Advanced Oral & Maxillofacial Surgery, Ltd.

Initial Business Response /* (1000, 6, 2015/04/15) */
Contact Name and Title: *** *** Billing
Contact Phone: XXX-XXX-XXXX
Contact Email: ***@advoms.com
To Whom it May Concern:
We are sorry to hear that Mr*** felt he had a "terrible experience" at our officePlease be aware
that at Advanced Oral & Maxillofaical Surgery, Ltd., we to do our utmost to provide quality and appropriate care for our patients
On 3/3/Mr*** presented to our office for consultation for dental implants at the referral of his general dentistMr*** was told that we were participating with his dental insurance carrier upon scheduling his appointmentOnce at our office, Mr*** provided x-rays from his general dentist that were over one year old and unusable for his implant consultationA new panoramic x-ray was taken for screening in lieu of proceeding immediately to CT scanning (3-D image), as this the CT scan would not be necessary if the panoramic showed no possibility for future implant placementThe new panoramic x-ray was taken at no charge to the patient($value) Upon review of the new x-ray and after consulting with Mr***, he was told that to further evaluate the area and treatment plan for implants, a CT scan would be requiredMr*** agreed to the CT scan and had the opportunity to refuse the scan but he did notHe was never told that the CT scan would be free or that he would not be responsible if his insurance carrier denied this serviceSubsequently the CT scan was takenDr*** *** then spent additional time evaluating the CT scan & treatment planning for possible implant placementHe also spent additional time speaking with Mr***'s general dentist in length regarding his possible treatmentDr*** did not charge Mr*** for this additional time spent
We are upfront with our patient's concerning our dealings with insurance carriers and their responsibility for payment for all services renderedSo much so, that every patient is given a copy of our office's Insurance Assignment and Payment Policy in writing for their review before being seen as well as a copy to take home for their recordsThis Insurance Assignment and Payment Policy clearly states all "patients are considered cash patients until our office receives verification of insurance benefits", "insurance benefits are not guaranteed", "patients are required to know their benefits, requirements and exclusions for treatment" and "regardless of insurance coverage, patients are responsible for any and all fees incurred."
On 3/17/Mr*** called our office's billing department and began screaming at *** who was attempting to explain the aboveAfter many minutes of abuse, it seemed appropriate for *** to end the call abruptly
On 4/2/Mr*** called and spoke with Dr*** *** who again explained the above information and after several minutes of heated conversation, agreed to extend a courtesy discount of $
We believe we have been more than accommodating to Mr*** and although, we are grieved that he was unhappy, we do feel that we have gone above and beyond what is necessary in our attempt to satisfy himWe are equally grieved he feels that his time spent with Dr***, Dr***'s time spent on his evaluation, treatment planning, in consulting with his dentist and the use of our technology was "for nothing."
I hope this information is helpful to you in your review of this caseIf you require any additional information please feel free to contact our office
Sincerely,
Advanced Oral & Maxillofacial Surgery, Ltd

October 27, 2017 Revdex.com of Chicago & Northern Illinois, Inc. Re: [redacted], Case#: 1[redacted] To Whom it May Concern: Please allow this letter to serve as our reply to the complaint against our office by [redacted].  Our office strives to provide quality oral surgery...

services.  We typically go above and beyond what is required to elicit correct payment and processing for our patient’s claims.  We are disappointed if Ms. [redacted] is upset and confused about her account.  Our office is equally frustrated that her claims were not properly processed by her medical carrier.  This problem has also caused us a great deal of additional work by to correct the matter and elicit proper processing and payment.  Benefits: On 6/10/16 benefits were verified with the medical and dental carriers and medical HMO referral/authorization was requested for the medically covered procedures.  The evaluation visit was to be covered by the medical plan at 100% and a $25.00 copay was to apply.  The 2 completely bony impacted teeth and associated anesthesia was to be covered by the medical plan at 100%.    The remaining 2 partially bony impacted teeth were to be covered by the dental plan were to be subject to a co-pay of $155.00 per tooth.   The approximate out of pocket expense for the surgical procedure was calculated to be $310.00.  (This amount did not include the evaluation visit’s copay of $25.00) The patient was notified via letter and that the approximate out of pocket expense for surgery was to be paid at the time of service.     Claims processing: Because Ms. [redacted] had a Medical HMO, we were required to file a claim for the medically covered services to the medical group/IPA or PHO first who was responsible for reviewing and approving the claim and forwarding the claim to medical plan for processing and payment.  Our medical and dental claims were filed with the appropriate carriers in an expeditious manner.   The medical claim was originally forwarded by the medical group/IPA or PHO to the medical plan for payment on or about 8/26/16.  The dental carrier paid their portion on 10/31/2016 and the payment was correct.  Upon receipt of the medical carrier’s payment on 9/12/16 it was determined that claim was both processed incorrectly and incompletely by [redacted] which caused multiple appeals, resubmissions and delays in correct processing.  We received additional and final word from the medical carrier on 10/20/17 resulting in one final credit adjustment to the account for $20.00.  Accounting: Ms. [redacted] current account balance is actually $25.00. Which consists of the remaining copay due for the evaluation visit as indicated above.  We have not overcharged Ms. [redacted]    There was an issue 8/26/16 when an insurance payment incorrectly posted to her account for another patient for $55.25.  This incorrectly posted payment was removed on 2/21/17 via a “miscellaneous debit” adjustment posted to the account for correction. There was one other “miscellaneous debit” adjustment on the account for $4.37 for the interest due us from [redacted] per IL State law because of their late and incorrectly processed claims. Our office send’s statements monthly regardless of pending insurance payments to elicit patient participation in obtaining payment from their insurance carrier(s).  Finally, to address Ms. [redacted] remarks:  “She continuously gets the run around and cannot get a straight answer” and “this feels like a scam”:    Let us say that if our office was unable to give a straight answer it was because we were awaiting correct processing by the insurance carrier or for additional information from them.  Our office does not charge late fees or monthly interest like some offices do.  “The claim is 2 years old.”  This is an incorrect statement.  Ms. [redacted] services were rendered in July of 2016 making the claim only 15 mo. old.  Ms. [redacted] is being charged her $155.00 copay for each of the 2 partially bony impacted teeth and $25.00 copay for her office visit.  Ms. [redacted] was advised that the $310.00 she paid at the time of service was an approximate amount as benefits and approximate out of pocket expenses quoted are not guaranteed by our office or by the insurance carriers. Our office was not required to appeal her claim for correct payment but did so as a courtesy.  We could have balance billed her for services incorrectly processed by [redacted] in accordance with our contract after 90 days.  We did not do so.  Ms. [redacted] responsibility to us is $155.00 + $155.00 + $25.00 = $335.00.  Ms. [redacted] has paid our office $310.00 so the current balance of $25.00 is due and payable.  We hope this information is helpful your review of this matter.  Please let us know if we can be of any further assistance.  [redacted] Advanced Oral & Maxillofacial Surgery, Ltd.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted] and find that this resolution is satisfactory to me.
Sincerely,
[redacted]