Avalon Foodservice

I am rejecting this response because: The time frame for the pre-authorization was approved for months The date of the pre-authorization letter is April 3, and began on that date to 7/3/ It is not the pre-authorization that is in dispute, it is the time period of months that passed before the billing person billed the dental insurance Because the plan is considered a "self funded" plan according to the State of California Department of Insurance, the employer is responsible for payment I'm not disagreeing that I owe my portion but the billing department NEGLIGENTLY handled the billing unprofessionaly and inadequate, thus why the claim never got paid By the time she submitted the claim which was on 11/18/and not 11/11/2013, the insurance with Premier had switched and resulted in further delaying the process of the claim By the time the employer received the claim for review it was almost months later, I cannot obtain access to the records of when the claim was submitted to the employer for payment but regardless, sitting on a claim and waiting months after a procedure had been done and approved for, with a prior authorization seems pointless If the doctor's office can't comply with due diligence in submitting claims on a timely basis and then expects the patient to pay for the entire balance appears negligent I have tried to talk to the ***, the biller for a reduced amount to help offset the now full amount but I got nowhere I have tried to make payments and have towards the balance but still feel that it is high and don't feel that I should be responsible for something that is an in-house billing error I also realize that as a "cash considered" consumer I should not have to pay for what they would charge an insurance and should get a discount because now it's considered a cash payment but I also asked about that and got nowhere I just want whats fair and never agreed to the amount because the insurance had approved the crown and was charged a high amount and now I'm paying the price for someone's mistake and inadequacy

In response to *** Loyola's complaint, we have tried to resolve this issue but she does not understand our point of viewShe is disputing the charges for the crown we did on 6-28-The crown was preauthorized by the insurance company for the period of 4-2-thru 7-1-Once the authorization
was received In our office she did not come in to have the work done for almost three month*** was told that a preauthorization is not a guarantee of paymentPremier Access Insurance allows claims to be submitted up to six months after the date of service, her claim was submitted within that time frameThe problem is with the Chukchansi TribeBecause of the problems the tribe was having they froze all claims on 5-1-So no claims were paid after that dateA few months later the casino closed its doors. *** feels we did not submit the claim soon enoughThe claim was submitted twice for payment, the second claim was the one the insurance company says they receivedIt was processed on 11-11-which is still within the six month time frameThe insurance company pays on the date of service not on the date the claim is received*** called Premier Access and spoke to ***, he said there was nothing he could do because of the freeze on the Chukchansi accountHe did not think another insurance company had taken over. My staff tried to talk to *** about this but she is stuck on the fact that the claim was not received until NovemberThe fact is she is responsible for the chargesThe work was done In good faith and I expected to be paid

I am rejecting this response because:
The time frame for the pre-authorization was approved for 6 months.  The date of the pre-authorization letter is April 3, 2013 and began on that date to 7/3/2013.  It is not the pre-authorization that is in dispute, it is the time period of 5 months that passed before the billing person billed the dental insurance.  Because the plan is considered a "self funded" plan according to the State of California Department of Insurance, the employer is responsible for payment.  I'm not disagreeing that I owe my portion but the billing department NEGLIGENTLY handled the billing unprofessionaly and inadequate, thus why the claim never got paid.  By the time she submitted the claim which was on 11/18/2013 and not 11/11/2013, the insurance with Premier had switched and resulted in further delaying the process of the claim.  By the time the employer received the claim for review it was almost 9 months later, I cannot obtain access to the records of when the claim was submitted to the employer for payment but regardless, sitting on a claim and waiting 5 months after a procedure had been done and approved for, with a prior authorization seems pointless.   If the doctor's office can't comply with due diligence in submitting claims on a timely basis and then expects the patient to pay for the entire balance appears negligent.  I have tried  to talk to the [redacted], the biller for a reduced amount to help offset the now full amount but I got nowhere.   I have tried to make payments and have towards  the balance but still feel that it is high and don't feel that I should be responsible for something that is an in-house billing error.  I also realize that as a "cash considered" consumer I should not have to pay for what they would charge an insurance and should get a discount because now it's considered a cash payment but I also asked about that and got nowhere.  I just want whats fair and never agreed to the amount because the insurance had approved the crown and was charged a high amount and now I'm paying the price for someone's mistake and inadequacy.