Ms. Carol Ryan
Professional Home Health
60 Rancho Road, Suite #27
Thousand Oaks, CA 91362
Dear Ms. Ryan:
What I am disputing is your interpretive accounting which is stretching
your medical commitments for this patient a little too thin.
You have repeatedly insisted that I intend to private pay. Is
that not what I was doing in October of 1997 when you were cross billing
Maxicare? Shame on you.
In your previous letter, you mandate that it is the patient's responsibility
to keep you abreast of changes. Is that what happened when you turned
over our account to Maxicare back in 1997 without our knowledge?
So it is our responsibility now that you are no longer double billing?
It seems that a simple problem between us has become a contest, based
upon the magnitude of issues in your last letter, an unexpected and veritable
account history. But what happened to the hard copy of my account
your promised me in 1997? It never arrived.
I think that before you cover everything up, those shenanigans should
be exposed.
So please stop your ridiculous attempt to make me pay for what the
plan should be paying for.
My wife is alive, her plan has unlimited benefits, and there is a contractual
commitment by Professional Home Health with the plan's carrier which was
apparently implemented by Professional Home Health, being at no time solicited
by the patient.
Last week, your nutritionist called for the first time and asked a
lot of questions. From prior conversations with your personnel, your
company has seemingly lost track of the prescribing physician, and apparently
all paperwork associated with your management of the plan. Until you can
reconstruct your lapse of memory, I don't think that you can arbitrarily
appeal to anyone, such as CareAmerica, for a ruling which they can neither
alter nor rescind, and which as you well know, is a plan initially under
the administrative responsibility of Maxicare. That is when
you initially honored its tenets.
Lastly, Professional Home Health is in the throes of abandoning this
patient. Reference to the ruling in the Department of Corporations
versus MedPartners refers not to an entirely different situation, but to
one identical to Professional Home Health's refusal to provide medical
services to patients due to unpaid bills by CareAmerica/Blue Shield, who
purchased this plan from Maxicare after they claimed that they were going
out of business. I am getting really noxious from all your over billing,
double billing, falsely billing, claiming private pay, and really, the
most ludicrous catch phrase of all, guarantor responsibility.
It seems that it is all too easy and tempting for business to enter
the health care and medical fields, operating as a consortium when
times are good, and thin splintering apart when times get tough, leaving
the patient to pursue a shell game of responsibility by couching denial
of services as being unauthorized benefits. Your authorization began
when you accepted the fulfillment of the doctors prescription to honor
whatever long-term benefits a patient should receive, not as contract between
yourself and patient, but between yourself and the plan's carrier, to uphold
that medical prerogative between doctor and patient. Believe me,
you are not on the outside looking in, but on the inside looking out, and
as far as I can tell with all necessary records available to you, unless,
you have misplaced them.
In regard to contacting Kathy Moore at Prairie Medical Group, she replaced
Kim Brown March 27, 1997 as Constance's case worker. Shortly thereafter,
Robin Taylor took over. This was late March, 1997, at which time,
Prairie Medical Group, just like you, had no patient records. You
might ask Dr. Jeffrey Gramer there, he was Constance's will-o'-the-wisp
PCP. If they wish to rescind this patient's prescription, that will
be their business.
Sincerely,
Joel E. Webb
910-B 20th Street, Santa Monica, CA 90403
copies to: Raouf Khalil, CEO, Professional Home Health
Services
Julie Uyemura, Director of Pharmacy, Professional Home Health Services
Claims Department, CareAmerica Health Plans
Mr. Eugene Froelich, Dept. of Corporations
Mr. Andrew Pontius, Consumers for Quality Care