sets of drilled and tapped bolt holes in specific places on the main longitudinal spars of the base frame. That’s right, the good stuff just bolts and clamps in place. In any event, none of that is the responsibility of any DME supplier. My supplier is only responsible for the “motive” aspects of the wheelchair, although that might change in the future. Presently though, your field techs only have to deal with the non-motive equipment on the chair when changing batteries. The end of one troublesome bolt simply makes the removal and putting the front battery box back in properly more difficult. It’s harder but doable. That’s not bad considering this is the third wheelchair the equipment has been mounted on.

Sorry Jonathan, but GASMH is stuck with me for the time being. Mike needs to submit an approval request for the items I require. Healthspring will then mail notification of the request to me. As I recall, those notices contain an email address for contacting them regarding DME suppliers. That’s the contact I’ll use to find out Healthspring’s take on my rights in reference to future service visits. However, this one is yours, and I’ll pay the $170 when I can. Of course you know what your options are if that guarantee is inadequate.

Scott Royall

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc]
Sent: Friday, December 2, 2016 15:45
To: ‘Scott Royall’ <royall>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Mr. Royal-

Attached is the current provider listing for the Harris county market, I highlighted some of the providers that work with custom power rehab.

As a patient, you always have the right to choose your provider. As a Medicare Advantage customer, you have the right to choose from the contracted providers that Cigna Healthspring credentials. You are in no way ever locked into one provider for life.

We try our best to work with every patient to meet their needs but our repair policy was put into place so we, as a business, could continue to care for people.

Thank you Mr. Royal and have a good weekend.

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Friday, December 2, 2016 2:47 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Jonathan,

Sorry to tell you that this information is incorrect. As it happens, the subject of changing DME suppliers came up about two years ago, and a Healthspring representative told in no uncertain terms that switching wasn’t an option. Now, it is always possible that things have changed, but I haven’t been sitting around for a week. I’ve been plumbing the depths of the Internet, and not limiting myself to just Healthspring either. The only insurer to come close to listing the DME suppliers was Medicare itself, and only 26 were shown nationwide. So if you have a URL for Healthspring’s list, and instructions on how a subscriber can change suppliers, please share. It would be a pleasant surprise if the latter exists.

In any case, it is unlikely that Healthspring even knows or cares which of its DME suppliers have instituted similar charges directly against the customer. With that in mind, I have a simple question for you. What is being done for those who genuinely can’t afford those charges? As I just explained to Mike, those out-of-pocket expenses can become a major burden over time.

Scott Royall

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc]
Sent: Friday, December 2, 2016 11:55
To: royall
Cc: troyl; davidw; mikem
Subject: FW: Wheelchair

Mr. Royal-

I have been asked to reach out to you in regard to your most recent email chain with Mr. Matkin.

My name is Jonathan and I am the new Operations Manager for Great American.

I wanted to reach out to you to review our new Service Policy. This is a policy that many in the industry have already adopted. Our policy for diagnosing issues with any mobility equipment is $170 for in home and then $85 for in office. Unfortunately these are not covered by the insurance and are therefore the responsibility of the recipient. This is a policy that is effective throughout the company for any payor or patient.

Healthspring does contract with other providers and this information is made available through their website.

Thank you for your understanding and please let me know if we can be of any further assistance.

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

Wheelchair

Poor Jonathan, you’re trying. It’s not your fault the entire industry considers its end users to be “patients.” That encourages the perception that we’re all invalids with diminished capacity.

Ahmm, no.

My 80-year-old mother unfortunately has less mental capacity than I do, and I don’t let my employees use my card over the phone. Therefore, the only remaining option is for the mountain to go to Mohammed. I’ll see you around 1:00 pm. Friday, and you’ll only get to charge me $85. This is strictly an one-time event too.

Bye.

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc@txmobility.com]
Sent: Wednesday, December 7, 2016 7:18
To: ‘Scott Royall’ <royall@conchbbs.com>
Cc: troyl@txmobility.com; davidw@txmobility.com; mikem@txmobility.com
Subject: RE: Wheelchair

Mr. Royall-

You can have your caregiver or family member call in your payment information and then I can schedule the service call.

Thank you

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Tuesday, December 6, 2016 3:53 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

My my, you’re a greedy little cuss, eh? What’s the problem, are people “forgetting” to pay? J (Sorry, that was just too juicy to pass up. Besides, it is a valid point. Not even my doctors are demanding immediate gratification, despite what their signs say. It comes down to respect and trust.)

What information are you needing? Surely you’re not asking for credit card data in email, right? That would unencrypted plain text, readable by anyone along the route it travels. Your billing department should have the rest of my information. In any case, what good does a receipt do me when my personal income is below the minimum taxable level? I owe the IRS only because I hire my own caregivers.

From: Jonathan Crisman [mailto:jonathanc]
Sent: Tuesday, December 6, 2016 13:50
To: ‘Scott Royall’ <royall>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

We can take a credit card. Send me the info and we can bring a receipt.

Thanks

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Tuesday, December 6, 2016 1:17 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Jonathan,

Seems reasonable. I’ll let you pick a day that’s best for you. Make the appointment for after 10:00 (preferably after 11:00). I don’t carry cash so I’ll have to owe GASMH.

Scott Royall

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc]
Sent: Tuesday, December 6, 2016 7:33
To: ‘Scott Royall’ <royall>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Mr. Royall-

It will only be a onetime charge for the diagnosis due at the time of appointment.

If available, I would be more than happy to attend.

Please let me know if you would like to schedule and I will get with service to schedule.

Thank you

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Monday, December 5, 2016 2:30 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Jonathan,

You’re apparently saying that GASMH needs to make two visits, one to diagnose, and another to actually perform the maintenance. Will I be charged $170 for each visit? Or is it the case that the $170 is for the diagnostic visit? If the latter, then Mike’s calling it a "diagnostic” charge seems much less farcical. A diagnostic visit is probably prudent with most power wheelchair users as few are thoroughly aware of how their machine functions.

If the $170 is for the diagnostic visit, I have only one firm requirement. I understand that it isn’t your job to go on diagnostic visits, but I must insist that you come on this one because I think it’s essential that you and I meet. I believe Troy would agree on that also. I am not your typical "patient,” and I think it necessary that you develop your own sense of my abilities and limitations. Please plan on spending an hour with me as I unfortunately communicate slowly, and it’s important we not be rushed. Of course I know you’re going to balk at this whole idea, but please remember this is a requirement I have of any DME supplier.

I would also ask that, as part of your preparation for our meeting, you please review the history of part orders for this chair. In particular, notice the long string of casters, and how it suddenly stopped last year. Yes, there’s a story there about who is the best diagnostician when it comes to my equipment, and it will serve nicely as an example. I wonder if Troy still has copies of the relevant email.

Scott Royall

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc]
Sent: Monday, December 5, 2016 9:48
To: ‘Scott Royall’ <royall>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Mr. Royal-

We will be more than happy to submit for authorization once we come out and diagnose the chair for repairs.

Please let me know if this is agreeable and we can schedule.

Thanks

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Saturday, December 3, 2016 7:04 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Jonathan,

Well, thank you for the information. I note that it appears to have come from a PDF that’s not publicly available. As to my supposed rights as a MSP subscriber, I have your word, and I have Healthspring’s. In any case, the issue is academic because of the number of suppliers on the list. I simply don’t have the weeks required to contact each of them to determine if they have out-of-pocket trip charges; my batteries likely won’t wait patiently so a little more help would be appreciated.

Of course, I could point out that, if the suppliers are being squeezed as you say, then it was a miracle that GASMH could afford to hire you, right? Teasing aside, I am aware that GASMH has had difficulty getting paid by Healthspring. I also know Medicare pays less than what the industry considers to be the going rate. My personal viewpoint is the whole medical industry has been high on seemingly unlimited government and insurance money for so long that it has become a very dysfunctional market. I honestly don’t know what it will take to reset the mess, but my instincts tell me it can’t be done without pain, suffering, and a boatload of natural selection. Not what liberals want to hear. Thing is, though, the standard American business practice of passing cost increases on to the consumer might come back to bite those businesses that do too much of it, because the demand for durable medical equipment may be more elastic than currently thought. Poor people may start trying to do without more than they already do if they can’t find affordable solutions. Just keep that cautionary thought in mind.

Oh, one other thing: Although I understand why you would think my “rehab” chair is customized, it isn’t. In fact, avoiding customization of the basic wheelchair itself has been a core rule in building everything added. About the only modifications that have been done to the wheelchair are three sets of drilled and tapped bolt holes in specific places on the main longitudinal spars of the base frame. That’s right, the good stuff just bolts and clamps in place. In any event, none of that is the responsibility of any DME supplier. My supplier is only responsible for the “motive” aspects of the wheelchair, although that might change in the future. Presently though, your field techs only have to deal with the non-motive equipment on the chair when changing batteries. The end of one troublesome bolt simply makes the removal and putting the front battery box back in properly more difficult. It’s harder but doable. That’s not bad considering this is the third wheelchair the equipment has been mounted on.

Sorry Jonathan, but GASMH is stuck with me for the time being. Mike needs to submit an approval request for the items I require. Healthspring will then mail notification of the request to me. As I recall, those notices contain an email address for contacting them regarding DME suppliers. That’s the contact I’ll use to find out Healthspring’s take on my rights in reference to future service visits. However, this one is yours, and I’ll pay the $170 when I can. Of course you know what your options are if that guarantee is inadequate.

Scott Royall

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc]
Sent: Friday, December 2, 2016 15:45
To: ‘Scott Royall’ <royall>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Mr. Royal-

Attached is the current provider listing for the Harris county market, I highlighted some of the providers that work with custom power rehab.

As a patient, you always have the right to choose your provider. As a Medicare Advantage customer, you have the right to choose from the contracted providers that Cigna Healthspring credentials. You are in no way ever locked into one provider for life.

We try our best to work with every patient to meet their needs but our repair policy was put into place so we, as a business, could continue to care for people.

Thank you Mr. Royal and have a good weekend.

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Friday, December 2, 2016 2:47 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Jonathan,

Sorry to tell you that this information is incorrect. As it happens, the subject of changing DME suppliers came up about two years ago, and a Healthspring representative told in no uncertain terms that switching wasn’t an option. Now, it is always possible that things have changed, but I haven’t been sitting around for a week. I’ve been plumbing the depths of the Internet, and not limiting myself to just Healthspring either. The only insurer to come close to listing the DME suppliers was Medicare itself, and only 26 were shown nationwide. So if you have a URL for Healthspring’s list, and instructions on how a subscriber can change suppliers, please share. It would be a pleasant surprise if the latter exists.

In any case, it is unlikely that Healthspring even knows or cares which of its DME suppliers have instituted similar charges directly against the customer. With that in mind, I have a simple question for you. What is being done for those who genuinely can’t afford those charges? As I just explained to Mike, those out-of-pocket expenses can become a major burden over time.

Scott Royall

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc]
Sent: Friday, December 2, 2016 11:55
To: royall
Cc: troyl; davidw; mikem
Subject: FW: Wheelchair

Mr. Royal-

I have been asked to reach out to you in regard to your most recent email chain with Mr. Matkin.

My name is Jonathan and I am the new Operations Manager for Great American.

I wanted to reach out to you to review our new Service Policy. This is a policy that many in the industry have already adopted. Our policy for diagnosing issues with any mobility equipment is $170 for in home and then $85 for in office. Unfortunately these are not covered by the insurance and are therefore the responsibility of the recipient. This is a policy that is effective throughout the company for any payor or patient.

Healthspring does contract with other providers and this information is made available through their website.

Thank you for your understanding and please let me know if we can be of any further assistance.

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

And Now… the IRS

Sakina,

I swear the fun never ends! Now it’s the damned IRS sending registered demand letters to me even though I’m supposedly already on Currently Not Collectable status! I only owe taxes because I dare to hire and manage my own caregivers. (I bet it wasn’t a Republican who decided only the wealthy had caregivers, AKA “the nanny tax.”) The IRS already has a lien on my house so I don’t know what other blood they expect to get from this turnip. They do still have the Taxpayer Advocacy Service, but apparently the only ways to contact those people is either by voice telephone call or to traipse downtown to Smith Street.

It’s pretty sorry when you need an advocate just to contact the advocates! Is there anything you can do?

Scott

[tags: disability]

Wheelchair

 

From: Scott Royall [mailto:royall@conchbbs.com]
Sent: Tuesday, December 6, 2016 15:53
To: ‘Jonathan Crisman’ <jonathanc@txmobility.com>
Cc: troyl@txmobility.com; davidw@txmobility.com; mikem@txmobility.com
Subject: RE: Wheelchair

My my, you’re a greedy little cuss, eh? What’s the problem, are people “forgetting” to pay? J (Sorry, that was just too juicy to pass up. Besides, it is a valid point. Not even my doctors are demanding immediate gratification, despite what their signs say. It comes down to respect and trust.)

What information are you needing? Surely you’re not asking for credit card data in email, right? That would unencrypted plain text, readable by anyone along the route it travels. Your billing department should have the rest of my information. In any case, what good does a receipt do me when my personal income is below the minimum taxable level? I owe the IRS only because I hire my own caregivers.

From: Jonathan Crisman [mailto:jonathanc]
Sent: Tuesday, December 6, 2016 13:50
To: ‘Scott Royall’ <royall>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

We can take a credit card. Send me the info and we can bring a receipt.

Thanks

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Tuesday, December 6, 2016 1:17 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Jonathan,

Seems reasonable. I’ll let you pick a day that’s best for you. Make the appointment for after 10:00 (preferably after 11:00). I don’t carry cash so I’ll have to owe GASMH.

Scott Royall

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc]
Sent: Tuesday, December 6, 2016 7:33
To: ‘Scott Royall’ <royall>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Mr. Royall-

It will only be a onetime charge for the diagnosis due at the time of appointment.

If available, I would be more than happy to attend.

Please let me know if you would like to schedule and I will get with service to schedule.

Thank you

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Monday, December 5, 2016 2:30 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Jonathan,

You’re apparently saying that GASMH needs to make two visits, one to diagnose, and another to actually perform the maintenance. Will I be charged $170 for each visit? Or is it the case that the $170 is for the diagnostic visit? If the latter, then Mike’s calling it a “diagnostic” charge seems much less farcical. A diagnostic visit is probably prudent with most power wheelchair users as few are thoroughly aware of how their machine functions.

If the $170 is for the diagnostic visit, I have only one firm requirement. I understand that it isn’t your job to go on diagnostic visits, but I must insist that you come on this one because I think it’s essential that you and I meet. I believe Troy would agree on that also. I am not your typical “patient,” and I think it necessary that you develop your own sense of my abilities and limitations. Please plan on spending an hour with me as I unfortunately communicate slowly, and it’s important we not be rushed. Of course I know you’re going to balk at this whole idea, but please remember this is a requirement I have of any DME supplier.

I would also ask that, as part of your preparation for our meeting, you please review the history of part orders for this chair. In particular, notice the long string of casters, and how it suddenly stopped last year. Yes, there’s a story there about who is the best diagnostician when it comes to my equipment, and it will serve nicely as an example. I wonder if Troy still has copies of the relevant email.

Scott Royall

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc]
Sent: Monday, December 5, 2016 9:48
To: ‘Scott Royall’ <royall>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Mr. Royal-

We will be more than happy to submit for authorization once we come out and diagnose the chair for repairs.

Please let me know if this is agreeable and we can schedule.

Thanks

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Saturday, December 3, 2016 7:04 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Jonathan,

Well, thank you for the information. I note that it appears to have come from a PDF that’s not publicly available. As to my supposed rights as a MSP subscriber, I have your word, and I have Healthspring’s. In any case, the issue is academic because of the number of suppliers on the list. I simply don’t have the weeks required to contact each of them to determine if they have out-of-pocket trip charges; my batteries likely won’t wait patiently so a little more help would be appreciated.

Of course, I could point out that, if the suppliers are being squeezed as you say, then it was a miracle that GASMH could afford to hire you, right? Teasing aside, I am aware that GASMH has had difficulty getting paid by Healthspring. I also know Medicare pays less than what the industry considers to be the going rate. My personal viewpoint is the whole medical industry has been high on seemingly unlimited government and insurance money for so long that it has become a very dysfunctional market. I honestly don’t know what it will take to reset the mess, but my instincts tell me it can’t be done without pain, suffering, and a boatload of natural selection. Not what liberals want to hear. Thing is, though, the standard American business practice of passing cost increases on to the consumer might come back to bite those businesses that do too much of it, because the demand for durable medical equipment may be more elastic than currently thought. Poor people may start trying to do without more than they already do if they can’t find affordable solutions. Just keep that cautionary thought in mind.

Oh, one other thing: Although I understand why you would think my “rehab” chair is customized, it isn’t. In fact, avoiding customization of the basic wheelchair itself has been a core rule in building everything added. About the only modifications that have been done to the wheelchair are three sets of drilled and tapped bolt holes in specific places on the main longitudinal spars of the base frame. That’s right, the good stuff just bolts and clamps in place. In any event, none of that is the responsibility of any DME supplier. My supplier is only responsible for the “motive” aspects of the wheelchair, although that might change in the future. Presently though, your field techs only have to deal with the non-motive equipment on the chair when changing batteries. The end of one troublesome bolt simply makes the removal and putting the front battery box back in properly more difficult. It’s harder but doable. That’s not bad considering this is the third wheelchair the equipment has been mounted on.

Sorry Jonathan, but GASMH is stuck with me for the time being. Mike needs to submit an approval request for the items I require. Healthspring will then mail notification of the request to me. As I recall, those notices contain an email address for contacting them regarding DME suppliers. That’s the contact I’ll use to find out Healthspring’s take on my rights in reference to future service visits. However, this one is yours, and I’ll pay the $170 when I can. Of course you know what your options are if that guarantee is inadequate.

Scott Royall

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc]
Sent: Friday, December 2, 2016 15:45
To: ‘Scott Royall’ <royall>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Mr. Royal-

Attached is the current provider listing for the Harris county market, I highlighted some of the providers that work with custom power rehab.

As a patient, you always have the right to choose your provider. As a Medicare Advantage customer, you have the right to choose from the contracted providers that Cigna Healthspring credentials. You are in no way ever locked into one provider for life.

We try our best to work with every patient to meet their needs but our repair policy was put into place so we, as a business, could continue to care for people.

Thank you Mr. Royal and have a good weekend.

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Friday, December 2, 2016 2:47 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Jonathan,

Sorry to tell you that this information is incorrect. As it happens, the subject of changing DME suppliers came up about two years ago, and a Healthspring representative told in no uncertain terms that switching wasn’t an option. Now, it is always possible that things have changed, but I haven’t been sitting around for a week. I’ve been plumbing the depths of the Internet, and not limiting myself to just Healthspring either. The only insurer to come close to listing the DME suppliers was Medicare itself, and only 26 were shown nationwide. So if you have a URL for Healthspring’s list, and instructions on how a subscriber can change suppliers, please share. It would be a pleasant surprise if the latter exists.

In any case, it is unlikely that Healthspring even knows or cares which of its DME suppliers have instituted similar charges directly against the customer. With that in mind, I have a simple question for you. What is being done for those who genuinely can’t afford those charges? As I just explained to Mike, those out-of-pocket expenses can become a major burden over time.

Scott Royall

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc]
Sent: Friday, December 2, 2016 11:55
To: royall
Cc: troyl; davidw; mikem
Subject: FW: Wheelchair

Mr. Royal-

I have been asked to reach out to you in regard to your most recent email chain with Mr. Matkin.

My name is Jonathan and I am the new Operations Manager for Great American.

I wanted to reach out to you to review our new Service Policy. This is a policy that many in the industry have already adopted. Our policy for diagnosing issues with any mobility equipment is $170 for in home and then $85 for in office. Unfortunately these are not covered by the insurance and are therefore the responsibility of the recipient. This is a policy that is effective throughout the company for any payor or patient.

Healthspring does contract with other providers and this information is made available through their website.

Thank you for your understanding and please let me know if we can be of any further assistance.

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

Wheelchair

Jonathan,

Seems reasonable. I’ll let you pick a day that’s best for you. Make the appointment for after 10:00 (preferably after 11:00). I don’t carry cash so I’ll have to owe GASMH.

Scott Royall

From: Jonathan Crisman [mailto:jonathanc@txmobility.com]
Sent: Tuesday, December 6, 2016 7:33
To: ‘Scott Royall’ <royall@conchbbs.com>
Cc: troyl@txmobility.com; davidw@txmobility.com; mikem@txmobility.com
Subject: RE: Wheelchair

Mr. Royall-

It will only be a onetime charge for the diagnosis due at the time of appointment.

If available, I would be more than happy to attend.

Please let me know if you would like to schedule and I will get with service to schedule.

Thank you

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Monday, December 5, 2016 2:30 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Jonathan,

You’re apparently saying that GASMH needs to make two visits, one to diagnose, and another to actually perform the maintenance. Will I be charged $170 for each visit? Or is it the case that the $170 is for the diagnostic visit? If the latter, then Mike’s calling it a “diagnostic” charge seems much less farcical. A diagnostic visit is probably prudent with most power wheelchair users as few are thoroughly aware of how their machine functions.

If the $170 is for the diagnostic visit, I have only one firm requirement. I understand that it isn’t your job to go on diagnostic visits, but I must insist that you come on this one because I think it’s essential that you and I meet. I believe Troy would agree on that also. I am not your typical “patient,” and I think it necessary that you develop your own sense of my abilities and limitations. Please plan on spending an hour with me as I unfortunately communicate slowly, and it’s important we not be rushed. Of course I know you’re going to balk at this whole idea, but please remember this is a requirement I have of any DME supplier.

I would also ask that, as part of your preparation for our meeting, you please review the history of part orders for this chair. In particular, notice the long string of casters, and how it suddenly stopped last year. Yes, there’s a story there about who is the best diagnostician when it comes to my equipment, and it will serve nicely as an example. I wonder if Troy still has copies of the relevant email.

Scott Royall

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc]
Sent: Monday, December 5, 2016 9:48
To: ‘Scott Royall’ <royall>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Mr. Royal-

We will be more than happy to submit for authorization once we come out and diagnose the chair for repairs.

Please let me know if this is agreeable and we can schedule.

Thanks

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Saturday, December 3, 2016 7:04 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Jonathan,

Well, thank you for the information. I note that it appears to have come from a PDF that’s not publicly available. As to my supposed rights as a MSP subscriber, I have your word, and I have Healthspring’s. In any case, the issue is academic because of the number of suppliers on the list. I simply don’t have the weeks required to contact each of them to determine if they have out-of-pocket trip charges; my batteries likely won’t wait patiently so a little more help would be appreciated.

Of course, I could point out that, if the suppliers are being squeezed as you say, then it was a miracle that GASMH could afford to hire you, right? Teasing aside, I am aware that GASMH has had difficulty getting paid by Healthspring. I also know Medicare pays less than what the industry considers to be the going rate. My personal viewpoint is the whole medical industry has been high on seemingly unlimited government and insurance money for so long that it has become a very dysfunctional market. I honestly don’t know what it will take to reset the mess, but my instincts tell me it can’t be done without pain, suffering, and a boatload of natural selection. Not what liberals want to hear. Thing is, though, the standard American business practice of passing cost increases on to the consumer might come back to bite those businesses that do too much of it, because the demand for durable medical equipment may be more elastic than currently thought. Poor people may start trying to do without more than they already do if they can’t find affordable solutions. Just keep that cautionary thought in mind.

Oh, one other thing: Although I understand why you would think my “rehab” chair is customized, it isn’t. In fact, avoiding customization of the basic wheelchair itself has been a core rule in building everything added. About the only modifications that have been done to the wheelchair are three sets of drilled and tapped bolt holes in specific places on the main longitudinal spars of the base frame. That’s right, the good stuff just bolts and clamps in place. In any event, none of that is the responsibility of any DME supplier. My supplier is only responsible for the “motive” aspects of the wheelchair, although that might change in the future. Presently though, your field techs only have to deal with the non-motive equipment on the chair when changing batteries. The end of one troublesome bolt simply makes the removal and putting the front battery box back in properly more difficult. It’s harder but doable. That’s not bad considering this is the third wheelchair the equipment has been mounted on.

Sorry Jonathan, but GASMH is stuck with me for the time being. Mike needs to submit an approval request for the items I require. Healthspring will then mail notification of the request to me. As I recall, those notices contain an email address for contacting them regarding DME suppliers. That’s the contact I’ll use to find out Healthspring’s take on my rights in reference to future service visits. However, this one is yours, and I’ll pay the $170 when I can. Of course you know what your options are if that guarantee is inadequate.

Scott Royall

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc]
Sent: Friday, December 2, 2016 15:45
To: ‘Scott Royall’ <royall>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Mr. Royal-

Attached is the current provider listing for the Harris county market, I highlighted some of the providers that work with custom power rehab.

As a patient, you always have the right to choose your provider. As a Medicare Advantage customer, you have the right to choose from the contracted providers that Cigna Healthspring credentials. You are in no way ever locked into one provider for life.

We try our best to work with every patient to meet their needs but our repair policy was put into place so we, as a business, could continue to care for people.

Thank you Mr. Royal and have a good weekend.

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Friday, December 2, 2016 2:47 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Jonathan,

Sorry to tell you that this information is incorrect. As it happens, the subject of changing DME suppliers came up about two years ago, and a Healthspring representative told in no uncertain terms that switching wasn’t an option. Now, it is always possible that things have changed, but I haven’t been sitting around for a week. I’ve been plumbing the depths of the Internet, and not limiting myself to just Healthspring either. The only insurer to come close to listing the DME suppliers was Medicare itself, and only 26 were shown nationwide. So if you have a URL for Healthspring’s list, and instructions on how a subscriber can change suppliers, please share. It would be a pleasant surprise if the latter exists.

In any case, it is unlikely that Healthspring even knows or cares which of its DME suppliers have instituted similar charges directly against the customer. With that in mind, I have a simple question for you. What is being done for those who genuinely can’t afford those charges? As I just explained to Mike, those out-of-pocket expenses can become a major burden over time.

Scott Royall

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc]
Sent: Friday, December 2, 2016 11:55
To: royall
Cc: troyl; davidw; mikem
Subject: FW: Wheelchair

Mr. Royal-

I have been asked to reach out to you in regard to your most recent email chain with Mr. Matkin.

My name is Jonathan and I am the new Operations Manager for Great American.

I wanted to reach out to you to review our new Service Policy. This is a policy that many in the industry have already adopted. Our policy for diagnosing issues with any mobility equipment is $170 for in home and then $85 for in office. Unfortunately these are not covered by the insurance and are therefore the responsibility of the recipient. This is a policy that is effective throughout the company for any payor or patient.

Healthspring does contract with other providers and this information is made available through their website.

Thank you for your understanding and please let me know if we can be of any further assistance.

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

Wheelchair

Jonathan,

You’re apparently saying that GASMH needs to make two visits, one to diagnose, and another to actually perform the maintenance. Will I be charged $170 for each visit? Or is it the case that the $170 is for the diagnostic visit? If the latter, then Mike’s calling it a “diagnostic” charge seems much less farcical. A diagnostic visit is probably prudent with most power wheelchair users as few are thoroughly aware of how their machine functions.

If the $170 is for the diagnostic visit, I have only one firm requirement. I understand that it isn’t your job to go on diagnostic visits, but I must insist that you come on this one because I think it’s essential that you and I meet. I believe Troy would agree on that also. I am not your typical “patient,” and I think it necessary that you develop your own sense of my abilities and limitations. Please plan on spending an hour with me as I unfortunately communicate slowly, and it’s important we not be rushed. Of course I know you’re going to balk at this whole idea, but please remember this is a requirement I have of any DME supplier.

I would also ask that, as part of your preparation for our meeting, you please review the history of part orders for this chair. In particular, notice the long string of casters, and how it suddenly stopped last year. Yes, there’s a story there about who is the best diagnostician when it comes to my equipment, and it will serve nicely as an example. I wonder if Troy still has copies of the relevant email.

Scott Royall

From: Jonathan Crisman [mailto:jonathanc@txmobility.com]
Sent: Monday, December 5, 2016 9:48
To: ‘Scott Royall’ <royall@conchbbs.com>
Cc: troyl@txmobility.com; davidw@txmobility.com; mikem@txmobility.com
Subject: RE: Wheelchair

Mr. Royal-

We will be more than happy to submit for authorization once we come out and diagnose the chair for repairs.

Please let me know if this is agreeable and we can schedule.

Thanks

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Saturday, December 3, 2016 7:04 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Jonathan,

Well, thank you for the information. I note that it appears to have come from a PDF that’s not publicly available. As to my supposed rights as a MSP subscriber, I have your word, and I have Healthspring’s. In any case, the issue is academic because of the number of suppliers on the list. I simply don’t have the weeks required to contact each of them to determine if they have out-of-pocket trip charges; my batteries likely won’t wait patiently so a little more help would be appreciated.

Of course, I could point out that, if the suppliers are being squeezed as you say, then it was a miracle that GASMH could afford to hire you, right? Teasing aside, I am aware that GASMH has had difficulty getting paid by Healthspring. I also know Medicare pays less than what the industry considers to be the going rate. My personal viewpoint is the whole medical industry has been high on seemingly unlimited government and insurance money for so long that it has become a very dysfunctional market. I honestly don’t know what it will take to reset the mess, but my instincts tell me it can’t be done without pain, suffering, and a boatload of natural selection. Not what liberals want to hear. Thing is, though, the standard American business practice of passing cost increases on to the consumer might come back to bite those businesses that do too much of it, because the demand for durable medical equipment may be more elastic than currently thought. Poor people may start trying to do without more than they already do if they can’t find affordable solutions. Just keep that cautionary thought in mind.

Oh, one other thing: Although I understand why you would think my “rehab” chair is customized, it isn’t. In fact, avoiding customization of the basic wheelchair itself has been a core rule in building everything added. About the only modifications that have been done to the wheelchair are three sets of drilled and tapped bolt holes in specific places on the main longitudinal spars of the base frame. That’s right, the good stuff just bolts and clamps in place. In any event, none of that is the responsibility of any DME supplier. My supplier is only responsible for the “motive” aspects of the wheelchair, although that might change in the future. Presently though, your field techs only have to deal with the non-motive equipment on the chair when changing batteries. The end of one troublesome bolt simply makes the removal and putting the front battery box back in properly more difficult. It’s harder but doable. That’s not bad considering this is the third wheelchair the equipment has been mounted on.

Sorry Jonathan, but GASMH is stuck with me for the time being. Mike needs to submit an approval request for the items I require. Healthspring will then mail notification of the request to me. As I recall, those notices contain an email address for contacting them regarding DME suppliers. That’s the contact I’ll use to find out Healthspring’s take on my rights in reference to future service visits. However, this one is yours, and I’ll pay the $170 when I can. Of course you know what your options are if that guarantee is inadequate.

Scott Royall

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc]
Sent: Friday, December 2, 2016 15:45
To: ‘Scott Royall’ <royall>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Mr. Royal-

Attached is the current provider listing for the Harris county market, I highlighted some of the providers that work with custom power rehab.

As a patient, you always have the right to choose your provider. As a Medicare Advantage customer, you have the right to choose from the contracted providers that Cigna Healthspring credentials. You are in no way ever locked into one provider for life.

We try our best to work with every patient to meet their needs but our repair policy was put into place so we, as a business, could continue to care for people.

Thank you Mr. Royal and have a good weekend.

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Friday, December 2, 2016 2:47 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Jonathan,

Sorry to tell you that this information is incorrect. As it happens, the subject of changing DME suppliers came up about two years ago, and a Healthspring representative told in no uncertain terms that switching wasn’t an option. Now, it is always possible that things have changed, but I haven’t been sitting around for a week. I’ve been plumbing the depths of the Internet, and not limiting myself to just Healthspring either. The only insurer to come close to listing the DME suppliers was Medicare itself, and only 26 were shown nationwide. So if you have a URL for Healthspring’s list, and instructions on how a subscriber can change suppliers, please share. It would be a pleasant surprise if the latter exists.

In any case, it is unlikely that Healthspring even knows or cares which of its DME suppliers have instituted similar charges directly against the customer. With that in mind, I have a simple question for you. What is being done for those who genuinely can’t afford those charges? As I just explained to Mike, those out-of-pocket expenses can become a major burden over time.

Scott Royall

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc]
Sent: Friday, December 2, 2016 11:55
To: royall
Cc: troyl; davidw; mikem
Subject: FW: Wheelchair

Mr. Royal-

I have been asked to reach out to you in regard to your most recent email chain with Mr. Matkin.

My name is Jonathan and I am the new Operations Manager for Great American.

I wanted to reach out to you to review our new Service Policy. This is a policy that many in the industry have already adopted. Our policy for diagnosing issues with any mobility equipment is $170 for in home and then $85 for in office. Unfortunately these are not covered by the insurance and are therefore the responsibility of the recipient. This is a policy that is effective throughout the company for any payor or patient.

Healthspring does contract with other providers and this information is made available through their website.

Thank you for your understanding and please let me know if we can be of any further assistance.

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

Wheelchair

Jonathan,

Well, thank you for the information. I note that it appears to have come from a PDF that’s not publicly available. As to my supposed rights as a MSP subscriber, I have your word, and I have Healthspring’s. In any case, the issue is academic because of the number of suppliers on the list. I simply don’t have the weeks required to contact each of them to determine if they have out-of-pocket trip charges; my batteries likely won’t wait patiently so a little more help would be appreciated.

Of course, I could point out that, if the suppliers are being squeezed as you say, then it was a miracle that GASMH could afford to hire you, right? Teasing aside, I am aware that GASMH has had difficulty getting paid by Healthspring. I also know Medicare pays less than what the industry considers to be the going rate. My personal viewpoint is the whole medical industry has been high on seemingly unlimited government and insurance money for so long that it has become a very dysfunctional market. I honestly don’t know what it will take to reset the mess, but my instincts tell me it can’t be done without pain, suffering, and a boatload of natural selection. Not what liberals want to hear. Thing is, though, the standard American business practice of passing cost increases on to the consumer might come back to bite those businesses that do too much of it, because the demand for durable medical equipment may be more elastic than currently thought. Poor people may start trying to do without more than they already do if they can’t find affordable solutions. Just keep that cautionary thought in mind.

Oh, one other thing: Although I understand why you would think my “rehab” chair is customized, it isn’t. In fact, avoiding customization of the basic wheelchair itself has been a core rule in building everything added. About the only modifications that have been done to the wheelchair are three sets of drilled and tapped bolt holes in specific places on the main longitudinal spars of the base frame. That’s right, the good stuff just bolts and clamps in place. In any event, none of that is the responsibility of any DME supplier. My supplier is only responsible for the “motive” aspects of the wheelchair, although that might change in the future. Presently though, your field techs only have to deal with the non-motive equipment on the chair when changing batteries. The end of one troublesome bolt simply makes the removal and putting the front battery box back in properly more difficult. It’s harder but doable. That’s not bad considering this is the third wheelchair the equipment has been mounted on.

Sorry Jonathan, but GASMH is stuck with me for the time being. Mike needs to submit an approval request for the items I require. Healthspring will then mail notification of the request to me. As I recall, those notices contain an email address for contacting them regarding DME suppliers. That’s the contact I’ll use to find out Healthspring’s take on my rights in reference to future service visits. However, this one is yours, and I’ll pay the $170 when I can. Of course you know what your options are if that guarantee is inadequate.

Scott Royall

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc@txmobility.com]
Sent: Friday, December 2, 2016 15:45
To: ‘Scott Royall’ <royall@conchbbs.com>
Cc: troyl@txmobility.com; davidw@txmobility.com; mikem@txmobility.com
Subject: RE: Wheelchair

Mr. Royal-

Attached is the current provider listing for the Harris county market, I highlighted some of the providers that work with custom power rehab.

As a patient, you always have the right to choose your provider. As a Medicare Advantage customer, you have the right to choose from the contracted providers that Cigna Healthspring credentials. You are in no way ever locked into one provider for life.

We try our best to work with every patient to meet their needs but our repair policy was put into place so we, as a business, could continue to care for people.

Thank you Mr. Royal and have a good weekend.

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

From: Scott Royall [mailto:royall]
Sent: Friday, December 2, 2016 2:47 PM
To: ‘Jonathan Crisman’ <jonathanc>
Cc: troyl; davidw; mikem
Subject: RE: Wheelchair

Jonathan,

Sorry to tell you that this information is incorrect. As it happens, the subject of changing DME suppliers came up about two years ago, and a Healthspring representative told in no uncertain terms that switching wasn’t an option. Now, it is always possible that things have changed, but I haven’t been sitting around for a week. I’ve been plumbing the depths of the Internet, and not limiting myself to just Healthspring either. The only insurer to come close to listing the DME suppliers was Medicare itself, and only 26 were shown nationwide. So if you have a URL for Healthspring’s list, and instructions on how a subscriber can change suppliers, please share. It would be a pleasant surprise if the latter exists.

In any case, it is unlikely that Healthspring even knows or cares which of its DME suppliers have instituted similar charges directly against the customer. With that in mind, I have a simple question for you. What is being done for those who genuinely can’t afford those charges? As I just explained to Mike, those out-of-pocket expenses can become a major burden over time.

Scott Royall

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc]
Sent: Friday, December 2, 2016 11:55
To: royall
Cc: troyl; davidw; mikem
Subject: FW: Wheelchair

Mr. Royal-

I have been asked to reach out to you in regard to your most recent email chain with Mr. Matkin.

My name is Jonathan and I am the new Operations Manager for Great American.

I wanted to reach out to you to review our new Service Policy. This is a policy that many in the industry have already adopted. Our policy for diagnosing issues with any mobility equipment is $170 for in home and then $85 for in office. Unfortunately these are not covered by the insurance and are therefore the responsibility of the recipient. This is a policy that is effective throughout the company for any payor or patient.

Healthspring does contract with other providers and this information is made available through their website.

Thank you for your understanding and please let me know if we can be of any further assistance.

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com

Wheelchair

Jonathan,

Sorry to tell you that this information is incorrect. As it happens, the subject of changing DME suppliers came up about two years ago, and a Healthspring representative told in no uncertain terms that switching wasn’t an option. Now, it is always possible that things have changed, but I haven’t been sitting around for a week. I’ve been plumbing the depths of the Internet, and not limiting myself to just Healthspring either. The only insurer to come close to listing the DME suppliers was Medicare itself, and only 26 were shown nationwide. So if you have a URL for Healthspring’s list, and instructions on how a subscriber can change suppliers, please share. It would be a pleasant surprise if the latter exists.

In any case, it is unlikely that Healthspring even knows or cares which of its DME suppliers have instituted similar charges directly against the customer. With that in mind, I have a simple question for you. What is being done for those who genuinely can’t afford those charges? As I just explained to Mike, those out-of-pocket expenses can become a major burden over time.

Scott Royall

[tags: disability]

From: Jonathan Crisman [mailto:jonathanc@txmobility.com]
Sent: Friday, December 2, 2016 11:55
To: royall@conchbbs.com
Cc: troyl@txmobility.com; davidw@txmobility.com; mikem@txmobility.com
Subject: FW: Wheelchair

Mr. Royal-

I have been asked to reach out to you in regard to your most recent email chain with Mr. Matkin.

My name is Jonathan and I am the new Operations Manager for Great American.

I wanted to reach out to you to review our new Service Policy. This is a policy that many in the industry have already adopted. Our policy for diagnosing issues with any mobility equipment is $170 for in home and then $85 for in office. Unfortunately these are not covered by the insurance and are therefore the responsibility of the recipient. This is a policy that is effective throughout the company for any payor or patient.

Healthspring does contract with other providers and this information is made available through their website.

Thank you for your understanding and please let me know if we can be of any further assistance.

Jonathan Crisman

Operations Manager

2111 FM 1960 Rd E

Humble, TX 77338

281.705.6254 Mobile

832.445.0956 Office

832.445.0958 Fax

jonathancI www.txmobility.com