Antique Maiden

May 24,2017***,l am writing to you in response to complaint #*** for *** ***.The patient was seen in our office on 2/17/we spoke to patient on 2/2/and explained to him the out of pocket of $was dueWe did explain to him at that time his bone graft and anesthesia were
not coveredHe did not request any itemized statements or pre-determinations at that time or the total cost of procedureHe did ask if this included any implant services which we explained it did not.We did not hear from patient again until March 8, At that time he wanted to know why the EOB he received only had the extraction on it and why we didn't submit all the servicesWe explained the claim may have been split but we did submit all services to *** dental but we were hadn't received any EOBs in our of?ce yet so we couldn't explain more until we received oursHe did ask about an estimated cost for a CT scan scheduled and we stated we would be in touch with him regarding thatHe again never requested any predeterminations or itemized statements.The patient called again on March 16, stating that he was dropping off a form for us to complete to send this claim to his medical insuranceHe never questioned what the balance was for just wanted it sent to medical insurance.On March 17, we spoke to *** insurance who stated the procedures he had done would not be covered under medicalWe still sent a claim so that the patient would be able to get a denial and understand it isn't covered under medical.He again had been very persistent that we weren't sending it to his medical insurance even though we kept telling the patient it wasn’t coveredWe spoke to *** again on March 24, and were told the same thing, this isn't a covered bene?tWe verified that we were not to take write offs for the patient's anesthesia and he was responsible for the full balance so a bill was generated to him.The patient called on April 4, at that time I explained to him that *** medical was stating it wasn’t coveredAlso explained that the balance was patient responsibility per the insuranceAt time the patient asked me why I never I sent a predetermination and l explained to him it is not required by the insurance and we make calls to verify bene?ts instead.He asked if I could send one in for his upcoming appt on May which l did.In all his phone calls with us he never questioned the reason for the balance or requested any itemized statements but just repeatedly requested this claim to be sent to his medical insurance.We are holding all statements until we look into this with *** further.Thank you,Kristi W.Billing representative

----- Forwarded message ----------From: Veronica S*Date: Tue, Apr 25, at 10:AMSubject: ***To: ***Thank you for speaking with me *** ***. I have attached the information on *** ***'s account same as I have sent to ** *** which is our collection
agency. If you would like more information I can send the financial agreement that *** *** signed in our office acknowledging that any unpaid balance will be directly sent to our collection agency in which he would be responsible for the collection fee which is 27% of the debt on top of his remaining balance. Please do not hesitate to contact our office directly with any questions.Thank youVeronica S***

[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: It is not 100% accurate I did ask Sudbrink's representative specifically if my insurance would cover the initial visit and was told it would I explained to Sudbrink's representative that my insurance had not been accepted elsewhere and that I wanted to make sure Sudbrink confirmed my coverage before wasting my time to go on an examination appointment, subjecting myself to more X-rays, and incurring an unnecessary bill Sudbrink's representative assured me that I was covered and, hence, when I got the the bill, I was not happy I'm a pretty busy guy and work hard to make an honest living; I can't tell my clients one thing and then do another It appears to me that by having the patient sign a financial responsibility form at the time of the appointment, Sudbrink can tell its prospective patients anything over the phone re coverage to get the patient in their office and then do whatever to collect I just can't operate that way in my business. The pay 50% offer I made was done at the time when I called to inform Sudbrink about the bill I received and had been told would be covered by my insurance, prior to wasting my time and subjecting me to X-rays When I informed Sudbrink's representative about this issue, she told me that if I didn't pay the bill, she we have their attorney collect it from me That is when I said, I asked you in advanced for you to confirm coverage, you claimed you did, that the visit would be covered by my insurance, and now you're threatening with your attorney I further told Sudbrink's rep that it was their mistake, but that I would be willing to pay 50% and write it off as a bad experience; she again threatened me with Sudbrink's attorney We all need to make a living, but I just can't operate like that.In any event, Sudbrink got its money and I'm done with them and this matter Thank you
Regards,
*** ***

June 15, 2017Our office manager spoke to the patient on June 8, 2017 and resolved the issues that he brought to our attention. We adjusted the outstanding balance that he had off and his account is now at a zero balance. He was happy with the result.Thank you,Kristi W.Billing representative

[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:They are holding statements until they look into this with [redacted] further.?? Kristi says that I never requested an itemization of charges. When you request a predeterminationof benefits, the provider has to provide [redacted] with itemized charges with Dx codes.  Each time I requested a predetermination, Kristi said that she verifies our coverage with [redacted]. When  I called questioning the $900 OOP, I requested that she submit a predetermination of benefits to [redacted] because I wanted the $900 OOP to be itemized. Kristi said the OOP would be the same if she did submitted a predetermination of benefits. Clearly, it is not the same. Here are the charges submitted by Sudbrink Oral Surgery: Extraction of erupted tooth- $!57.00 [redacted] ,therapeutic paraenteral drugs $95.00 [redacted], Oral gel $12.00 [redacted]                                                                                                                                          Bone graft-$495.00 [redacted]  Total charges-$1509.00   Total noncovered charges-$1362.80                                                                                                                                       General anesthesia 15 minutes- $250.00 [redacted]                                                                                                                                           General anesthesia 15 minutes- $250.00 [redacted]  How did Kristi come up with $900.00 OOP when she verified 
Regards,                                                                                                                                General anesthesia 15 minutes $250.00  [redacted]   these services with [redacted]?
[redacted]