Acclaim Dental Group

February 17, Dear ** [redacted] , This letter is in response to the letter I received from your office regarding a complaint from person submitting the complain with ID [redacted] ***came to my dental practice on August for her initial dental check upUpon a complete exam and x-ray of her mouth it was revealed that she has early localized periodontal disease and needed deep cleaning (periodontal treatment) of isolated sitesShe was fully informed of the findings and diagnosis and recommended treatment and she consented to treatment the same day My office has a standard routine when it comes to dental insurance and financial policies: When a new patient calls to schedule their first visit with us, my insurance coordinator obtains all of their dental insurance information when they callBefore their arrival for their first visit she completes a very detailed insurance verification form by calling the insurance companiesThis form provides us with most information we need regarding dental coverage of a patientHowever, the information they provide to us over the phone is not a guarantee of benefitsAttachment A is the one specifically for ** [redacted] Per the information provided to us by her insurance company, her periodontal treatment should have been covered 90% In addition when new patients arrive to the office, they are given a copy of “Our Office Policies” with all detailed information about our financial policies which includes how the insurance benefits are handled on the first paragraphAttachment B is the copy signed by *** On her first visit of August 2013, ** [redacted] was given an “estimated” copay amount based on what her dental insurance should have coveredHowever, after the claims were submitted to her dental insurance, they denied the perio treatment rendered per the EOB mailed to us dating 10/17/They requested additional documents (Attachment C)My insurance coordinator submitted all requested documents along with a narrative explaining why the treatment was performed (Attachment D)Despite of our second effort, her dental insurance once again denied benefits per another EOB mailed to us dating 11/21/(Attachment E) At this point, my insurance coordinator and I reviewed ***.’s accountSince she was referred to our office by another existing patient, I authorized a courtesy discount of $to give her a break and more affordable to pay her balanceHer balance was reduced to $for which she was sent a statementPlease also note despite of our office policy which indicates for each month of delinquent payment there will be a late fee charge of $25, she was never charged for the three months that she was late for paymentShe finally made her payment on January 24, (See Attachment F) My insurance coordinator also had several conversations with her explaining the process of claim submission and denial with her dental insurance***kept delaying her payment insisting that she wants to follow up with her insurance companyThen, she had the insurance company to call my office to investigate because she had accused us of overcharging her! Once my insurance coordinator spoke with the representative from the insurance company explaining all the charges and the discounts ** [redacted] had received, they authorized us to proceed with our billingAfter that, ***called my office and stated that per her conversation with the insurance representative, my narrative was incorrectShe wanted me to specifically use her terminology and submit another claim on her behalfAt this point, I felt that I had already exhausted too much of my staff time and my time trying to convince ***and her dental insurance companyTherefore, I suggested that she could write an appeal letter herself and my office would help her with providing all the documents she needed to submitI would also, review and so-sign her letter if she wantedOr, there would be an additional charge of $to compensate for staff time & recopying documents and certified mail feesShe refused both offers and instead decided to retaliate against me this way! In addition, we were notified on February 11th, by her dental insurance company that, they have decided to reprocess her claim and consider it for payment after our second attempt in appealing the case (Attachment G)So, not only she received a significant amount of discount from me, but also she is being reimbursed from her dental insurance as well! Also, I would like to note that as a participating dentist with her dental insurance network, I am obliged to follow the terms of my dental contract with themIf there were ever any breach of that contract, the dental insurance would alert me about it and would initiate a correctionI can assure you that, all my clinical and administrative actions have been within the boundaries of my dental contract and her insurance company [redacted] ***., on the other hand has completely, disregarded all the signed documents that fully explain to her what my office policies areHer payment of $will not be refunded Thank you for allowing me to explain my position on this matter Sincerely,

February 17, 2014
Dear **. [redacted],
This letter is in response to the letter I received from your office regarding a complaint from person submitting the complain with ID [redacted].
**. [redacted]. came to my dental practice on August 29 2013 for her initial dental...

check up. Upon a complete exam and x-ray of her mouth it was revealed that she has early localized periodontal disease and needed deep cleaning (periodontal treatment) of isolated sites. She was fully informed of the findings and diagnosis and recommended treatment and she consented to treatment the same day.
My office has a standard routine when it comes to dental insurance and financial policies:
When a new patient calls to schedule their first visit with us, my insurance coordinator obtains all of their dental insurance information when they call. Before their arrival for their first visit she completes a very detailed insurance verification form by calling the insurance companies. This form provides us with most information we need regarding dental coverage of a patient. However, the information they provide to us over the phone is not a guarantee of benefits. Attachment A is the one specifically for **. [redacted] Per the information provided to us by her insurance company, her periodontal treatment should have been covered 90%.
In addition when new patients arrive to the office, they are given a copy of “Our Office Policies” with all detailed information about our financial policies which includes how the insurance benefits are handled on the first paragraph. Attachment B is the copy signed by **. [redacted].
On her first visit of August 29 2013, **. [redacted] was given an “estimated” copay amount based on what her dental insurance should have covered. However, after the claims were submitted to her dental insurance, they denied the perio treatment rendered per the EOB mailed to us dating 10/17/2013. They requested additional documents (Attachment C). My insurance coordinator submitted all requested documents along with a narrative explaining why the treatment was performed (Attachment D). Despite of our second effort, her dental insurance once again denied benefits per another EOB mailed to us dating 11/21/2013 (Attachment E).
At this point, my insurance coordinator and I reviewed **. [redacted].’s account. Since she was referred to our office by another existing patient, I authorized a courtesy discount of $564 to give her a break and more affordable to pay her balance. Her balance was reduced to $102 for which she was sent a statement. Please also note despite of our office policy which indicates for each month of delinquent payment there will be a late fee charge of $25, she was never charged for the three months that she was late for payment. She finally made her payment on January 24, 2014 (See Attachment F).
My insurance coordinator also had several conversations with her explaining the process of claim submission and denial with her dental insurance. **. [redacted]. kept delaying her payment insisting that she wants to follow up with her insurance company. Then, she had the insurance company to call my office to investigate because she had accused us of overcharging her! Once my insurance coordinator spoke with the representative from the insurance company explaining all the charges and the discounts **. [redacted] had received, they authorized us to proceed with our billing. After that, **. [redacted]. called my office and stated that per her conversation with the insurance representative, my narrative was incorrect. She wanted me to specifically use her terminology and submit another claim on her behalf. At this point, I felt that I had already exhausted too much of my staff time and my time trying to convince **. [redacted]. and her dental insurance company. Therefore, I suggested that she could write an appeal letter herself and my office would help her with providing all the documents she needed to submit. I would also, review and so-sign her letter if she wanted. Or, there would be an additional charge of $50 to compensate for staff time & recopying documents and certified mail fees. She refused both offers and instead decided to retaliate against me this way!
In addition, we were notified on February 11th, by her dental insurance company that, they have decided to reprocess her claim and consider it for payment after our second attempt in appealing the case (Attachment G). So, not only she received a significant amount of discount from me, but also she is being reimbursed from her dental insurance as well!
Also, I would like to note that as a participating dentist with her dental insurance network, I am obliged to follow the terms of my dental contract with them. If there were ever any breach of that contract, the dental insurance would alert me about it and would initiate a correction. I can assure you that, all my clinical and administrative actions have been within the boundaries of my dental contract and her insurance company . [redacted]., on the other hand has completely, disregarded all the signed documents that fully explain to her what my office policies are. Her payment of $102 will not be refunded.
Thank you for allowing me to explain my position on this matter.
Sincerely,

Review: I had dental services performed by Dr. [redacted] at Acclaim Dental Group on 8/29/2013. Per her recommendation, I had a deep cleaning performed and was told that my co-payment was $75.00. After paying the co-payment, I received a letter in the mail stating the my insurance claim was declined and that I now owed Acclaim Dental Group $740.00. I called [redacted] to further understand why the claim had been denied. They explained to me that the documentation that the dentist provided did not validate the services provided, and therefore they would not accept the claim. I then called Acclaim Dental Group and explained what the insurance company had told me. I was told that the dentist would call me back directly, which she never did. After multiple attempts to contact her to discuss this matter, I was told that if I wanted another claim filed then I would have to pay an additional $50.00. It is to my understanding, that had she been more detailed with her explanation of services performed, the insurance claim would have been accepted and I would have not been forced to pay an additional $102.00. I find her professionalism to be lacking, and I feel that she needs to take better care of her patients regarding their insurance and the requirements. I do not feel that I should have had to pay any additional amount due to her lack of documentation.Desired Settlement: I desire a refund of the $102.00 that I was forced to pay. I do not feel that it was my responsibility to pay that amount due to her lack of communication and documentation.

Business

Response:

February 17, 2014

Dear **. [redacted],

This letter is in response to the letter I received from your office regarding a complaint from person submitting the complain with ID [redacted].

**. [redacted]. came to my dental practice on August 29 2013 for her initial dental check up. Upon a complete exam and x-ray of her mouth it was revealed that she has early localized periodontal disease and needed deep cleaning (periodontal treatment) of isolated sites. She was fully informed of the findings and diagnosis and recommended treatment and she consented to treatment the same day.

My office has a standard routine when it comes to dental insurance and financial policies:

When a new patient calls to schedule their first visit with us, my insurance coordinator obtains all of their dental insurance information when they call. Before their arrival for their first visit she completes a very detailed insurance verification form by calling the insurance companies. This form provides us with most information we need regarding dental coverage of a patient. However, the information they provide to us over the phone is not a guarantee of benefits. Attachment A is the one specifically for **. [redacted] Per the information provided to us by her insurance company, her periodontal treatment should have been covered 90%.

In addition when new patients arrive to the office, they are given a copy of “Our Office Policies” with all detailed information about our financial policies which includes how the insurance benefits are handled on the first paragraph. Attachment B is the copy signed by **. [redacted].

On her first visit of August 29 2013, **. [redacted] was given an “estimated” copay amount based on what her dental insurance should have covered. However, after the claims were submitted to her dental insurance, they denied the perio treatment rendered per the EOB mailed to us dating 10/17/2013. They requested additional documents (Attachment C). My insurance coordinator submitted all requested documents along with a narrative explaining why the treatment was performed (Attachment D). Despite of our second effort, her dental insurance once again denied benefits per another EOB mailed to us dating 11/21/2013 (Attachment E).

At this point, my insurance coordinator and I reviewed **. [redacted].’s account. Since she was referred to our office by another existing patient, I authorized a courtesy discount of $564 to give her a break and more affordable to pay her balance. Her balance was reduced to $102 for which she was sent a statement. Please also note despite of our office policy which indicates for each month of delinquent payment there will be a late fee charge of $25, she was never charged for the three months that she was late for payment. She finally made her payment on January 24, 2014 (See Attachment F).

My insurance coordinator also had several conversations with her explaining the process of claim submission and denial with her dental insurance. **. [redacted]. kept delaying her payment insisting that she wants to follow up with her insurance company. Then, she had the insurance company to call my office to investigate because she had accused us of overcharging her! Once my insurance coordinator spoke with the representative from the insurance company explaining all the charges and the discounts **. [redacted] had received, they authorized us to proceed with our billing. After that, **. [redacted]. called my office and stated that per her conversation with the insurance representative, my narrative was incorrect. She wanted me to specifically use her terminology and submit another claim on her behalf. At this point, I felt that I had already exhausted too much of my staff time and my time trying to convince **. [redacted]. and her dental insurance company. Therefore, I suggested that she could write an appeal letter herself and my office would help her with providing all the documents she needed to submit. I would also, review and so-sign her letter if she wanted. Or, there would be an additional charge of $50 to compensate for staff time & recopying documents and certified mail fees. She refused both offers and instead decided to retaliate against me this way!

In addition, we were notified on February 11th, by her dental insurance company that, they have decided to reprocess her claim and consider it for payment after our second attempt in appealing the case (Attachment G). So, not only she received a significant amount of discount from me, but also she is being reimbursed from her dental insurance as well!

Also, I would like to note that as a participating dentist with her dental insurance network, I am obliged to follow the terms of my dental contract with them. If there were ever any breach of that contract, the dental insurance would alert me about it and would initiate a correction. I can assure you that, all my clinical and administrative actions have been within the boundaries of my dental contract and her insurance company . [redacted]., on the other hand has completely, disregarded all the signed documents that fully explain to her what my office policies are. Her payment of $102 will not be refunded.

Thank you for allowing me to explain my position on this matter.

Sincerely,