Associated Pediatric Dentistry

We billed the primary insurance and it states the members responsibility is $136, it did not cover 100%The amount billed was $and we are not a participating provider with ***, her primary insuranceWe submitted the claim to her second insurance provider and they made a payment of $and
we are a participating provider with the secondary insuranceWe had to write off as a loss $51.35, which we didThe explanation of benefits states the subscribers liability amount is $

Here is our sequence of events: January 8, 2016Services Rendered: [redacted] Periodic Exam $52.00 D1110 Adult Prophylaxis $88.00 D1208 Fluoride Treatment $36.00 Total: $176.00-Parents notified us of dental insurance change. It is customary for us to make a copy of the insurance card for the...

patient's chart. However, there is no copy of the dental insurance card in [redacted]'s chart. -We gave parents the existing health history information form, and requested that they look it over, make any changes as necessary, and sign on the back of the form. (Copy enclosed) There was no new form for them to fill out.   We had no reason to believe that the policy would not cover our services. We are a provider for [redacted].  January 29, 2016Services Rendered: [redacted] Composite filling-1 surface $170.00 D9230 Nitrous Oxide Analgesia $25.00 Total: $195.00 August 24, 2016Services Rendered: [redacted] Periodic Exam $52.00 [redacted] Bitewing Radiographs $47.00 [redacted] Adult Prophylaxis $88.00 [redacted] Fluoride Treatment $36.00 Total: $223.00 August 30, 2016-We spoke with [redacted] and they informed us they did not have claims on file for 1/8/16 and 1/29/16. The customer service agent informed us the policy had terminated on 7/31/2016. At no time did [redacted] inform us that our services would not be covered under this plan. We sent the claims by fax to [redacted]. -Called family and left a message with Mrs. [redacted] about the coverage terminating on 7/31/16. She said she would talk about it with her husband and get back to us. -Mr. [redacted] called back. Stated that he is waiting for new insurance information from [redacted] IL. Per Mr. [redacted]'s request, called Delta, spoke with a customer service agent named [redacted]. Tried to find coverage for patient under Mrs. [redacted]'s SSN and [redacted]'s SSN, with no information coming up.  September 14, 2016-Mr. [redacted] called, gave us new insurance information by phone. -Submitted claim for 8/24/16 visit through our electronic claims clearinghouse.  September 20, 2016-Rec'd rejection from [redacted] IL for dates of service 1/8/16 and 1/29/16. The explanation of benefits from [redacted] IL states “Procedure is not a covered benefit of your dental plan or the procedure was performed by an out-of-network provider. Patient is responsible for the entire billed amount.” September 23, 2016-Rec'd rejection from [redacted] IL for date of service 8/24/16. The explanation of benefits shows it was rejected twice. The first one states “Patient was not eligible on date service was requested or performed and, therefore, is responsible for the entire billed amount.” The second rejection on the EOB states “Procedure is not a covered benefit of your dental plan or the procedure was performed by an out-of-network provider. Patient is responsible for the entire billed amount.” I'd like to address some of the questions that Mrs. [redacted] poses in her letter.  -We did not know that the [redacted] IL insurance policy would not cover our charges. We are a provider for [redacted]. At no time did we mislead, or deliberately withhold information.  -I will copy directly from the Office Policy and Treatment Consent as printed on the back of our Health History form. I have attached a copy, signed multiple times by Mr. [redacted], for your reference. Our policy states: INSURANCE: To avoid misunderstanding regarding dental insurance, we wish the persons responsible to know that all professional services rendered are charged directly to them and that they are responsible for payment of fees. We will be happy to complete and assist in filing your insurance claim, upon of receipt of full (or partial) payment. We do not render our services on the basis that insurance companies will pay all our fees. You are responsible for knowing your own insurance coverage.  -We are accustomed to [redacted] IL taking 6 months or more to pay on claims. The delay from January to August is quite normal. At this time, [redacted] IL, due to an Illinois state budget situation, is paying on claims 12 months old. We did not send the [redacted] family a bill during the time from January 2016 to August 2016 because our system showed that their claim was still pending insurance.  -I have enclosed a copy of the billing history for [redacted]'s account. The first statement we sent was on 9/26/2016. It is our policy to notate the patient's account if we add a sticker or comment on a statement that we send to a family. As you will see from [redacted]'s account notes, we sent a plain statement each time. At no time did we pressure the family to make payment or threaten with any collections action. It can also be noted that our office charges no interest or late fees on patient accounts.  Tell us why here...