Dear Mr***
I am very sorry that you have incurred any concerns regarding your proposed treatment Let me address them
one by one to try and clear up where confusion may have occurred
First, when you entered the practice with concerns they were two fold and had to be handled differentlyReimbursement for your Sleep Disorder concern is handled through your medical insurance company while you reimbursement for your dental concerns such as the cleaning of your teeth, dental x-rays and exam are handled through your dental insurance companyUnfortunately they do not normally converse with each other, so when you asked about claims being filed you normally have to ask both sides of the insurance company about each respective claimWhen you asked the your "insurance company" about two claims having been filed they would have only known about one depending on which side of the company you called, medical or dentalUnfortunately, Sleep Disordered treatment is through the medical insurance side of the company even though the remedy you are seeking is a dental remedy to a non-compliance of the CPAP treatment generally prescribed by your physicianAlso unfortunately, medical insurance companies will not let a dentist into network as we generally do not have a medical degree and it is an insurance grogram originally covering only medical proceduresLet me now state one very important fact, our office does not have a contract with your insurance company and certainly not through the medical insurance side of the house for the stated reason above, BUT only you have a contract with your insurance companyTherefore the insurance company doesn't always give us the information that we would like to have and as *** told you, the information we gat is always an estimate of what the insurance company will doWe don't see the EOB unless the patient sends or shows it to usWe can however, after the fact, assist you the patient in contacting the insurance company to explain the EOB that the company has given only to you but we generally get no information and the company is only obligated to tell you why they have made the determination they have madeSo when *** talks to patients regarding their insurance portion of the their bill it is always tongue and cheek so to speak because she is at first making a best guess and then relying on information that the insurance company gives which at first blush is not always the correct informationThe more positive way to know beforehand is to file a predetermination that *** said you elected not to do and which your insurance company assured her was not necessary
Second, is an explanation of the chargesAs you understood from the beginning, my charge for an OAT (Oral Appliance Therapy) is $and we in reality expect the patient to pay for that regardless of how much their insurance company determines it is obligated under the contract that you have with themYou did make a charge on your Visa for $on July 16, This was an expected partial payment of your obligation and you have received statements that are sent automatically by our billing software when there are ba***s dueYou were told by *** to not pay the statement and wait for the insurance company to reimburse your bill for their contribution before paying the ba***That is our methodology as we are never sure how many months it will take your insurance company to pay their portion or how much additional information they (your insurance company) will ask for before their reimbursement is sentThe estimated insurance benefit was calculated as $based on information from your insurance company after your deductible of you medical insurance policy is settledThis as stated was always an estimateYour ba*** to this office was $minus the $paid initially by youThe fee for the OAT minus the $amounts to the $which is the ba*** due before insurance reimbursement and the estimated insurance was $(conservative) and is a generated estimate by our softwareThat is why *** always tells the patient that it is an estimate and don't pay it until the insurance company has paid their portionThe ba*** after medical insurance reimbursement for the OAT then becomes the patient's responsibilityYou will note, when your receive a separate ECIB, that we have not seen, from your dental insurance provider and will be sent to you when your insurance elects to pay the claim (and we are still waiting for that), that your cleaning, x-rays and exam will be credited paid in full and the 'patient co-pay portion" will be written off by my office which has become our customary procedure for out of network plans, which describes your planIt is done complimentary for our dental patients
I understand that you may feel that we are not honoring the commitments made to you, but that simply is not the caseYour medical insurance company decided to pay you less than we expected and they first indicated to ***As a result you feel that you have had to pay more than you originally thought you would or shouldThat is unfortunate because your medical insurance company did not pay what everyone thought they wouldAnd that is an issue that you would have to take up with your medical insurance company since you have the contract with them and we do notYou have lost confidence, through no fault of our own, that we are honestly dealing with you and I understand thatTo remedy that feeling of loss of confidence in our ability to treat you, I am returning your payment of $I have instructed *** to mail back the check we received from your medical insurance company with a copy of this letter and with another letter to your medical insurance company stating that we cannot satisfy your wishes for treatmentThat should restore your medical insurance benefits
I am including two names of excellent dental practitioners who fabricate and fit these types of appliances for the treatment of sleep apneaI hope that you can find someone that you will have confidence in for your treatmentTheir names are:
*** *** ***
*** *** *** * ***
*** ** *** ***
*** *** ** ***
*** ***
*** *** *** *** ***
** ***
*** * *** *** ** *** ***
*** *** *** ***
*** ***
Please let *** know when you have made a decision so I can forward your records to them and they can immediately treat you
Sincerely,
*** ** ***, JrDDS
I contracted with this company to install a replacement a/c system and water heater in an older condo I had just bought. They were very competative in pricing and eager to do business, offering a "no surprises guarantee." Although they encountered a situation which required them to incur additional expense, they honored their guarantee and did not pass [redacted] expense on to me. The job was completed in a neat, professional, and timely manner and the systems perform flawlessly. I'm happy to recommend this company whole heartedly.
[redacted]
Royal Palm Beach, Florida
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.
Regards,
[redacted]
Dear Mr***
I am very sorry that you have incurred any concerns regarding your proposed treatment Let me address them
one by one to try and clear up where confusion may have occurred
First, when you entered the practice with concerns they were two fold and had to be handled differentlyReimbursement for your Sleep Disorder concern is handled through your medical insurance company while you reimbursement for your dental concerns such as the cleaning of your teeth, dental x-rays and exam are handled through your dental insurance companyUnfortunately they do not normally converse with each other, so when you asked about claims being filed you normally have to ask both sides of the insurance company about each respective claimWhen you asked the your "insurance company" about two claims having been filed they would have only known about one depending on which side of the company you called, medical or dentalUnfortunately, Sleep Disordered treatment is through the medical insurance side of the company even though the remedy you are seeking is a dental remedy to a non-compliance of the CPAP treatment generally prescribed by your physicianAlso unfortunately, medical insurance companies will not let a dentist into network as we generally do not have a medical degree and it is an insurance grogram originally covering only medical proceduresLet me now state one very important fact, our office does not have a contract with your insurance company and certainly not through the medical insurance side of the house for the stated reason above, BUT only you have a contract with your insurance companyTherefore the insurance company doesn't always give us the information that we would like to have and as *** told you, the information we gat is always an estimate of what the insurance company will doWe don't see the EOB unless the patient sends or shows it to usWe can however, after the fact, assist you the patient in contacting the insurance company to explain the EOB that the company has given only to you but we generally get no information and the company is only obligated to tell you why they have made the determination they have madeSo when *** talks to patients regarding their insurance portion of the their bill it is always tongue and cheek so to speak because she is at first making a best guess and then relying on information that the insurance company gives which at first blush is not always the correct informationThe more positive way to know beforehand is to file a predetermination that *** said you elected not to do and which your insurance company assured her was not necessary
Second, is an explanation of the chargesAs you understood from the beginning, my charge for an OAT (Oral Appliance Therapy) is $and we in reality expect the patient to pay for that regardless of how much their insurance company determines it is obligated under the contract that you have with themYou did make a charge on your Visa for $on July 16, This was an expected partial payment of your obligation and you have received statements that are sent automatically by our billing software when there are ba***s dueYou were told by *** to not pay the statement and wait for the insurance company to reimburse your bill for their contribution before paying the ba***That is our methodology as we are never sure how many months it will take your insurance company to pay their portion or how much additional information they (your insurance company) will ask for before their reimbursement is sentThe estimated insurance benefit was calculated as $based on information from your insurance company after your deductible of you medical insurance policy is settledThis as stated was always an estimateYour ba*** to this office was $minus the $paid initially by youThe fee for the OAT minus the $amounts to the $which is the ba*** due before insurance reimbursement and the estimated insurance was $(conservative) and is a generated estimate by our softwareThat is why *** always tells the patient that it is an estimate and don't pay it until the insurance company has paid their portionThe ba*** after medical insurance reimbursement for the OAT then becomes the patient's responsibilityYou will note, when your receive a separate ECIB, that we have not seen, from your dental insurance provider and will be sent to you when your insurance elects to pay the claim (and we are still waiting for that), that your cleaning, x-rays and exam will be credited paid in full and the 'patient co-pay portion" will be written off by my office which has become our customary procedure for out of network plans, which describes your planIt is done complimentary for our dental patients
I understand that you may feel that we are not honoring the commitments made to you, but that simply is not the caseYour medical insurance company decided to pay you less than we expected and they first indicated to ***As a result you feel that you have had to pay more than you originally thought you would or shouldThat is unfortunate because your medical insurance company did not pay what everyone thought they wouldAnd that is an issue that you would have to take up with your medical insurance company since you have the contract with them and we do notYou have lost confidence, through no fault of our own, that we are honestly dealing with you and I understand thatTo remedy that feeling of loss of confidence in our ability to treat you, I am returning your payment of $I have instructed *** to mail back the check we received from your medical insurance company with a copy of this letter and with another letter to your medical insurance company stating that we cannot satisfy your wishes for treatmentThat should restore your medical insurance benefits
I am including two names of excellent dental practitioners who fabricate and fit these types of appliances for the treatment of sleep apneaI hope that you can find someone that you will have confidence in for your treatmentTheir names are:
*** *** ***
*** *** *** * ***
*** ** *** ***
*** *** ** ***
*** ***
*** *** *** *** ***
** ***
*** * *** *** ** *** ***
*** *** *** ***
*** ***
Please let *** know when you have made a decision so I can forward your records to them and they can immediately treat you
Sincerely,
*** ** ***, JrDDS
I contracted with this company to install a replacement a/c system and water heater in an older condo I had just bought. They were very competative in pricing and eager to do business, offering a "no surprises guarantee." Although they encountered a situation which required them to incur additional expense, they honored their guarantee and did not pass [redacted] expense on to me. The job was completed in a neat, professional, and timely manner and the systems perform flawlessly. I'm happy to recommend this company whole heartedly.
[redacted]
Royal Palm Beach, Florida
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.
Regards,
[redacted]