Arcadia Family Clinic

This patient came to us as a transfer/referral from his retired doctor When we made this transition we gained custody of all patient charts from that doctor Within those charts are full records and past x-rays Whenever we have a new patient come into the practice, we do a full comprehensive exam and a full series of digital x-rays for our diagnostic purposes That way, our doctors are able to get a full look at the patient’s entire mouth and can see the dental history through their digital films Before we do any of these procedures we make sure to get the patient’s insurance information (if there is any) and verify with that insurance company what will and will not be covered services If there are things that won’t be covered due to frequency, waiting period, not a benefit of the plan, etcwe are sure to inform the patient of this When the patient gave our staff his insurance information, we used it to get a “breakdown of benefits” which lists prior dates of service He made phone call to create the appointment with us on 11/22/17, and his appointment was scheduled for 12/20/for the comprehensive exam and full x-rays On 11/27/we got the breakdown of the benefits and saw there was a prior date of service for a full series of x-rays on 11/04/14, and his insurance would pay for another series after years To our knowledge, these x-rays would be paid for by the insurance after we took them on 12/20/17, since it would be after the year frequency mark The reason we go through this process is to better assess the patient’s dental health and needs for treatment Once this is done we schedule for whatever type of cleaning he or she may need, i.eprophylaxis, full mouth debridement, scaling and root planning, periodontal maintenance, so on and so forth We cannot blindly schedule a patient for a cleaning when we don’t know what we will be working with We also do not charge patients for an office visit or with other “hidden fees” We charge based on a procedures—exam, cleaning, x-rays When this was explained to the patient he still was adamant that he will not pay for these services It is the responsibility of the patient to understand their dental benefits, and this patient is not taking responsibility of what was not covered by his insurance

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
Glenn ***

*** ***
came to us as a new patient on 11/11/14.
Our standard practice, when a patient makes a new appointment, is to get
their insurance information and to mail
them three pages of information:
a
registration form; a health history
form; and a Wisconsin Privacy Consent form.
We ask for their dental insurance information in order to get a listing
of their benefits so we can let them know what their insurance will cover on
any work that they may need done in our office
The best
diagnostic tool for the dentist are a full mouth set of xrays. When we call the insurance companies to get
the listing of benefits, we always ask for an xray history AND we ask the
patient if they’ve been to a dentist recently and if they can get us a copy of
their xrays from their previous dentist.
*** did not have any xray history based upon what the insurance company
told us nor did she bring any or have any sent to us from her previous dentist
There is a
spot on the new patient form for the patient to list their previous dentist as
well as any xrays that they can recall having.
If there is any question as to whether or not xrays had been taken
recently and the patient doesn’t know, we can contact their previous
dentist. *** did not list a previous
dentist, and answered the question as to whether or not xrays were taken at her
most recent dental appointment and she answered “no”
When the
insurance claim was paid for ***’s initial appointment, her insurance company
did not cover the entire cost of the full set of xrays. They paid all but $80. We then billed that $to her. She called our office on 12/19/questioning
the $bill. We explained to her that
her insurance did not cover the entire cost ($128) because of “frequency”,
meaning that she had the xrays done too soon after her previous xrays
(insurance companies usually will not pay for a full set of xrays unless they
are taken years apart)
She then
stated that she told our doctor not to take them because they wouldn’t be
covered by her insurance, but we have no records to indicate that. Insurance company said it was OK, no previous
dentist was listed for us to call, she brought nothing to her appointment and she
answered “no” to the previous xray question on her new patient form.
After
hearing our professional explanation, she said she would pay the $and then
she would be done with us. At no time
during that conversation did we tell her that we were sending her to
collections immediately. We received no
payment from her for months. She was
sent to collections on 2/25/
Regards,
***
Patient
Coordinator

This patient came to us as a transfer/referral from his retired doctor.  When we made this transition we gained custody of all patient charts from that doctor.  Within those charts are full records and past x-rays.  Whenever we have a new patient come into the practice, we do a full...

comprehensive exam and a full series of digital x-rays for our diagnostic purposes.  That way, our doctors are able to get a full look at the patient’s entire mouth and can see the dental history through their digital films.  Before we do any of these procedures we make sure to get the patient’s insurance information (if there is any) and verify with that insurance company what will and will not be covered services.  If there are things that won’t be covered due to frequency, waiting period, not a benefit of the plan, etc. we are sure to inform the patient of this.  When the patient gave our staff his insurance information, we used it to get a “breakdown of benefits” which lists prior dates of service.  He made phone call to create the appointment with us on 11/22/17, and his appointment was scheduled for 12/20/17 for the comprehensive exam and full x-rays.  On 11/27/17 we got the breakdown of the benefits and saw there was a prior date of service for a full series of x-rays on 11/04/14, and his insurance would pay for another series after 3 years.  To our knowledge, these x-rays would be paid for by the insurance after we took them on 12/20/17, since it would be after the 3 year frequency mark.  The reason we go through this process is to better assess the patient’s dental health and needs for treatment.  Once this is done we schedule for whatever type of cleaning he or she may need, i.e. prophylaxis, full mouth debridement, scaling and root planning, periodontal maintenance, so on and so forth.  We cannot blindly schedule a patient for a cleaning when we don’t know what we will be working with.  We also do not charge patients for an office visit or with other “hidden fees”.  We charge based on a procedures—exam, cleaning, x-rays.  When this was explained to the patient he still was adamant that he will not pay for these services.  It is the responsibility of the patient to understand their dental benefits, and this patient is not taking responsibility of what was not covered by his insurance.

We would hate to see you miss out on a day’s worth of pay, therefore we will be writing this amount of $125.00 from your account.  We are not able to speak on another treating doctor’s diagnoses or means of treatment.  However, at our office we have our own methods of diagnostic treatment—including a full comprehensive exam and full series of x-rays, as per our last reply.  These methods work very well here and our patients greatly appreciate them, as you can see in our Google and Facebook reviews.  Due to HIPAA (Health Insurance Portability and Accountability Act), we are unable to submit anything with your personal information that would be seen as helpful and necessary in diagnosing and proving this necessity.  These are included but not limited to—chart notes, periodontal charting, x-rays, etc.  If we were able to submit any of those items it would be clear to see that none of the treatment would be seen as “unnecessary”. I would also like to add that nowhere in your chart did [redacted] mention removal of your wisdom teeth.  He was deeply concerned with your high blood pressure—which was taken more than once to be sure—and of course he recommends flossing.  Almost every patient that walks through our door is recommended to floss and to use an electric tooth brush.   Because we don’t know how your new doctor goes about diagnosing and treating conditions, we will not speak on the “validity” of their practices—as you have done so freely with ours. Regardless of all this information, we DID go through the necessary steps to ensure your insurance coverage.  Regardless of this, your insurance NEVER guarantees payment for services provided.  It is up to YOU to know what your insurance coverage is; anything verified by the reception staff is out of COURTESY to the patient.  I would also like to note that if you yourself have had a bad experience with Dr. Landon, feel free to let us know.  However, we will not accept hearsay from a third party.