All Smiles Dental Center

Revdex.com La Posada Dr Austin, Texas 78752Attention: [redacted] Re: Case# [redacted] We are writing to dispute the complaint that the patient [redacted] filed against our officeShe was seen on 1-3-for a limited exam and x-ray and again on 1-23-for extractions of which we provided the estimated treatment plan which she signed and we have it noted that it is an estimate only and responsible for treatment not paid by the insurance companyWe have included a copy of the explanation of benefits from the insurance company as well as the treatment plan and consent to treatmentsThe exam and x-ray for date of service 1-3-she has a balance of and for date of service 1-23-17, the insurance claim was for a total of 510.00, insurance paid and patient should've paid but only paid so has an outstanding balance of 99.20.Those dates of services combined give her an outstanding balance of 108.20.Thank you and if I can be of any further assistance, please contact me or Stephanie Sincerely, [redacted] Office Manager Serapio De La RosaGeneral dentist

Revdex.com 1005 La Posada Dr Austin, Texas 78752Attention: [redacted] Re: Case# [redacted]We are writing to dispute the complaint that the patient [redacted] filed against our office. She was seen on 1-3-17 for a limited exam and x-ray and again on 1-23-17 for 3...

extractions of which we provided the estimated treatment plan which she signed and we have it noted that it is an estimate only and responsible for treatment not paid by the insurance company. We have included a copy of the explanation of benefits from the insurance company as well as the treatment plan and consent to treatments. The exam and x-ray for date of service 1-3-17 she has a balance of 9.00 and for date of service 1-23-17, the insurance claim was for a total of 510.00, insurance paid 218.40 and patient should've paid 291.60 but only paid 192.40 so has an outstanding balance of 99.20.Those 2 dates of services combined give her an outstanding balance of 108.20.Thank you and if I can be of any further assistance, please contact me or Stephanie.  Sincerely, [redacted]
Office Manager Serapio De La RosaGeneral dentist