Alderwood Endodontics

Revdex.com PO Box DuPont WA Re: ID [redacted] Dear Ms [redacted] We are responding to a complaint that was filed by a patient on 5/6/We have read her complaint and have the following response: [redacted] called on 2/4/to make an appointment and scheduled for the next day, February 5, During that phone conversation she informed me that her insurance was [redacted] At no time during our conversation did she ask, nor did I state, that the visit would be covered by her insuranceWe are not in-network with her insurance so there is no possible way for us to know if the services would be covered, therefore, I could not have told her they would be, nor did IAdditionally, from over years experience in working with insurances, I am aware that the [redacted] military plan does not provide us with a fax-back optionSo her claim that 'I reassured her that her operation is covered by her insurance is simply false [redacted] called us on 5/3/disputing the amount dueShe told our Schedule Coordinator, who took notes on the phone conversation, that she did not think she should have to pay the balance since she had to have an examination done all over again by someone who was in-networkShe stated that she did not know the difference of what "in" or "out" of network was I called her back on 5/4/and explained the balance owingOf the $that is owing,$is for the pulp vitality test that her insurance denied stating "Not a covered expense" under her policy(See attached EOB from [redacted] ) and the additional $is the difference between our $fee and the $allowed by [redacted] She acknowledged that she didn't know the difference between in and out of network on her dental plan until [redacted] explained it to herI told her I recalled our initial conversation and never quoted her that her visit would be covered by her insurance Additionally, when she came in for her appointment, prior to being seen by our doctor, she signed our Financial Policy (attached) and did not question this We have not "falsely advertised" ourselves as she claimsWe pride ourselves on being up-front with information and NEVER guarantee to a patient what their insurance will cover [redacted] 's balance owing is correct and due immediately Office Manager

Complaint: [redacted] I am rejecting this response because: The statement provided by the office manager is not entirely trueI have had my root canal done before several timesWhenever I called to schedule appointments, I always ask if they take my dental insuranceA brochure was provided by my dentist with several names on it and they also adviced me to ask first if they take my insuranceI asked them during our initial conversation, and I told them that my husband is in the military and I was checking to see if they take my dental insuranceThey asked for my husband's information (SSN, name), and after I gave her the info, she said they do take our insuranceThroughout our entire conversation nor did she informed me that they are a "not in network" clinicI asked if my insurance will cover me if I do come by and have my root canal doneI understand they are expensive and we HAVE to ask first if they do accept our insurance After the first visit, the manager showed me the bill which would be about $1,So I called [redacted] , to see how much I'm covered for, and [redacted] explained to me the reason why its expensive, was because they are out of networkThat was when I found out what "out of network" isSo I called the dental office to dispute the chargesThe lady that I spoke to, told me the manager will contact me the next day When the manager called, I explain my case and she told me that they dont tell us if they are "in network" or "out of network" unless we askAnd I replied with, I wish I knew that information beforehand so I would not have gone there, instead I would be finding a clinic that do accept my insurance without any hidden chargesI went and found another clinic who accepted my insurance and told me without me asking "out of network" or "in network", and redo the whole process I understand I have to pay a portion after my insurance covers their portion which I signed the financial statement forMy frustration was that I wasn't fully informed from the beginning that they are "not in network", before making the appointment [redacted] informed me that "out of network" is expensiveI am disputing the total amount of $196.00, which my insurance paid $for that visit

Revdex.com PO Box 1000
DuPont WA 98327
Re: ID [redacted]
Dear Ms. [redacted]
 We are responding to a complaint that was filed by a patient on 5/6/16. We have read her complaint and have the following response:
[redacted] called on 2/4/16 to make an appointment and...

scheduled for the next day, February 5, 2016. During that phone conversation she informed me that her insurance was [redacted]. At no time during our conversation did she ask, nor did  I state, that the visit would be covered by her insurance. We are not in-network with her insurance so there is no possible way for us to know if the services would be covered, therefore, I could not have told her they would be, nor did I. Additionally, from over 20 years experience in working with insurances, I am aware that the [redacted] military plan does not provide us with a fax-back option. So her claim that 'I     reassured her that her operation is covered by her insurance is simply false.
[redacted] called us on 5/3/16 disputing the amount due. She told our Schedule Coordinator, who took notes on the phone conversation, that she did not think she should have to pay the balance since she had to have an examination done all over again by someone who was in-network. She stated that she did not know the difference of what "in" or "out" of network was.
I called her back on 5/4/16 and explained the balance owing. Of the $116.00 that is owing,$70.00 is for the pulp vitality test that her insurance denied stating "Not a covered expense" under her policy. (See attached EOB  from [redacted]) and the additional $46.00 is the difference between our $126.00 fee and the $80.00 allowed by [redacted]. She acknowledged that she didn't know the difference between in and out of network on her dental plan until [redacted] explained it to her. I told her I recalled our initial conversation and never quoted her that her visit would be covered by her insurance.
Additionally, when she came in for her appointment, prior to being seen by our doctor, she signed our Financial Policy (attached) and did not question this.
 
We have not "falsely advertised" ourselves as she claims. We pride ourselves on being up-front with information and NEVER guarantee to a patient what their insurance will cover. [redacted]'s balance owing is correct and due immediately.
 
Office Manager

Complaint: [redacted]I am rejecting this response because:
The statement provided by the office manager is not entirely true. I have had my root canal done before several times. Whenever I called to schedule appointments, I always ask if they take my dental insurance. A brochure was provided by my dentist with several names on it and they also adviced me to ask first if they take my insurance. I asked them during our initial conversation, and I told them that my husband is in the military and I was checking to see if they take my dental insurance. They asked for my husband's information (SSN, name), and after I gave her the info, she said they do take our insurance. Throughout our entire conversation nor did she informed me that they are a "not in network" clinic. I asked if my insurance will cover me if I do come by and have my root canal done. I understand they are expensive and we HAVE to ask first if they do accept our insurance. 
After the first visit, the manager showed me the bill which would be about $1,400.00. So I called [redacted], to see how much I'm covered for, and [redacted] explained to me the reason why its expensive, was because they are out of network. That was when I found out what "out of network" is. So I called the dental office to dispute the charges. The lady that I spoke to, told me the manager will contact me the next day.  When the manager called, I explain my case and she told me that they dont tell us if they are "in network" or "out of network" unless we ask. And I replied with, I wish I knew that information beforehand so I would not have gone there, instead I would be finding a clinic that do accept my insurance without any hidden charges. I  went and found another clinic who accepted my insurance and told me without me asking "out of network" or "in network", and redo the whole process. 
I understand I have to pay a portion after my insurance covers their portion which I signed the financial statement for. My frustration was that I wasn't fully informed from the beginning that they are "not in network", before making the appointment. [redacted] informed me that "out of network" is expensive. I am disputing the total amount of $196.00, which my insurance paid $80.00 for that visit.