Advanced Dental Designs, P.C.

April 20, Dear Sir,I would like to inform following facts about *** ***’s visit on 4/9/We charge $instead of
regular cop-pay of $for the following services we rendered on 4/9/*** Exam co-pay $ *** 2Bws co-pay $ *** *** co-pay $ *** PA co-pay $ Office Visit co-pay $ Kind of plan she has is a HMO which works as discount plan at our endFor member it may be an insurance but for us it is a discount plan and no claim or payment involved from insurance companyBecause it is discount plan (HMO) we need to submit EncounterWe do not need to submit claim as it is not required by the insurance companyEven if we send a claim, it will be consider as an Encounter and processed accordinglyPractically, there is no claim involved and so there is no payment expected from the insurance company for the services render to HMO/Discount plan membersThere are different arrangements by Insurance companies with different doctorsTherefore, there is chance of communication gap between member and provider department of each insurance companiesI do not want to go in details at this point, however, I am ready discuss in length once this matter move forward for trial in the courtMy front desk repeatedly told *** *** that the statement is just for her record to show the services which are performed and proof of payment made by herAfter few months when we will receive acknowledgement of an Encounter by Insurance Company, we will write off balance and after that point of time balance goes to zero in patient file*** *** for some reason was not ready to accept the way how this process work so my front desk show her inability to write off balance manually because there are steps involved like creating, submitting, receipt of acknowledgement of the Encounter and write off balanceCreation of Encounter will be done latter onSome time we have to go online and send Encounter through insurance website if it does not go through clearing houseFrequently, we have technical issue somewhere with insurance website or clearing house to send Encounter because of periodical change in HMO / Discount plan due to constant change in government and insurance policyWe just try to work out with everybody everywhereThere is a process involved from sending Encounter to receipt of acknowledgement from InsuranceAll involved parties including patient, insurance companies, Revdex.com and Administration has to wait until this process complete before they decide to convict doctor of medical malpractice or insurance fraudPatient always get upset when they realize that they have to pay and start asking question about why they have to pay? And how much money doctor gets paid by insurance? We do not know certainly about how much insurance pay, however, we try to answer, but some time it may be impossible to answer to their satisfaction and at that point patient like *** *** tell us on our face that you are doing either medical malpractice or insurance fraudWe always settle account according to the Explanation of Benefits that we receive from insurance companyWe have no problem to refund if patient is not satisfied about our serviceThere are more than thousands of HMO or Discount plans offered by few insurance companies and there are equal numbers of fees schedule depends on kind of HMO plansIt is possible that we may make a mistake in calculation of co-paySome time we collect less co-pay and we loseHowever if we have collected more money we do settle account and refund to patient after we hear from Insurance companyMeantime, we ask patient to pay estimated co-payIf we do not collect co-pay we cannot pay our bill for rent, supply & utilities and it is economically not possible to pay salary to our employeesSome time it do happen neither insurance nor patient pay for services we provideWe have no choice but to write off if we do not receive payment from either partyA small provider always come in direct contact with patient personally therefore cannot afford to use collection agency to collect co- pay otherwise it will be difficult for doctor to live or work in the city of PhiladelphiaI do have experience in past that one insurance do not allow to collect co-pay from patient and another insurance consider fraud if we do not collect co-payIt was difficult time to explain to *** *** about the procedures sheneedsI do not want to go in detail as she decided to go to another providerImportantly, I want to inform office of the Attorney General or BBA that there is no claim or insurance payment involved for the treatment provided to *** ***.If you need any further clarification, let us know.Thank you for your time and appreciate your help in solving problem between doctor and patient.Yours truly,

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed as Answered]
Complaint: ***
I am rejecting this response because:
There were no fillings, and I DO NOT WANT TO ACCEPT YOUR OFFER TO COME IN TO YOUR OFFICE
Regards,
*** ***

I am right on my opinion on what is primary and secondary insuranceAll commercial insurance is primary insuranceOur claim with Delta (which is your primary insurance) is still there on file with DeltaPlease request Delta to release fundThis is the easiest way to solve your problemIf we do not receive payment form Delta, you are responsible for the payment dueDelta recoup money at your behest so only you can solve this problem. Thank you.Swami

Only two date of services are there on Statement I sent you. As I said in my previous reply, at this time I am not concern about recovery of charges for filling, however, I want you to come to our office so we can prove what service we rendered. If you do not want to accept my suggestion it is your choice. Thank you. Swami

I spoke to [redacted] about this complain. She do not want to accept that we did fillings on her teeth. I asked what about x-rays and exam. I request  if she can pay for at least x-ray and exam for that she can not deny so she hang up on me. I request Lolita if she can come back so we can...

give her proof regarding fillings we did. She just try to avoid answer and after hang up she called and complain [redacted]. I received call from member service regarding her complain. I request [redacted] to find out why insurance is not paying for her dental treatment. [redacted] called me and said medicare do not pay because she has commercial insurance as primary plan in her file. I told [redacted] few months before to give me information about her primary insurance and refuse to give that information. [redacted] did not co-operate to provide necessary information so we can re-submit claim to both insurance and do co-ordination of benefit. I lost so much time and finally I had to send her invoice and because of that she complained to Revdex.com. I would like to request [redacted] thru Revdex.com if she can provide me information about Primary insurance so I can do co-ordination of benefit. Thank you. Swami ([redacted]

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
 Complaint: [redacted]
I am rejecting this response because: I just contacted Delta Dental back and spoke to a Supervisor they state thats not the case when Im not the named policy holder. They also stated they requested that you guys resubmitt the bill to both them and [redacted] and it would be sorted out. To this date you have not forward the bill to either insurers.  This is simple, just please submitt a bill to both and then I can go from there to figuring out whom shall pay
Regards,
[redacted]

Dear Sir,We are asking [redacted] to pay for money recouped by Delta Dental at her behest. Per federal rule commercial insurance like Delta Dental is always primary. We suppose to get paid by Delta first to be able to bill to Medicaid insurance i.e. [redacted]. We should receive payment from...

primary insurance to be able to bill to secondary insurance.  We need proof of payment by primary insurance to produce for payment from secondary insurance. It is a federal rule that we should get money first from primary being able to bill to secondary. What she has done is against federal rule. She interfere into compliance for federal rule of co-ordination of benefit by asking primary insurance to recoup money. The primary problem is money recoup by Delta Dental so we have not get paid for the service rendered to [redacted]. Thank you.Swami

One Of There Dental Assistants Is Un-Licensed, And If I'm Correct Its Illegal To Employ Un-Licensed Dental Assistants, They Have The Un-Licensed Dental Asst Assiting In Serious Procedures Such As Tooth Extractions And Root Canels, That's Highly Unethical, They Pay Her A Lower Pay Then All The Other Licensed Dental Assistants, So That Suggests They Are Full Aware Of The Fact That She Is Un-Licensed, Which In Turn Is Taking Away Jobs For The Assistants That Are Actually Licensed Dental Assistants!!!

Review: I have reason to believe that Advanced Dental Designs is making fraudulent charges to the insurance company as well as to its customers. I was given a receipt for work done today and told that I owed $50.00. I paid the $50.00 and when I got the receipt it said that I had a balance of $224.00 remaining. I asked for clarification and the clerk told me not to worry about it because that was for the insurance company. I explained that I was not comfortable leaving the office with a receipt that showed I had a balance when I know I paid in full. The clerk said that she was unable to give me a receipt with a balance of zero because of the way their software was set up. I asked for her to write a note and sign it as proof that my balance was paid in full. She refused. The dental hygienist agreed to write the note and sign it, but the clerk did not allow her to do so. The clerk then printed out a receipt that said I had a zero balance. I questioned her because earlier she said it was not possible to do. She told me to take my receipt and leave. So I left with both receipts for the same day with two different balances.After leaving, I called my insurance company and found out that Advanced Dental Designs was trying to charge me double the price for various services. I was told by the clerk that a root canal would cost me $500.00, however, my insurance company Delta Dental sent me a fee schedule which states that my maximum out of pocket expense for a root canal would only be $245.00. Finally, I was supposed to receive a dental cleaning which I was told would not be covered by my insurance, instead I would have to pay $200($50/quadrant)& I found out that was also a lie. It is for these reasons that I believe that Advanced Dental Designs, P.C. located at 6529 Germantown Avenue, Philadelphia, PA 19119 (215)848-8214 is committing insurance fraud and cheating both their clients and the insurance companies. This office needs to be investigated for the benefit of the insurance companies as well as the clients.Desired Settlement: An investigation of the financial records of this Dental office and their payment/fee practices.

Business

Response:

April 20, 2014Dear Sir,I would like to inform following facts about [redacted]’s visit on 4/9/2014.1. We charge $50 instead of regular cop-pay of $54 for the following services we rendered on 4/9/2014.[redacted] Exam co-pay $ 0 [redacted] 2Bws co-pay $ 0 [redacted] co-pay $ 45 [redacted] PA co-pay $ 4 Office Visit co-pay $ 52. Kind of plan she has is a HMO which works as discount plan at our end. For member it may be an insurance but for us it is a discount plan and no claim or payment involved from insurance company. Because it is discount plan (HMO) we need to submit Encounter. We do not need to submit claim as it is not required by the insurance company. Even if we send a claim, it will be consider as an Encounter and processed accordingly. Practically, there is no claim involved and so there is no payment expected from the insurance company for the services render to HMO/Discount plan members. There are different arrangements by Insurance companies with different doctors. Therefore, there is chance of communication gap between member and provider department of each insurance companies. I do not want to go in details at this point, however, I am ready discuss in length once this matter move forward for trial in the court.3. My front desk repeatedly told [redacted] that the statement is just for her record to show the services which are performed and proof of payment made by her. After few months when we will receive acknowledgement of an Encounter by Insurance Company, we will write off balance and after that point of time balance goes to zero in patient file.4. [redacted] for some reason was not ready to accept the way how this process work so my front desk show her inability to write off balance manually because there are steps involved like creating, submitting, receipt of acknowledgement of the Encounter and write off balance. Creation of Encounter will be done latter on. Some time we have to go online and send Encounter through insurance website if it does not go through clearing house. Frequently, we have technical issue somewhere with insurance website or clearing house to send Encounter because of periodical change in HMO / Discount plan due to constant change in government and insurance policy. We just try to work out with everybody everywhere. There is a process involved from sending Encounter to receipt of acknowledgement from Insurance. All involved parties including patient, insurance companies, Revdex.com and Administration has to wait until this process complete before they decide to convict doctor of medical malpractice or insurance fraud.5. Patient always get upset when they realize that they have to pay and start asking question about why they have to pay? And how much money doctor gets paid by insurance? We do not know certainly about how much insurance pay, however, we try to answer, but some time it may be impossible to answer to their satisfaction and at that point patient like [redacted] tell us on our face that you are doing either medical malpractice or insurance fraud.6. We always settle account according to the Explanation of Benefits that we receive from insurance company. We have no problem to refund if patient is not satisfied about our service. There are more than thousands of HMO or Discount plans offered by few insurance companies and there are equal numbers of fees schedule depends on kind of HMO plans. It is possible that we may make a mistake in calculation of co-pay. Some time we collect less co-pay and we lose. However if we have collected more money we do settle account and refund to patient after we hear from Insurance company. Meantime, we ask patient to pay estimated co-pay. If we do not collect co-pay we cannot pay our bill for rent, supply & utilities and it is economically not possible to pay salary to our employees. Some time it do happen neither insurance nor patient pay for services we provide. We have no choice but to write off if we do not receive payment from either party. A small provider always come in direct contact with patient personally therefore cannot afford to use collection agency to collect co- pay otherwise it will be difficult for doctor to live or work in the city of Philadelphia. I do have experience in past that one insurance do not allow to collect co-pay from patient and another insurance consider fraud if we do not collect co-pay.7. It was difficult time to explain to [redacted] about the procedures sheneeds. I do not want to go in detail as she decided to go to another provider.8. Importantly, I want to inform office of the Attorney General or BBA that there is no claim or insurance payment involved for the treatment provided to [redacted].If you need any further clarification, let us know.Thank you for your time and appreciate your help in solving problem between doctor and patient.Yours truly,