Brown's Plumbing Company

Thank
you for allowing us to respond to this unfortunate disputeOriginally I spoke
with the complainant's wife on the morning of February 19, She wanted to
schedule an appointment just for herselfAs with all new patients who ask if
we take dental Insurance, we respond by stating
that Dr*** *** is an
Out-of-Network dental providerTechnically, we are saying that we will file
any insurance, excluding Medicare, and MedicaidWe are always asked to clarify
the term Out-of-Network to the potential patientsWe define the term as:
patients are responsible for any remaining balance left, after insurance has
paid its estimated percentageThis is an explanation we give many times, each
day.On
February 23, 2015: we received a call from the complainant's wife, asking if we
were still open, despite of inclement weatherWhen I said we were open, I
mentioned that we had cancellationsThis is when she inquired if we could see
her husband too, since he was off from work this dayWe were able to
accommodate her request, and we scheduled
his appointment around the same time as hersThat afternoon, they both arrived
with the paperwork in hand and filled outAll the policy forms were signedWe
did make copies of the insurance card, and of their driver's licensesDuring
their brief wait time, neither patient expressed concerns of their insurance
coverageNo conversation had been made with the complainant yet.During
their checkout, I did make it aware of their insurance company's way ofpaymentThey both understood that this particular insurance company would more than likely mail a check to their address, rather than our office.On
March 18th, 2015: The complainant himself called and questioned me
about insurance not paying 100% of their visitsHis argument was that he
should not be responsible for the differenceI recalled the conversation had
with his wife about Dr*** being Out-of-Network, and how 100% of the
Insurance UCR is not agreed with most Out-of-Network dental providers, such as
Dr***.He
accused us of not giving this disclaimer to him before the appointment took
place, and that his wife was never informed of such informationAfter he hung
up, [ noticed that we had not received any payment or explanation of benefits
from his insuranceI called the complainant's insurance company and spoke with
an agent who verified two checks (covering the insurance portion) were sent to the
patient's addressI called the complainant back, and asked that they remit
those payments, plus take care of the remaining balanceHe agreed to pay the
summed amount of the checks, but would not pay for anything else,We
spoke again on March 20th, I explained that all remaining
balances needed to be paidAgain, he stressed his disagreements and proceeded
to tell me, he would think about the situation, and what he would doA check
was sent to our office on April ft, in the amount insurance paid
on the claim.Our
office does have the paperwork on file, all which is properly signed by both
parties agreeing to abide by our policiesThe policies do state that we file
insurances as a courtesy, and the remaining balance is the patient's responsibility
Due to HIPPA's guidelines, we will not release these documentsIt is
unfortunate that he feels that he has been taken advantage of, but all patients
are given paperwork that states our office and insurance policiesPrior to
their initial exam, those patients must fill out the forms, date, and sign.Should you have any
questions, please give me a callBest regards,
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