Initial Business Response /* (1000, 5, 2014/04/09) */
see attached
Boger Dental appreciates the opportunity to address both of this patients concernsWe understand complications with insurance can be frustrating for patients, but in this particular case we feel context is important so
future patients understand the lengths Boger Dental staff will go to ensure an optimal patient experience
Concern 1: The patient claims he was misled regarding his insurance information
At the time this patient made his appointment based on the information our staff was it did not appear our office was in-network with his insurance providerOur staff explained this to the patient prior to confirming his appointmentbut the patient stated he didn't care, that he needed his appointment and that he would pay out of pocket if necessary
The following day the patient came in for his appointmentPrior to the patient seeing our dentist, our staff again told the patient his insurance would consider our office out of networkWe showed the patient an explanation of his plan's benefits, highlighting the fact his plan would consider h?m out of network for the care he requiredAt this point, the patient told our staff he had talked to his insurance provider personally and had been told he would be considered in~ network for his treatment
It's important for our patients to understand that like many clinical providersBoger Dental is only able to provide patients with insurance estimatesFor questions about plan specifics or when there are potential discrepancies, we ask patients to work directly with their insurance providers so they receive the most direct, accurate informationThis patient informed us he had worked with his provider directly and the care would be covered
After treatment, when it became evident the patient had misunderstood his policy coverage and was filing an appeal with his insurance providerBoger Dental offered the patient a series of options that would make payment easier for himThis included a payment plan that extended beyond our standard payment plan and a discounted service rate provided he could pay for his care in fullDespite these options, this patient has neglected to pay Boger Dental for the majority of his care and has to this point declined further discussions related to payment
Concern 2: Patient claims he was misled about his care options
Prior to providing treatment, Boger Dental explains treatment plans to our patients and ensures they understand each component of their treatmentWe get patient consent prior to delivering care and will not start treatment until patients understand components of their treatmentIn this case the patient consented to his care and understood the course of treatment that was outlined
While this patient expresses concern over the path of treatment I our case notes show that we went over additional treatment options with this patientAfter a consultationthe patient ultimately elected to move forward with the original treatment plan he had requested
At Boger Dental our goal is to provide each patient an exceptional experienceWe regret that this patient is frustrated by his experience but it's our belief that in this particular instance this patient's frustration is misplacedWe're confident our staff and treatment team did all they could to help this patient understand both his insurance plan and ultimate course of treatment
Initial Consumer Rebuttal /* (3000, 7, 2014/04/10) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Concern 1:
I was not told that my insurance provider is out of network for that hospital and why somebody would don't care to pay huge amountsIf I didn't care, why would I reach you with this concern? No brainierThey rather told me that it's in network andIf there is a way to pull their call tapes from my number *** we would get all the truths outIt's absolutely a lie and please show me the video tapes of that day where they explained me that I'm out of network
Those notes which were shown in the document were notes..I'm a software engineer and I know how can we update the notes later..That statement is absolutely a wrong statement and those notes were added now to prove a pointIf there is a way show me last modified timestamps of that particular record
Concern 2:
Show me the proof where Dr.*** mentioned in the notes that resin filling is not a covered service for my plan and I still said yes
Initial Business Response /* (1000, 5, 2014/04/09) */
see attached
Boger Dental appreciates the opportunity to address both of this patients concernsWe understand complications with insurance can be frustrating for patients, but in this particular case we feel context is important so
future patients understand the lengths Boger Dental staff will go to ensure an optimal patient experience
Concern 1: The patient claims he was misled regarding his insurance information
At the time this patient made his appointment based on the information our staff was it did not appear our office was in-network with his insurance providerOur staff explained this to the patient prior to confirming his appointmentbut the patient stated he didn't care, that he needed his appointment and that he would pay out of pocket if necessary
The following day the patient came in for his appointmentPrior to the patient seeing our dentist, our staff again told the patient his insurance would consider our office out of networkWe showed the patient an explanation of his plan's benefits, highlighting the fact his plan would consider h?m out of network for the care he requiredAt this point, the patient told our staff he had talked to his insurance provider personally and had been told he would be considered in~ network for his treatment
It's important for our patients to understand that like many clinical providersBoger Dental is only able to provide patients with insurance estimatesFor questions about plan specifics or when there are potential discrepancies, we ask patients to work directly with their insurance providers so they receive the most direct, accurate informationThis patient informed us he had worked with his provider directly and the care would be covered
After treatment, when it became evident the patient had misunderstood his policy coverage and was filing an appeal with his insurance providerBoger Dental offered the patient a series of options that would make payment easier for himThis included a payment plan that extended beyond our standard payment plan and a discounted service rate provided he could pay for his care in fullDespite these options, this patient has neglected to pay Boger Dental for the majority of his care and has to this point declined further discussions related to payment
Concern 2: Patient claims he was misled about his care options
Prior to providing treatment, Boger Dental explains treatment plans to our patients and ensures they understand each component of their treatmentWe get patient consent prior to delivering care and will not start treatment until patients understand components of their treatmentIn this case the patient consented to his care and understood the course of treatment that was outlined
While this patient expresses concern over the path of treatment I our case notes show that we went over additional treatment options with this patientAfter a consultationthe patient ultimately elected to move forward with the original treatment plan he had requested
At Boger Dental our goal is to provide each patient an exceptional experienceWe regret that this patient is frustrated by his experience but it's our belief that in this particular instance this patient's frustration is misplacedWe're confident our staff and treatment team did all they could to help this patient understand both his insurance plan and ultimate course of treatment
Initial Consumer Rebuttal /* (3000, 7, 2014/04/10) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Concern 1:
I was not told that my insurance provider is out of network for that hospital and why somebody would don't care to pay huge amountsIf I didn't care, why would I reach you with this concern? No brainierThey rather told me that it's in network andIf there is a way to pull their call tapes from my number *** we would get all the truths outIt's absolutely a lie and please show me the video tapes of that day where they explained me that I'm out of network
Those notes which were shown in the document were notes..I'm a software engineer and I know how can we update the notes later..That statement is absolutely a wrong statement and those notes were added now to prove a pointIf there is a way show me last modified timestamps of that particular record
Concern 2:
Show me the proof where Dr.*** mentioned in the notes that resin filling is not a covered service for my plan and I still said yes