Reflect 04

Page date 8/2/24
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7/18/24 Visit #3

Reimbursement claim form dated (and mailed) 8/01/24. $112.50 for Reflect doctor visit on 7/18/24.

There was a problem with the insurance coverage. It could have been caused by the Medicare coverage gap, a/k/a/ donut hole. Reflect submitted a request, and Devoted approved my scrip the next day.

Post Office receipt, including tracking number.
9589 0710 5270 1335 2896 48

This screen shot, dated 8/2/24 at about 11:15am, shows that the estimated delivery date is Monday, 8/5/24.

This screen shot, dated 8/6/24 at about 3:45pm, shows that the my letter was "delivered" by the US Post Office on Tuesday, 8/6/24.

I received a check from Devoted. Check date = 8/29/24. Check amount = $67.99.

I paid Reflect $112.50. The explaination of payment (EOP) shows that Devoted made 2 deductions:
1) $25.00 for my co-pay, and
2) $19.51 with an explanation code of PR 119.

The PR 119 adjustment code states:
"You have reached the coverage limit for this benefit"

I received the Devoted "Notice of Denial of Payment" Letter on 9/7/24. This document providers a little bit better explanation for the $19.51 deduction.

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4/30/24 Visit #2

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2/06/24 Visit #1
This first visit had a lot of reimbursement problems. They continue.

The Post Office tracking documentation shows my appeal was made available for pickup on 5/31/24, and Devoted was unwilling or unable to pick up my letter for the next 15 days.

I sent Devoted a request for a response, via fax, on 7/12/24. As of 9/9/24, I have not received a response.
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Philip G Rice
11268 E Linvale Dr
Aurora, CO 80014

D5SYZR
dob = 4/25/53
phil.rice@mkgappraisal.com
(720) 282-3376

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