Aadland Dental

Ms [redacted] came into our office on for a cleaning and examAfter speaking with her about her Perio history of SRP and gum grafts as well as completing her perio charting indicating a clinical need for Perio maintenance we completed a Perio Maintenance D$and a comprehensive exam D$When we received payment from Cigna on the Perio Maintenance, they had downgraded to a DProphy due to the lack of Perio history sent with the claimI called them and explained what [redacted] had told us about her history of SRP and gum graftsThe representative asked me to send a letter including her perio chart to back up the historyWe have had multiple conversations with the insurance company as Ms [redacted] has continued to fight with us regarding the amount that she paidWE received a follow up EOB from the insurance company after one of our conversations (#2) showing that they changed the cleaning on back to a PMR and that the patient responsibility was for a PMR not a ProphyTo date the charges that were sent to the insurance company were $for the PMR and $for the examWe have been paid $and $to date from the insurance company for a total of $116, leaving a patient balance of $Ms [redacted] paid $on This leaves an account balance of $1.20, which we wrote off to be done with this matter The reason that Ms [redacted] was charged on the day of service is the computer defaulted to an 80% perio rate which is standard for most insurancesWe have since corrected this in the system to 90% to match the benefits but then found out that if Ms [redacted] would give the insurance company the approximate year that her SRP was completed, they would pay for the Perio maintenance at 100%They would pay us the remainder of the balance and we would refund the patient back what she paid usMs [redacted] has been told this by the insurance company and refuses to do so

Ms *** came into our office on for a cleaning and examAfter speaking with her about her Perio history of SRP and gum grafts as well as completing her perio charting indicating a clinical need for Perio maintenance we completed a Perio Maintenance D$and a comprehensive exam
D$When we received payment from Cigna on the Perio Maintenance, they had downgraded to a DProphy due to the lack of Perio history sent with the claimI called them and explained what *** had told us about her history of SRP and gum graftsThe representative asked me to send a letter including her perio chart to back up the historyWe have had multiple conversations with the insurance company as Ms *** has continued to fight with us regarding the amount that she paidWE received a follow up EOB from the insurance company after one of our conversations (#2) showing that they changed the cleaning on back to a PMR and that the patient responsibility was for a PMR not a ProphyTo date the charges that were sent to the insurance company were $for the PMR and $for the examWe have been paid $and $to date from the insurance company for a total of $116, leaving a patient balance of $Ms *** paid $on This leaves an account balance of $1.20, which we wrote off to be done with this matter
The reason that Ms *** was charged on the day of service is the computer defaulted to an 80% perio rate which is standard for most insurancesWe have since corrected this in the system to 90% to match the benefits but then found out that if Ms *** would give the insurance company the approximate year that her SRP was completed, they would pay for the Perio maintenance at 100%They would pay us the remainder of the balance and we would refund the patient back what she paid usMs *** has been told this by the insurance company and refuses to do so

Ms [redacted] came into our office on 7.27.16 for a cleaning and exam. After speaking with her about her Perio history of SRP and gum grafts as well as completing her perio charting indicating a clinical need for Perio maintenance we completed a Perio Maintenance D4910 $114 and a comprehensive exam...

D0150 $46. When we received payment from Cigna on the Perio Maintenance, they had downgraded to a D1110 Prophy due to the lack of Perio history sent with the claim. I called them and explained what [redacted] had told us about her history of SRP and gum grafts. The representative asked me to send a letter including her perio chart to back up the history. We have had multiple conversations with the insurance company as Ms [redacted] has continued to fight with us regarding the amount that she paid. WE received a follow up EOB from the insurance company after one of our conversations (#2) showing that they changed the cleaning on 7.27.16 back to a PMR and that the patient responsibility was for a PMR not a Prophy. To date the charges that were sent to the insurance company were $114 for the PMR and $46 for the exam. We have been paid $70 and $46 to date from the insurance company for a total of $116, leaving a patient balance of $44. Ms [redacted] paid $42.80 on 7.27.16. This leaves an account balance of $1.20, which we wrote off to be done with this matter.
The reason that Ms [redacted] was charged on the day of service is the computer defaulted to an 80% perio rate which is standard for most insurances. We have since corrected this in the system to 90% to match the benefits but then found out that if Ms [redacted] would give the insurance company the approximate year that her SRP was completed, they would pay for the Perio maintenance at 100%. They would pay us the remainder of the balance and we would refund the patient back what she paid us. Ms [redacted] has been told this by the insurance company and refuses to do so.