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

Wheelchair

Mike,

Likewise, I need to iterate that I appreciate that you have been professional enough to at least answer your email more consistently than your colleagues. You have also been transparent enough to share information that you believe I should have. Those factors, along with the fact that it took you several hours to compose this last email, suggest to me that you have discussed this matter with upper management at Great American Scooter and Mobility of Humble (henceforth referred to as simply “GASMH”). Rather, I am going to make that presumption in your favor as I do not think you foolhardy enough to make these decisions on your own.

This discussion has become protracted and very contentious, and nobody wants it concluded successfully more than I do. I would love to be able to lay out my final position and be done with the matter, but some of your recent statements make clear there are realities that GASMH is not recognizing. Therefore, I have no choice but to state a couple of things explicitly before I can conclude.

First, I was being quite facetious when I asked if Healthspring intended to allow its subscribers to switch durable medical equipment (DME) suppliers in their new contract. That is something Healthspring has never offered, to my knowledge, and the purpose of my question was to cause you to do a reality check. GASMH, as a contracted DME supplier, should be aware that Healthspring does not offer its subscribers any way of changing DME suppliers. As the Medicare Supplemental Plans are largely standardized, it is unlikely that the other plan providers offer their subscribers that either. What I know from a week of research is that plan providers do NOT make their lists of contracted DME suppliers public. Potential subscribers can receive packets that contain lists of participating doctors and hospitals, even formularies of prescription medication covered by a plan, but no list of DME suppliers. Evidently, a DME supplier is chosen by the plan provider based on geography and type/brand of equipment needed.

Second, the latest information I can find on the management of GASMH (2014) still lists Troy Liles as President, and David Wood as Vice President. Although you and I have not met, both of those gentlemen know me and are aware of my somewhat unusual symbiotic relationship with this wheelchair. This wheelchair is far more than a mobility device. It also serves as the base supporting an array of equipment originally developed while I worked for Shell Oil. Although I can neither walk or talk, the custom-made equipment enables me to function and interact with anyone. Undoubtedly, you have seen people tack all sorts of assistive communication devices on their wheelchairs, but what I have is lightyears beyond that. I wrote my own communication software while I was with Shell, and I run it on a regular high-end laptop that also runs a broad variety of other things. That is connected to all sorts of other equipment like an audio system and various wireless communication and safety devices. All of which is fed by a 24-to-12 voltage converter plugged directly into the battery harness of the wheelchair. I am still a reasonably active person so all of this equipment continues to prevent me from becoming just another vegetable rotting in an institution somewhere.

Now all of the relevant facts from my side have been laid out. There can be no more illusion that I’m free to go elsewhere for service when, for all intents and purposes, I am stuck with GASMH. If your new charges pose a hardship for me, you know I can’t afford someplace else uninsured.

Of course the situation is probably different for GASMH as it’s generally true that businesses reserve the right to refuse specific customers service. No doubt there is a clause in that new contract with Healthspring granting the right to refuse service to plan subscribers for reasons not insurance-related. Making those new so-called “diagnostic” charges not coverable by insurance was clever, because the only recourse offered to subscribers dissatisfied with a DME supplier is an internal dispute process. These new charges will conveniently fall outside the purview of any such process.

So let’s use my current disagreement with GASMH over these dubious new charges to explore the likely outcomes. I could be dishonest and accept the charges knowing that I probably couldn’t pay all of them. Or I could be honest upfront and decline the charges, knowing that paying any one of them would be legally viewed as accepting responsibility for paying them all. Naturally, GASMH may well refuse service in return, leaving me stranded somewhere when these batteries do go flat. The critical issue isn’t so much what the charges are supposedly for as it is the phrase, “per visit.” These batteries are recommended to be changed every eight months, guaranteeing GASMH at least two visits within 12 months. If, Heaven forfend, the wheelchair actually malfunctions, that’s another one or two visits minimum, bringing my annual cost to $680 or more! A unscrupulous supplier might rack up a sizable fee by doing service piecemeal and drawing it out over multiple visits. I make no secret of the fact that I will run out of money sometime in mid-2019, but I’m not going to allow nuisance charges to rush that end any. No, if I’m going to accept “per visit” charges, GASMH has to agree to reasonable 12-month caps on those charges.

I should mention one other aspect of this wheelchair. All of the most essential communication equipment aboard also has at least some internal emergency power. Probably enough to summon transportation home, and definitely sufficient to update certain people on my situation. That can’t be considered a threat because I don’t know what these people will do. Perhaps nothing. Still, none of them are especially bashful, and some of them have media/political contacts so it might be wise to tread lightly on me.

With all due respect, Mike, I rather not hear further from you until Troy and I have worked out a few matters.

Scott Royall

[tags: disability]

From: mikem@txmobility.com [mailto:mikem@txmobility.com
Sent: Friday, November 11, 2016 15:36
To: Scott Royall <royall@conchbbs.com>
Subject: RE: Wheelchair

Mr Royall,

I would first like to say that we value you as a patient and want to help you in any way that we can in the future. Unfortunately, if we continue to provide service for you there will be a charge of $170 dollars if we come out to the house and an $85 dollar charge if you bring the chair in. This is a set amount and cannot be changed. In saying all this we would like you to know that we completely understand if you need to contact other providers to avoid this charge, but if you use us in the future this will be the charge. If I can help you any further please let me know.

Thanks,

Mike