Brandywine Cosmetic & Family Dentistry

May 1, 08/24/Our patient *presented with three failed crowns indicated for replacementPatient states she was injured in school in the 5th grade - Teeth 7, 8, 04/18/*presented for an emergency exam-Her crowns are no longer attached 8, and one came out Patient
advised we will submit a preauthorization for a crown on 8, *was very adamant she is reluctant to have treatment due to her experiences she has had since the 5th gradeMaryland Medicaid paid for *crown in response to the preauthorization. 8/13/*..s mother-*.- called stating *is having trouble with her teethA representative-***-stated *is no longer eligible under Maryland Medicaid program8/15/*presented for the crown replacement of tooth 8/27/Delivered crown for *., patient satisfied
1/09/Patient inactive with Maryland Medicaid
2/20/*presents for an emergency exam for a fractured tooth deemed non-restorablePatient is using her mothers insurance-*.- GuarantorPatient was given options for surgical extraction; a flipper, a 3-unit bridge or Implant and crown for tooth x-ray was taken and Impression was done for dentureNext Visit: -Sx-Ext Delives DentureSubmitted preauthorization for Implant/Crown
3/05/New impression for PU Denture sent to the lab3/26/*..- patients' mother, called upset using profanity stating we billed her insurance company in her nameA corrected claim was submitted to *insurance to reprocess the claim**as the policy holder, and *as the dependent patient,
3/27/I called *to inform her that the claim has been corrected and resubmitted*..-as the policy holder, *..as the patient4/01/Called patient to discuss payment options
47/14/Called patient to explain that her mothers insurance denied the claim for a flipper*States she is going to see if she can pay her balance so she can get her case deliveredNote: Patients mother *may consider the preauthorization statements or benefit statements are-payments for services renderedi.e; *insurance denied *full coverage for pretreatment estimate for her implant and crownThe estimate of what will be owed if the implant is done is $3,This is an estimate not a bill *case is here and she has an outstanding balanceShe may return for her surgical extraction and delivery of her denture when her balance is paid in full5/01/and her grandmother calledI have informed them we will no longer accept combative profanity when calls are made to the office*states that is her mother," I do not speak to my mother" *states she cannot afford to pay for her dentureI explained to her that we provided a service that she requestedThe treatment plans and preauthorization were presentedShe accepted and signed for themShe applied to care creditHer mothers insurance denied her coverage claim for the dentureShe is responsible for the balanceWe will keep the casePt can request a copy of the regardRespectfully,

Review: Dr. [redacted] has filed fraudulent insurance claims. I have contacted my insurance provider and Dr. [redacted] personally to insist that she cease filing claims to my insurance. She also confirmed on the phone that she was paid by the State to replace my daughter's crown (1) and has not done so. Instead she insisted that the payment had expired and then later insisted that she did the work and that we just can't remember. She filed fraudulent dental insurance claims stating that I was the patient on 2/20 and was paid. Already Paid[redacted]02/20/14Dental [redacted]$140.00 [redacted]02/20/14Dental [redacted]$140.00 Claims Filed and Payments being issued on 3/28[redacted]02/20/14Dental [redacted]$700.00 [redacted]02/20/14Dental [redacted]$700.00Desired Settlement: I would like Dr. [redacted] to stop filing false claims on my behalf and cancel the claims previously submitted for payment because I have not utilized her practice for over a year and am no longer her patient. I would also like for her to reimburse the government for the dental procedure she was previously paid for that she refuses to complete.

Business

Response:

May 1, 201408/24/2014 Our patient *. presented with three failed crowns indicated for replacement. Patient states she was injured in school in the 5th grade - Teeth 7, 8, 904/18/2012 *.. presented for an emergency exam-Her crowns are no longer attached 8, and one came out 7. Patient advised we will submit a preauthorization for a crown on 8, *.. was very adamant she is reluctant to have treatment due to her experiences she has had since the 5th grade. Maryland Medicaid paid for *. crown in response to the preauthorization. 8/13/12 *..s mother-*.- called stating *.. is having trouble with her teeth. A representative-[redacted]-stated *.. is no longer eligible under Maryland Medicaid program.8/15/2012 *.. presented for the crown replacement of tooth 88/27/2012 Delivered crown for *., patient satisfied1/09/2014 Patient inactive with Maryland Medicaid2/20/2014 *.. presents for an emergency exam for a fractured tooth 7 deemed non-restorable. Patient is using her mothers insurance-*.- Guarantor. Patient was given options for surgical extraction; a flipper, a 3-unit bridge or Implant and crown for tooth 7. x-ray was taken and Impression was done for denture.Next Visit: -Sx-Ext 7 Delives Denture.Submitted preauthorization for Implant/Crown3/05/2014 New impression for PU Denture sent to the lab.3/26/2014 *..- patients' mother, called upset using profanity stating we billed her insurance company in her name. A corrected claim was submitted to *. insurance to reprocess the claim. **. as the policy holder, and *.. as the dependent patient,3/27/2014 I called *. to inform her that the claim has been corrected and resubmitted. *..-as the policy holder, *..as the patient.4/01/2014 Called patient to discuss payment options47/14/2014 Called patient to explain that her mothers insurance denied the claim for a flipper. *.. States she is going to see if she can pay her balance so she can get her case delivered.Note: Patients mother *. may consider the preauthorization statements or benefit statements are-payments for services rendered. i.e; *.. insurance denied *.. full coverage for pretreatment estimate for her implant and crown. The estimate of what will be owed if the implant is done is $3,273.00. This is an estimate not a bill *. case is here and she has an outstanding balance. She may return for her surgical extraction and delivery of her denture when her balance is paid in full.5/01/2014 and her grandmother called. I have informed them we will no longer accept combative profanity when calls are made to the office. *.. states that is her mother," I do not speak to my mother" *.. states she cannot afford to pay for her denture. I explained to her that we provided a service that she requested. The treatment plans and preauthorization were presented. She accepted and signed for them. She applied to care credit. Her mothers insurance denied her coverage claim for the denture. She is responsible for the balance. We will keep the case. Pt can request a copy of the regard.Respectfully,