Racine Dental Group, S.C.

I will need your assistance following through on this claim.  I spoke to the office coordinator for Dr. [redacted]. This is what is shown in our records.9/9/2014 - [redacted] was seen by Dr. [redacted] because he had a broken tooth. A protective restoration was placed over the tooth and [redacted] was...

reappointed.9/17/2014 – [redacted] came in for impressions for the broken tooth.9/18/2014 – [redacted] came in for a routine appointment.9/19/2014 – [redacted] came in for a follow up visit in reference to visit on 9/17/2015.10/14/2014- [redacted] had permanent restoration placed on the broken tooth.12/12/2014- WEA denied the claim due to invalid information.12/16/2014- Insurance was resubmitted with the correct information obtained from [redacted].4/28/2015 – Insurance contributed 50% rather than 80% on the crown. RDG staff phoned WEA. WEA asked that we resubmit the claim, which we did. WEA did not contribute any additional benefit. The allowable fee was $900.00 for the crown. WEA paid $450.00.  [redacted] was quoted an 80% benefit for the crown on 9/9/14 by the office coordinator based on the information we had in our database. A prior authorization was not sent to WEA because [redacted] requested the broken tooth be fixed as soon as possible. After WEA denied the claim asking for the correct numbers, we found that the benefit for the crown was actually 50% rather than 80%.It did take a long time to get through the insurance red tape. We have no notation from WEA stating a reduction in the benefit because the claim was not submitted in a timely manner.The actual balance due by [redacted] is $270.00.I will be out of the office on Thursday and Friday, December 10 and 11.  I will return to work on December 14, 2015 at 8am.Please advise what the next step is in this process.I appreciate your help.[redacted]Practice CoordinatorRacine Dental GroupPhone 262-619-7728Fax  262-995-7524

On December 28, 2015 I sent [redacted] a letter explaining a detailed history of his account along with a good faith adjustment of half of his balance due to Racine Dental Group.  Yesterday we received his payment in full. I believe this case is now closed.Please contact me if you need any additional information.Best,[redacted]Practice CoordinatorRacine Dental GroupPhone 262-619-7728Fax  262-995-7524

Review: I had crown installed on 9/17/14 by dr. [redacted] and paid my cost of $180. I was told my insurance would cover the rest and insurance conformed that. Than I received a bill for $1412.00 on 10/31/14 called RDG billing and was told the check from insurance probably did not clear yet. I received bill for $1440.24 on 11/30/14 I called RDG talked to Julie, $28.24 was a service fee and was removed from the bill and the bill was resubmitted to insurance for a non payment. I received bill for $1439.00 on 12/31/14. I called RDG, they said claim was denied. I called insurance and was told RDG did not summit bill on time (30 days). I called RDG they said paper work must have got misplaced in move to new building. my insurance said resubmit bill and they would pay RDG. I received bill for $288.00 on 5/31/14 called RDG, they said insurance only paid $1152.00. called insurance in witch I no longer had, and they said the bill was summited in 2015 so they would only pay 70% instead of 80% as in 2014. I called RDG back and told them I would not be paying for their mistake! 8/31/15 I received a bill for $275.40 I called RDG and asked what this was for? they said from crown in 2014. I'm tired of pulling out my statements every couple of months for them! I had to change dentists after 20+ years. from past experience it seems when you don't go in for their 6 month cleaning they send you a bill.Desired Settlement: correct my credit report and bill, an apology letter to Dr. [redacted] office and myself. no further contact by billing department. payment for my time spent dealing with this.

Business

Response:

I will need your assistance following through on this claim. I spoke to the office coordinator for Dr. [redacted]. This is what is shown in our records.9/9/2014 - [redacted] was seen by Dr. [redacted] because he had a broken tooth. A protective restoration was placed over the tooth and [redacted] was reappointed.9/17/2014 – [redacted] came in for impressions for the broken tooth.9/18/2014 – [redacted] came in for a routine appointment.9/19/2014 – [redacted] came in for a follow up visit in reference to visit on 9/17/2015.10/14/2014- [redacted] had permanent restoration placed on the broken tooth.12/12/2014- WEA denied the claim due to invalid information.12/16/2014- Insurance was resubmitted with the correct information obtained from [redacted].4/28/2015 – Insurance contributed 50% rather than 80% on the crown. RDG staff phoned WEA. WEA asked that we resubmit the claim, which we did. WEA did not contribute any additional benefit. The allowable fee was $900.00 for the crown. WEA paid $450.00. [redacted] was quoted an 80% benefit for the crown on 9/9/14 by the office coordinator based on the information we had in our database. A prior authorization was not sent to WEA because [redacted] requested the broken tooth be fixed as soon as possible. After WEA denied the claim asking for the correct numbers, we found that the benefit for the crown was actually 50% rather than 80%.It did take a long time to get through the insurance red tape. We have no notation from WEA stating a reduction in the benefit because the claim was not submitted in a timely manner.The actual balance due by [redacted] is $270.00.I will be out of the office on Thursday and Friday, December 10 and 11. I will return to work on December 14, 2015 at 8am.Please advise what the next step is in this process.I appreciate your help.[redacted]Practice CoordinatorRacine Dental GroupPhone 262-619-7728Fax 262-995-7524

Consumer

Response: