Complaints

• Initial Complaint

  01/07/2025

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  This establishment has notified myself amongst many other moms who have written a review and filed a complaint with the company falsely informing us that our insurance has covered the equipment listed once we have filled in our insurance information to this company. I received a claim stating otherwise that it was entirely false and my insurance does not cover anything from 1 Natural Way and I am now charged $152 for equipment that is 1/3rd of the cost. This company is lying about coverage and about the cost in the end when notifying that we owe $0.00.

  

  Business response

  01/15/2025

  The customer applied into our system to receive a breast pump through her insurance plan.  At the time of application, we do confirm that the customer has an active policy.  A copy of the email advising the customer of this is attached.  It is incumbent on the customer to be aware of their benefits prior to obtaining any medical service, since we are not aware of specific restrictions or exclusions that a customers plan or employer may have in place.  This information should be provided to the customer at the time of enrollment in the plan.
  The customer ordered a breast pump, supplies, pregnancy support band and compression stockings.   The claims for the support band and stockings were in fact processed and paid by her insurance plan.  The breast pump and supplies were denied with the insurance indicating these items were non-covered items.  Insurance plans typically cover a breast pump and supplies under the Womens Preventative portion of the *************** Act.    1 Natural Ways claims department has appealed the claim denial to request that these claims be reviewed and reprocessed.  At this time, the claims have not been reprocessed.     
  A copy of the customers order form which includes our financial responsibility policy is included for reference.  This form is signed by the customer at the time of ordering.   It does state that if a claim is denied, the customer is responsible.   The amount the customer is being billed for the breast pump is the amount that we would have expected to receive from the insurance company if the claim had been paid (which in this case is less than retail).    Since we are a durable medical equipment provider processing through insurance, our amounts do not reflect the retail pricing that might be found at a retail store or online retailer.     The **** for the pump received by the customer is $172 and the customer was billed $152 (the insurance allowable amount).  We have however, offered the customer a prompt pay discount of 20% but have not received payment at this time.
  We do regret that the customer has experienced this issue however, as with any medical service, when we reach out to the insurance company, it is a quote and not a guarantee of benefits until the claim is processed.   

  Customer response

  01/24/2025

   
  Complaint: 22775737
  
  I am rejecting this response because:

  they did not make it clear that when they reach out to the insurance company, it is a quote and not a guarantee of benefits until the claim is processed. My total was shown as everything is free through insurance AFTER it showed it was run through the insurance company. Why would they run it through insurance, tell me that the cost was $0 after communicating with the insurance, but yet I receive such a high bill? That is false advertising to me the consumer. I can settle if there is at least a 80% discount off the original bill amount. 

  Sincerely,
  
  ***** Guyvan

• Initial Complaint

  11/25/2024

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Resolved

  More info

  This company has you input all your insurance information so they can make sure to show you which breast pumps are covered by your insurance and which ones will be an upgrade fee. So I did that, then when I went to check out with just a breast pump, they took me to a screen that showed all the other things my insurance would cover FOR FREE (a pair of compression socks, a belly support band, and 100 breast milk bags.) I thought, ok I'll get those since they're free. Went to "checkout", everything showed $0, placed my order, and received my stuff (except the breast milk bags ?? ). Ok cool. BUT THEN, I see invoices pop up on my insurance website and then get an email from 1 Natural Way saying I owe them $12 for the support band, and SEVENTY DOLLARS for ONE PAIR OF COMPRESSION SOCKS. I could have ordered THREE PAIRS of compression socks from ****** for $14. But they charged my insurance $70, which was obviously denied, and then "discounted" it down to me for $52 each. (How kind...) When I emailed them about this scamming crap, they simply told me that I signed their statement saying the prices quoted were just estimates, and that I would be responsible for any copay by the insurance. BUT THEY RAN MY INSURANCE TO DETERMINE WHICH BREAST PUMPS WERE FREE AND WHICH WERE UPGRADES, so they KNEW the socks, band, and bags, would not be fully covered, but portrayed them to be that way so I would order them. They literally show you a $0.00 order form when you're signing your electronic signature so you think you're just agreeing to pay $0.00. P.S. They also don't send you the invoice until months after you receive your items, and there's no returns at that point either. They are 100% aware of what they are doing, and I'm absolutely SHOCKED they are allowed to be doing this to people.

  

  Business response

  12/03/2024

  The customer applied into our system via our website in order to receive a breast pump through her insurance policy.  While checking her coverage for the breast pump, we also checked to see if the customer would qualify for any other items that we offer based on her insurance (i.e. compression stockings and pregnancy support bands).     These items are generally covered differently by insurance than a breast pump.   They are typically subject to a deductible and co-insurance.  However, during verification,  our system does check to see if the customer has any out of pocket cost for these items.  If there is no out of pocket cost showing through the insurance portal, the items are offered to the customer. 
  As with any medical service, the verification/insurance check is a quote and not a guarantee of coverage until the claim has been processed.    This information is provided to the customer at the time of ordering via the attached order form.    Since the order in which claims are processed with insurance can affect this quote, we unfortunately cannot guarantee payment in full by the insurance until the claim processing is completed. 
  The items that we are providing are medical grade durable medical equipment items and not retail items.   The amount we bill to the insurance company is based on their allowable amount for each specific item and is not related to the retail price that you might see at a store or online retailer.
  The delay in the customer receiving the invoice for the compression stockings was due to our standard process of submitting an appeal to the insurance company to have the claim denial reviewed for possible reprocessing.   We do try to notify the customer of any amount due as soon as possible after the claim processes, however the customer will typically receive their Explanation of Benefits well before they receive any notification from us.   
  While this customers insurance did process her breast pump claim, they did not pay the claim for the stockings, indicating that it was a non covered benefit.  Unfortunately, we were not made aware of this exclusion at the time of insurance verification.    The insurance did also cover a large portion of the pregnancy support band which the customer received.   Based on this information, the customers account has already been adjusted to accept the payments received from the insurance as payment in full.  There is currently no balance due for any items.  

  Customer response

  12/04/2024

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID 22593080, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ******* *******

• Initial Complaint

  11/13/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  SCAM!!! Natural way emailed me telling me my insurance approved my breast pump and then got a prescription from my provider and then as soon as the breast pump shipper, they emailed me telling my insurance denied my claim and I need to pay $381.00 before Im sent to collections, they completely lied, I havent even received the breast pump in the mail yet, I plan on calling and returning the package as soon as it gets here so I dont have to pay that much money. This is company is horrible and especially ripping off expectant mothers.

  

  Business response

  11/21/2024

  Thank you for the opportunity to respond.    The customer applied through our website to receive a breast pump through her insurance policy.   Her information was processed and the order was shipped on 10/31/24.   A claim was submitted to her insurance for processing. 
  On 11/12/24 an email was sent to a large number of customers whose claims were still being processed by insurance indicating that they had a balance due on their account.   This email was sent in error and a corrected email was sent out within the hour.   This customer was notified to disregard the invoice since her claim was still processing. 
  Regardless, the customer insisted on returning the item once it was delivered.    Per our posted return policy, we do not typically allow returns or exchanges on hygienic items.  However since the package was still in transit to her address, we allowed an exception.
  We have corresponded with this customer (see attachment) and approved her return as a one time exception.  At this time we are awaiting the return of the item from the customer.  Once the item is returned, the claim will be cancelled and the issue will be considered closed. 
  Again, the customer received an invoice in error and a correction was immediately sent to the customer advising her to disregard the invoice.  We do apologize for any confusion or inconvenience this has caused the customer.  

• Initial Complaint

  10/18/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I ordered a pump through them. On their website it said the pump I ordered was covered by all insurances. It took about a week to get approved and then it said it was mailing to me. I received the pump. Now I get a letter saying my insurance does not cover it. I have used ******** in ALL the rest of my pregnancies (4) and have never ran into this issue. They make sure they have insurance approval before its mailed and dont say covered by all insurances when they arent. At this point I really hope Im not sent the breastmilk bags that are being sent after my due date just to collect another bill for false marketing.Ordered on 9/6/24

  

  Business response

  10/22/2024

  The customer applied into our system to receive a breast pump through her insurance benefits. Since we are contracted with her insurance through our third party partner/********* we confirmed that her policy was active and allowed her to place her order. 
  Once the order was placed and a prescription was received,her order was shipped on 9/13/24.   There was no further communication from the customer until we received notification of the BBB complaint. 
  The customer indicated in her complaint that she received a letter stating her insurance did not cover the item.   We have not sent any letters or billed the customer for any items.  The claim submission has been reviewed with our ************************* and it was determined that the claim appears to have been denied incorrectly.   The type of denial is not a patient responsibility denial and would not generate a bill to the customer.    At this time we are appealing the claim denial and working with the insurance to have the claim reprocessed. 
  However, it is important to note that each customer does sign a Products Order Form (see attached) which does state that the customer may be responsible for any amounts not paid by the insurance at the time of claims processing. 
   It is possible that the customer received a copy of her Explanation of Benefits from her insurance,but rather than reaching out to us to inquire about it, chose to file a public complaint with BBB.   The customer will receive an updated Explanation of Benefits once the claim is reprocessed.  However, the customer is welcome to contact us directly with any questions or concerns about her account. 
  The customers remaining order of bags has been cancelled and the customer will not receive any additional items from us.
  Thank you for the opportunity to respond to this issue.  

• Initial Complaint

  08/20/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  This establishment has notified myself amongst many other moms who have written a review and filed a complaint with the company falsely informing us that our insurance has covered the equipment listed once we have filled in our insurance information to this company. I received a claim stating otherwise that it was entirely false and my insurance does not cover anything from 1 Natural Way and I am now charged $95 for equipment that is 1/3rd of the cost. This company is lying about coverage and about the cost in the end when notifying that we owe $0.00.

  

  Business response

  08/29/2024

  Thank you for the opportunity to respond to the customers complaint.  
  The customer applied into our system for a breast pump through insurance on 8/7/24.  The customer placed her order on 8/7/24, after which we confirmed that she had an active policy and notified the customer of this information.  The customer was provided with a copy of the order form which includes the Assignment of Benefits information since the order is being processed through insurance.  See attached.   This form does advise the customer of our financial responsibility policy as well as the fact that a final determination is not made until the insurance processes the claim.
  7. I acknowledge that the prices quoted for the item(s) I ordered are an estimate of coverage based on my insurance policy and may be subject to a deductible, co-payment, and/or coinsurance. I understand that I am responsible for paying the balance due as required by my insurance at the time of claims processing.
  8. I have read and understand 1 Natural Way's financial responsibility policy
  At this time, we have not billed the customer, and I was not able to locate any correspondence or phone calls from the customer inquiring about this issue.  Our first notification was the BBB complaint filed by the customer.  It does appear that the customer received her explanation of benefits from her insurance, which prompted the complaint.
  Upon reviewing the customers claim, it appears that her insurance is indicating that we are out of network with her policy and the claim was applied to her deductible and coinsurance.    We are a contracted provider with the customers insurance and typically breast pumps are not subject to the deductible and coinsurance, but rather are covered under the Womens Preventative benefit of the *************** Act.     See attached confirmation of coverage and in-network status from the insurance company portal for this customer.
  At this time, we are working directly with the customers insurance to resolve this issue and are requesting that the claim be reprocessed.   This process may take some time; however,the customer is not being billed while we are working on this issue.  The customer will receive an updated explanation of benefits if the claim is reprocessed. 
  Again, we appreciate the opportunity to respond and appreciate the customers patience while we continue to work on this.  

• Initial Complaint

  05/14/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  The 1 natural way sent me messages based on the information I left on your website said that I am qualified for the insurance-covered pump replacement parts and milk storage bags. I provided the insurance information again and placed the order. At every step of the order process, the 1 natural way told me that everything was $0 cost and insurance coverage. Then today I received an insurance message saying there is an over $600 bill from the 1 natural way that was denied due to out-of-network. This was totally not the case when I ordered the replacement parts and milk storage bags. If there are things that did not go with what you claimed as $0 cost and covered by the insurance, you should at least let me know before you shipped. The 1 natural way explained that typically it is an in-network provider with United Health Care, but if my insurance denied the claim, I am responsible for the bill. The 1 natural way stated its policy that every price they showed me before was just quoted but not true, and all the 1naturalway customers have to accept this policy. If all the prices you showed me were fake and misleading, then what purpose did they serve other than to merely to deceive and entice me into ultimately purchasing your products at exorbitant prices without my knowledge? Moreover, the 1naturalway states its policy that it only accepts return and refund for unopened and sealed original packages. This is excessively restrictive and also an overlord policy. I only learned the true price few weeks (if not informed by my insurance, I may need few more months to learn that from 1naturalway) after I received the packages, which is too late to do anything but pay the huge bill. Normally, no one would wait weeks or months without opening the packages they received. By enforcing such a policy, the 1 Natural Way prioritizes its own interests over the rights of its customers, effectively dictating terms that are unfavorable to consumers.

  Customer response

  05/15/2024

  I am reaching out due to my complaint of #********. Due to character limit, I did not fully explain my situation. Here’s what I want to add to my complaint. I received over $600 bill for 3 milk storage bags and 1 pump replacement part from 1naturalway, even though it said $0 and covered by insurance (I would like to submit my receipt to BBB). Those replacement parts are only $30 and milk storage bags are only $11 on Amazon. The 1 natural way explained that ‘Ordering items through the insurance and ordering from Amazon/Target are not the same and should not be compared’. This sounds a bit like quibbling and evades the core issue to me. Regardless of the purchasing channel, the pump replacement parts remain the same products from Spectra. It is unlikely that a brand would intentionally produce different quality items to distinguish between Amazon/Target and your company. This response only serves to obscure the lack of openness and transparency in pricing, especially under the guise of insurance coverage. After all, before I received the bill, I always thought it was covered by insurance and it cost me $0. I never had clear and upfront information about costs before I got this bill.

  

  Business response

  05/23/2024

  
  Thank you for the opportunity to respond.   The customer applied into our system and placed an order for breastfeeding supplies on 4/21/24.   The customer provided her insurance information and her insurance was confirmed that it was active.  On 4/26/24 we sent a verification email to the customer letting her know that we had confirmed that her policy was active, however it is the responsibility of the customer to know their benefits.  A copy of this email is attached.  We also include a link to our Financial Responsibility policy for the customers review.  A copy of this is attached.
  In addition, the customer electronically signs the Order Form which indicates that:  I understand that:  I am responsible for paying the balance due as required by my insurance at the time of claims processing.   When the customer originally reached out to us, she was not receiving any billing statements, but rather had received a copy of her Explanation of Benefits from her insurance showing that the claim had been denied.   The claim was denied due to the customer using an out of network provider.   We are contracted with United Health Care through our partner Medequip, however each plan or employer group may have specific limitations or restrictions that we are not aware of that may require them to use a specific provider.  For this reason, we advise that the customer is responsible for knowing their benefits. 
  The customer indicated that she was being billed for $600.  However, at no time was she billed by 1 Natural Way for that amount.   When we did receive the denial information, she was ultimately billed $266.96 which is the standard allowable amount that her insurance would have paid for these items if the claim had been processed and paid.   Since we are a Durable Medical Equipment provider and are working with contracts through insurance companies, the patient is billed for the allowable amount that we would have expected to receive from the insurance company if the claim is ultimately denied. 
  We do not typically allow returns of any items due to the hygienic nature of the items we provide.  However, as a courtesy, we did offer to review this to see if an exception for return could be allowed.  Unfortunately, the customer indicated that she had already opened the items and therefore, they were not able to be returned. 
  In addition, we have reached back out to the insurance company to file an appeal for the claim denial and are currently awaiting that response.
  Since we are not a direct competitor of Amazon, we are not able to offer the prices that are offered on Amazon.  However, since the insurance claim was denied and this is now private pay,  we are able to offer a one time adjustment to match the retail pricing on our website.  The customers account has been adjusted to show this as the new balance due.  If the insurance does approve the appeal and pays the claim for the full allowed amount, the customer would be refunded for any payments made. 
  Again, we appreciate the opportunity to respond and hope that this will be an acceptable accommodation. 
  

• Initial Complaint

  04/03/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  This company provides breast pump and supplies to pregnant moms. I went on to their website and entered my insurance information and picked a pump that was covered by insurance. At $0 cost to me. Months later I receive a bill for $108. They were out of network for my insurance. They wouldn’t take the pump back even though I didn’t use it. They threatened to send to collections so I just paid it. Their website needs to be correct with what insurance covers and doesn’t cover. That’s what their company is. I started looking at places to leave a review and noticed I was not even close to being the first one this happened too. They are scamming people left and right. Yes I received the product but I picked one that should have been covered by insurance. I would’ve picked something else had I known I was going to pay out of pocket. They also charged more for the product than Amazon sells it for.

  

  Business response

  04/18/2024

  We appreciate the opportunity to respond to the customers complaint. 
  The customer applied into our system for a breast pump through insurance.   At the time the customer applies, we confirm that the customer has an active policy and that we are contracted with the customers insurance.   We are contracted with Blue Cross Blue Shield of Arizona to provide breast pumps.   The customer received a Verification Email (see attachment) on 8/24/23 advising that we had confirmed her policy was active.   However, as with any service provided by a medical provider, it is the customers responsibility to ensure that they are utilizing an in-network provider according to their specific plan guidelines and restrictions.     Within any insurance, employers and/or groups can set their own specific guidelines and restrictions and where a policyholder must obtain benefits.    It is up to the customer to be aware of and follow these guidelines. 
  At the time the customer placed the order on 10/12/24, the customer also signed the Products Order Form (see attachment).  This form specifically addresses the issues involved.  Please note the following points:
              4 – references the customers rights and responsibilities
              5 – customer acknowledges the following:  I acknowledge that the prices quoted for the item(s) I ordered are an estimate of coverage based on my insurance policy and may be subject to a deductible, co-payment, and/or coinsurance. I understand that I am responsible for paying the balance due as required by my insurance at the time of claims processing.
              6 – 1 Natural Way Financial Responsibility policy
              7 – Return policy information – returns are not accepted
  Since we are a Durable Medical Equipment provider and are working directly with insurance, we do not base our pricing, or the amounts submitted to insurance on retail prices.  Pricing is based on contracted rates with the insurance company which are tied to their allowable amount for a specific item/billing code.  When the claim denied, we did attempt to appeal the denial prior to billing the customer.  However, the denial was upheld by the insurance and the claim was not paid.
  The customer did inquire about returning the product, unfortunately we were unable to approve a return in this case.  While our return policy clearly states that we do not allow returns or exchanges, we are happy to allow an exception if the situation warrants.  In this case, the breast pump was shipped to the customer on 10/16/23 and the customer did not reach out to us regarding the billing issue until 2/5/24.  Since almost 4 months had passed since we had shipped the product, we were unable to approve the return.  Breast pumps are hygienic items and once they leave our warehouse and remain in the possession of the customer for many months, we are unable to guarantee the integrity of the hygienic nature of the item and therefore that item would not be able to be resold.     
  We appreciate that the customer has paid her outstanding balance, and regret that we are unable to refund the amount as requested due to the fact that we did not receive the expected payment from her insurance company, and we provided the product in good faith to the customer. 
  
  

• Initial Complaint

  02/08/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On 8/28/23 and 10/3/23 I ordered replacement breast pump supplies through 1 natural way (milkzoom replacement supplies). I got a bill in the mail in december for these two dates stating allegience did not pay the claims. I called allegience early december and was told that the claims were being reprocessed. The end of december I checked back and saw that allegience had processed the claims. I received another bill in the mail January 2024 for the two claims that 1 natural way never received payment for. I reached out to 1 Natural way to determine and they state that they never received the money. I then called allegience and spoke to **** who stated that she can see that Allegience paid evacore a third party company who then will pay the claims to the provider. **** provided me with the transaction number of ********* and stated the amount of $177.18 was paid to evacore to pay the 1 natural way company. **** then provided me the number to evacore to have them determine what happened to the funds. I spoke with ****** at Evacore who stated that they don't handle any kind of payments and so she would advise I call Allegience back. I let her know that 1 natural way is threatening legal action since the claims were never paid. She stated she doesn't know anything about transactions and would reach out to allegience and give a call back. Not one of these companies are taking responsibility and it is causing stress and hardship on myself. This needs to be taken care of as it has been ongoing for almost 6 months now and I should not be held responsible because these companies can't figure out how to do their jobs appropriately.

  

  Business response

  02/20/2024

  We appreciate the opportunity to respond to the customers complaint.

  The customer was receiving bills for the outstanding claims which we did not receive payment for from her insurance company.  This include services for supplies which were shipped on 8/28/23 and 10/3/23.   

  As the customer indicated, she is being advised by her insurance that these dates of service were paid by her insurance company in December of 2023.  At this time, we have not received payment from either Cigna/Allegiance or Evicore.  

  However, our billing department has spoken with her insurance carrier Allegiance by Cigna. They state that the claims were reprocessed in December last year. From there, Allegiance sends this information to Evicore. Evicore is the entity that sends actual payment to 1 Natural Way. We have not received these payments as of this date, however, we are actively working with the insurance and Evicore to receive these payments.  While this is being resolved, the balance due has been transferred back to the insurance company since that is ultimately where the payments will come from.  The customer will no longer receive billing statements for these two dates of service while we continue to work with the insurance company to resolve the issue. 
  

  
  

• Initial Complaint

  02/05/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  This company takes advantage of new mothers and their desire to breastfeed their baby by making dishonest claims about the cost of their breastpump supplies. I have two serious concerns that I ask that the company resolve as soon as possible. Concern #1: I lost my insurance coverage December 1st, 2023. I had ordered breast pump supplies on November 29th, 2023 while still having insurance. The company did not file the claim until the products were sent on December 13th, 2023 when I was not insured despite the fact that I ordered the products when I was insured. The company did not reach out to me to let me know that they will file the claim only when the products are sent out NOT when they are ordered. Furthermore, USPS failed to ensure that I received the package as it was not delivered to the address and I talked to others in our building and they did not know where it was. When I expressed this concern to 1NaturalWay they have ignored this concern. Concern #2: I got new insurance and called 1NaturalWay to inform them of the change in insurance and ensure that I was in-network with their services. They claimed that I was. When I went to order breastpump supplies on their website , it said that the cost of the supplies would be totally free. No where did it even tell me the cost of the supplies if my insurance did not cover them. There was no Good Faith Estimate provided for the breast pump supplies so I could be aware of what my patient responsbility may be if my insurance failed to cover the supplies (however I was under the impression that they were covered given my conversation with the customer service agent AND the fact that everything on the website where I ordered the supplies said "FREE" or $0.00). I ended up getting slapped with a nearly $150 dollar bill because insurance did not in fact cover the supplies. I was incredibly disturbed by the company's dishonesty regarding their prices as I have a son with medical issues and pump.

  

  Business response

  02/16/2024

  Thank you for allowing us the opportunity to respond.  The customer is receiving bills for two claims which were denied by her insurance company.   When the customer places an order for supplies, they are shown the retail price of the parts they are ordering simply for reference and to show what the customer would pay if they purchased the items at a retail price.  However, since we are submitting a claim to insurance for the items, our contract requires that items be billed based on the insurance company’s allowable amount for the items ordered.  This allowable amount will vary based on the parts ordered and each insurance company sets their own allowable amounts.   The amount the customer is being billed is the allowable amount established by the insurance company and is the amount that we expected to receive from the insurance company had the claim been processed successfully.   When the customer places an order, they are required to sign the Products Order Form which includes the Assignment of Benefits section (see attached documents).  This form does advise the customer that if the claims are denied, the customer will be responsible for the balance due.

  The customer placed an order for replacement parts/breastfeeding supplies on 11/29/23.   Insurance guidelines require that we wait a minimum of 30 days between shipments and claim submissions.  Since the customers previous order had shipped on 11/08/23, we were unable to ship the order which was placed on 11/29/23 until 30 days had passed from 11/8/23.  The soonest the order could have shipped would have been 12/9/23, however there is a processing time before the order leaves our warehouse. The order ultimately shipped on 12/13/23.   Prior to shipping the order, we verified that the policy was still active at that time.  At no time, did the customer notify us that her coverage was ending or changing.  If that had occurred, we would have cancelled the order.    Upon checking the insurance portal, the customers coverage is showing that it was active until 12/31/2023, therefore the customer was advised to contact their insurance to request that they review the claim denial.   In addition, the customer advised that they did not receive the package which was shipped on 12/13/23.  The package was shipped via USPS to the address provided by the customer.   When the customer contacted us about the bill, she advised that she had moved and did not live at that address any longer.  We were never notified that the customer had moved prior to shipping the package.   We do provide a Shipping Confirmation Email (see attached) to the customer at the time the order is shipped, which advises the customer that their order has been shipped.  The email contains the address the order is being shipped to as well as the tracking number from the carrier.   The customer did not reach out to us upon receiving the email to advise that they had moved.  We were not notified that the package was not received until the customer reached out to us in February.  At that time, we were unable to initiate a search request with the post office due to the time that had passed and the package tracking showed that it was successfully delivered to the address we were provided.   The customer did reach out to USPS and they advised that the package was most likely stolen.  The shipping confirmation email the customer receives states that we are not responsible for lost or stolen packages once they are delivered. 
  
  The second bill that the customer is receiving was for an order of replacement parts which was placed on 1/17/24.  The customer reached out to 1 Natural Way on 1/17/24 prior to placing the order, to advise that she had a new insurance plan and inquired if the supplies would be covered.   The customer’s account was updated and we provided the following information to the customer:
              “We do offer supplies through that insurance plan, however, if you have any specific coverage questions, if that particular plan provides coverage for supplies in general, you will want to ask your insurance directly.  We are able to check for active coverage, but for any specific coverage questions, we always recommend checking with your insurance company. “
  The customer placed her order and we verified that the new policy was active.  The customer was sent a Verification Email (see attached) which states that we verified that the policy was active, and it is the responsibility of the customer to know their benefits. 

  The customers claim for the 1/18/24 date of service was processed and a portion of the charges were applied to the customers deductible.  A portion of the charges were denied as non-covered charges.  Typically, insurance plans will cover breast pumps and replacement parts under the Womens Preventative benefit through the Affordable Care Act.   The customer was referred back to her insurance to request that they review and possibly reprocess the claim.  
  The Explanation of Benefits from the customers insurance for both dates of service indicate that the balance(s) due are Patient Responsibility.

  The customer indicated that she had not opened the package which she received in January and requested to return the items.  Our return policy does state that we do not allow returns or exchanges of any items due to the hygienic nature of the products we provide.   This information is provided to the customer on both the Order Confirmation email and the Shipping Confirmation Email.  However, we advised that we would review the request for return to see if an exception could be made.  The customer provided photos showing that the shipping box was still sealed and had never been opened, so a return was approved.  The customer was also provided with a postage paid return label to use in sending the package back to 1 Natural Way.  At this time, we are awaiting the return of the package.  Once the package is received back and the inspection completed, the balance for the returned items will be removed from the customers account. 

  The customer will remain responsible for the charges from the 12/13/23 date of services unless she is able to resolve the claim denial issue directly with her insurance.
  The customers issues and complaint were reviewed by our Chief Compliance Officer, and it was determined that all policies and procedures were correctly adhered to. 

• Initial Complaint

  12/20/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Hello, On 11/1/2023, I provided our secondary Insurance information to 1 Natural Way for a breast pump. Based on that information, two breast pumps were free, according to Natural way. I went with this company, due to Facebook ads. I used them previously for my Elvie breast pump. I used our primary insurance on that pump. It doesn't empty me out. Indiana medicaid kicked in after birth of our son due to income guidelines. I provided the medicaid insurance information. As you can see in the attached documents, they provided $0 charge. Last week I received a bill. They ran it under our primary insurance. Which, I didn't provide for this transaction. They had it saved from previously. Originally a customer service representative stated I needed to contact Anthem Medicaid. I contacted them, they stated 1 Natural Way isn't in network with them. I contacted Natural way back. I spoke with a sales representative, name and contact information in attached documents. After reading the bill that says BCBS Indiana, the verification letter she needed to speak with her supervisor. They decided to let me return it if unopened. Of course it's opened. I sterilized the parts but never used the system. I borrowed a pump until I found my inserts for the flanges. Attached email then says I can't returned open products. The bill is due the 20th and I feel they scammed me. I would never buy an off brand pump when insurance pays for the top two pumps. My husband and I both work and receive benefits for our children and I receive coverage for one year. Obviously money is tight when we pay hundreds on primary insurance and inflation. I really appreciate any help!

  

  Business response

  12/27/2023

  Thank you for allowing us the opportunity to respond.  We regret that the customer has received a bill as a result of the insurance claim being denied.    As indicated in the complaint, the customer provided her secondary insurance to 1 Natural Way in order to receive a breast pump through insurance.     The customer had previously received a pump through her primary insurance for a prior pregnancy.  This primary insurance information was on file with her account.  However, even if this information had not been on file, when we verify coverage with any insurance plan, we are typically notified by the insurance company if there is another primary insurance in place which must be billed first.  Insurance guidelines dictate that a provider must bill (submit claims) to a patient’s primary insurance plan first.   If this is not done, the secondary plan will generally deny the claim and advise us to submit to the primary insurance plan.  A patient is not able to choose which plan they want to submit their claims through.    In this case, if we had submitted the claim to her secondary insurance which was provided, we still would have received a claim denial.   It is ultimately the customers responsibility to be aware of which insurance plan is primary and provide the proper insurance information to a provider.   

  
  When the customer places their order, they are prompted to sign the Order Form which includes the Assignment of Benefits.  Included on the order form is the name and ID number for the insurance plan the order is being submitted under.   See attachment.   The Assignment of Benefits section does provide the required disclaimers and notifications to the customer with details of our Financial Responsibility policy and Return policy.  It is also stated that the coverage verification is an estimate.  This is not a guarantee of coverage and it is ultimately the insurance company who makes the final decision at the time of claims processing. 

  
  Once the order is placed and upon completing the verification, we did also provide an email to the customer with the following statement:  If you have more than one medical insurance policy, it is your responsibility to know which policy is primary and to provide us with that information.   Links to our Financial Responsibility policy and Return policy are also included in this email.   A copy of this email is also attached for reference.

  
  The insurance plan listed on the billing statement (Anthem BCBS Indiana) is the primary insurance plan which was billed.  This is the primary/ commercial policy and not the secondary/ Medicaid policy.  Anthem and Blue Cross Blue Shield requires that we submit claims to the state where services are provided.  Therefore, even though the customer has a primary insurance through Anthem BCBS OH, we are required to bill Anthem BCBS Indiana since that is where we shipped the product.   This policy is different from her secondary Medicaid policy through Anthem Healthy Indiana Plan. 

  
  As we are a licensed Durable Medical Equipment provider and due to the hygienic nature of the items we provide, we do not typically allow returns.  However, we did offer to allow an exception to our return policy if the item was still unopened with the manufacturers hygienic seal still in place.   Unfortunately, the customer did notify us that she had already opened the package, therefore, we were unable to allow an exception to have the item returned.   We do understand that any unexpected bill is unpleasant,  and we did provide the customer with payment options.    At this time, the patient does have a zero balance as her payment was received on 12/20/23.  Unfortunately, we are unable to refund this amount since this is the amount that we had expected to receive from the insurance company as payment for the item that we provided to the customer.    We are happy to respond to any additional questions and provide additional documentation as needed. 

  
  

  Customer response

  01/03/2024

  
  Complaint: ********
  
  I am rejecting this response because:

  I'm rejecting this response due to the lack of training and knowledge you have.  I attached the bill from your company showing you billed Medicaid, contradicts your reply. I didn't provide our Primary Insurance for this transaction, as stated in your billing and your reply. Your company sent approval of a free pump based on Medicaid ID I provided. Meaning you failed to run the insurance as stated before shipping the product as your email said. "In the verification email"  If my money isn't returned, I'm supporting Business Bureau to post this situation and I will let social media know,  which will result in others not falling for this scam. Shame on this company for lying, telling people your insurance company pays and then bills customers.  Completely discussed with your reply. 

  Sincerely,
  
  ******* *********

  

  Business response

  01/09/2024

  Tell us why here...Thank you for the opportunity to respond.  The billing statement which was sent to the customer indicates that the insurance we submitted the claim to was Anthem BCBS Indiana, which is a commercial account.  As indicated previously, this is not the same as the Anthem Healthy Indiana plan.  A copy of the billing statement is attached for reference.  
  Both the verification and the order information (attached again) were based on the commercial insurance information, not the Medicaid information.  
  If the benefit for the breast pump has not been utilized through the customers secondary insurance plan, we do recommend reaching out to inquire about submitting her paid receipt and Explanation of Benefits from the primary insurance company for processing.  This will be at the discretion of the insurance company. 
  As indicated previously, insurance companies must submit claims to primary insurance plans first.  We regret that we are unable to refund the customer as requested.  We did provide the product in good faith.  We have helped thousands of customers receive their breast pump with favorable outcomes and regret that this did not happen in this instance.  
  
  

  

  Business response

  01/12/2024

  [BBB Transcription via Email]

  After further discussion with our billing department, they are reviewing the customers account to determine if we are able to submit a claim to her secondary (Medicaid) policy.  In the meantime, the customers payment of $95 has been refunded to her to allow time for the additional claims processing.   The customer has been advised of the refund.  We appreciate the customers patience and the opportunity to respond with complete and accurate information. 

  Customer response

  01/15/2024

  
  Complaint: ********
  
  I am rejecting this response because:

    Hello, 

    Sorry for any misunderstanding.  The reply on here is different from an email received directly from Natural Ways staff. I appreciate the refund.  Attached email states you are checking eligibility.  

    I clicked not satisfied based on this reply in BBB.  If my credit card isn't recharched, I'll be satisfied and will click satisfied. Please let me know if any further action is needed. Thanks 

  
  Sincerely,
  
  ******* *********

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