Business ProfileforNational Biological Corporation

My daughter has a rare medical skin condition called ******************** Her doctor prescribed an at-home photo-therapy medical device so she didn't have to miss school to drive 45 minutes 3x's a week. I received a call from Ty at National Biological advising that my insurance would not cover the durable medical equipment. I asked to appeal, and he said he would call me back. He did in fact call me back and said they spoke (emphasis on spoke) with insurance and it is in fact a denied coverage and he wanted to talk about financing options. I called my insurance company and was advised that this is covered - I have patient responsibility of course, but it is covered. Regence then looked into it further and did not see any denied claims, so that if it wasn't covered, I didn't even have the opportunity to appeal with Regence for coverage. If a request is not received by Regence, I cannot push them to cover the services. Regence then tried to get a hold of National Biological to at minimum submit a claim, and they refused. Regence escalated it and they continued to try to contact National Biological to submit the request, but calls were dodged and messages were not returned (so peculiar that Ty then said that they spoke with Insurance and it was denied - definitely not the case). National Biological is a preferred provider with my policy, however, they refuse to submit claims and are in violation with their agreement with Regence. They very much push for and prefer cash pay and financing options. I tried to escalate this situation to the next level at National Biological before writing this complaint, but they said it was unnecessary. I was able to locate another company and get coverage with no issues for this very much-needed medical device. I hope that medical offices that send prescriptions here see this complaint and choose to go through another manufacturer and avoid this headache. They are a terrible company to deal with, I absolutely would NOT recommend.

BBB, My apologies for this late reply, as the notification for this review came to an inbox of a former employee. The patient is understandably confused as to her insurance eligibility. Determining eligibility can be a confusing process, and National Biological has a team of experts in place to determine a patient’s eligibility in order to minimize collections later. In short, her insurance ONLY covers phototherapy for a skin condition called psoriasis. Her daughter (details are disclosed by the patient in her letter to you) suffers from an entirely different medical condition, and as such, her insurance will not pay for a phototherapy device. This was explained to the patient. The details of her insurance plan, confirming phototherapy is only covered for cases of psoriasis, is publicly available online. I have attached a link it for your reference. ***************************************************** Our sales representative tried to communicate this to the patient on multiple occasions, and we did speak to her insurance provider on 1/3/2024. The representative from this insurance plan, “******”, stated during this call that while they did cover phototherapy, she was not familiar with the details of their own company’s medical policy and coverage being limited to only patients with psoriasis. ****** requested the opportunity to research the matter and call us back. We never received any returned call from the insurance company. National Biological is very transparent with patients on their expected financial liability prior to sale. Unfortunately, the patient’s liability was 100% of the device price in this instance, as their insurance policy clearly states they will not cover this device for this condition. Her insurance provider caused unnecessary confusion by incorrectly stating the treatment costs would be covered when in fact they would not be based on their own published policy. Unfortunately, this confusion is very common in the insurance industry, and causes angst amongst patients. However, the patient’s frustration should be focused on her plan provider for not having a more generous policy towards coverage for phototherapy treatment. Best regards.

My insurance did cover the device and ******* had asked many times for your company to submit the claim, however your company refused citing this same information you continue to use. All you needed to do was submit the claim. You can say it’s not covered all you want, but it is and was. I now have a wonderful device from another company. Here is the bottom line, your refusal to submit the claim even after ******* advised your rep that it was covered, cause me to not be able to appeal the decision had it NOT been covered. ******* would have approved it if I appealed it because her condition is rare and there are no FDA approved therapies. You need to readdress your policies and not tell me that your company is too small to submit all requests insurance. And then have the audacity try to get me to finance it. Again - to anyone reading this, don’t go through this company. They want cash pay and will lie and say that insurance denies items when they are in fact covered.