Initial Business Response / [redacted] (1000, 5, 2016/05/12) */ We are sorry for the misunderstanding regarding this patient's dental benefitsUnfortunately dental benefits are quite confusing and this is the root of the problem that has developed with this patient Here is a summary of the Patient's insurance benefits: The patient's insurance benefit plan is contracted through the patient's employer and our office has no say in the benefits providedWe are only able to submit claims on the patient's behalfIt is noted in our records that the benefit under the patient's dental plan for restorative (fillings) procedures is 60% of the "allowable amount"The insurance company makes up this "allowable amount" and will not disclose it to our dental officeTherefore, it is extremely difficult to predict, with accuracy, each dental plan's exact payment scheduleThe information provided via phone by the patient's dental insurance to our office staff is not a guarantee of paymentThis is explained in our office's insurance plan disclaimer that is given to each patient on their first visit Our office financial arrangements: Our office financial policy for patients with insurance is that we ask for an initial partial payment towards the treatment fee on the date of serviceWe submit the claim to the patient's insurance company for payment for the services renderedAfter we receive the insurance benefit portion, a statement is sent to the patent for the final patient responsibility Alternative restorations: It is common for insurance companies to pay benefits for the least expensive alternative for treatmentFor this patient, resin fillings were the best restoration for the condition of the teethThe alternative restoration in this specific patient's situation would be amalgam fillingsIncidentally, the resin and amalgam fillings are the same restorative fee, and in this case, the exact same out-of-pocket cost to the patientThe third alternative is milled indirect restorations which would have been several thousand dollars of out-of-pocket patient responsibility for the patient Offered Solution: During the second conversation between our patient and our office manager regarding the higher than expected patient responsibility, our office manager offered a resolution to give a 10% credit for the fees incurred and the adjusted balance could be split into two monthly paymentsThe patient found this to not be an acceptable resolution and stated that, "the matter will be taken to the next level"In light of the above explanation, we believe the offered resolution is fair for both parties considering the confusion stems from the patient's own dental insurance coverage
Initial Business Response /* (1000, 5, 2016/05/12) */
We are sorry for the misunderstanding regarding this patient's dental benefits. Unfortunately dental benefits are quite confusing and this is the root of the problem that has developed with this patient.
Here is a summary of the Patient's...
insurance benefits:
The patient's insurance benefit plan is contracted through the patient's employer and our office has no say in the benefits provided. We are only able to submit claims on the patient's behalf. It is noted in our records that the benefit under the patient's dental plan for restorative (fillings) procedures is 60% of the "allowable amount". The insurance company makes up this "allowable amount" and will not disclose it to our dental office. Therefore, it is extremely difficult to predict, with accuracy, each dental plan's exact payment schedule. The information provided via phone by the patient's dental insurance to our office staff is not a guarantee of payment. This is explained in our office's insurance plan disclaimer that is given to each patient on their first visit.
Our office financial arrangements:
Our office financial policy for patients with insurance is that we ask for an initial partial payment towards the treatment fee on the date of service. We submit the claim to the patient's insurance company for payment for the services rendered. After we receive the insurance benefit portion, a statement is sent to the patent for the final patient responsibility.
Alternative restorations:
It is common for insurance companies to pay benefits for the least expensive alternative for treatment. For this patient, resin fillings were the best restoration for the condition of the teeth. The alternative restoration in this specific patient's situation would be amalgam fillings. Incidentally, the resin and amalgam fillings are the same restorative fee, and in this case, the exact same out-of-pocket cost to the patient. The third alternative is milled indirect restorations which would have been several thousand dollars of out-of-pocket patient responsibility for the patient.
Offered Solution:
During the second conversation between our patient and our office manager regarding the higher than expected patient responsibility, our office manager offered a resolution to give a 10% credit for the fees incurred and the adjusted balance could be split into two monthly payments. The patient found this to not be an acceptable resolution and stated that, "the matter will be taken to the next level". In light of the above explanation, we believe the offered resolution is fair for both parties considering the confusion stems from the patient's own dental insurance coverage.
Initial Business Response / [redacted] (1000, 5, 2016/05/12) */ We are sorry for the misunderstanding regarding this patient's dental benefitsUnfortunately dental benefits are quite confusing and this is the root of the problem that has developed with this patient Here is a summary of the Patient's insurance benefits: The patient's insurance benefit plan is contracted through the patient's employer and our office has no say in the benefits providedWe are only able to submit claims on the patient's behalfIt is noted in our records that the benefit under the patient's dental plan for restorative (fillings) procedures is 60% of the "allowable amount"The insurance company makes up this "allowable amount" and will not disclose it to our dental officeTherefore, it is extremely difficult to predict, with accuracy, each dental plan's exact payment scheduleThe information provided via phone by the patient's dental insurance to our office staff is not a guarantee of paymentThis is explained in our office's insurance plan disclaimer that is given to each patient on their first visit Our office financial arrangements: Our office financial policy for patients with insurance is that we ask for an initial partial payment towards the treatment fee on the date of serviceWe submit the claim to the patient's insurance company for payment for the services renderedAfter we receive the insurance benefit portion, a statement is sent to the patent for the final patient responsibility Alternative restorations: It is common for insurance companies to pay benefits for the least expensive alternative for treatmentFor this patient, resin fillings were the best restoration for the condition of the teethThe alternative restoration in this specific patient's situation would be amalgam fillingsIncidentally, the resin and amalgam fillings are the same restorative fee, and in this case, the exact same out-of-pocket cost to the patientThe third alternative is milled indirect restorations which would have been several thousand dollars of out-of-pocket patient responsibility for the patient Offered Solution: During the second conversation between our patient and our office manager regarding the higher than expected patient responsibility, our office manager offered a resolution to give a 10% credit for the fees incurred and the adjusted balance could be split into two monthly paymentsThe patient found this to not be an acceptable resolution and stated that, "the matter will be taken to the next level"In light of the above explanation, we believe the offered resolution is fair for both parties considering the confusion stems from the patient's own dental insurance coverage
Initial Business Response /* (1000, 5, 2016/05/12) */
We are sorry for the misunderstanding regarding this patient's dental benefits. Unfortunately dental benefits are quite confusing and this is the root of the problem that has developed with this patient.
Here is a summary of the Patient's...
insurance benefits:
The patient's insurance benefit plan is contracted through the patient's employer and our office has no say in the benefits provided. We are only able to submit claims on the patient's behalf. It is noted in our records that the benefit under the patient's dental plan for restorative (fillings) procedures is 60% of the "allowable amount". The insurance company makes up this "allowable amount" and will not disclose it to our dental office. Therefore, it is extremely difficult to predict, with accuracy, each dental plan's exact payment schedule. The information provided via phone by the patient's dental insurance to our office staff is not a guarantee of payment. This is explained in our office's insurance plan disclaimer that is given to each patient on their first visit.
Our office financial arrangements:
Our office financial policy for patients with insurance is that we ask for an initial partial payment towards the treatment fee on the date of service. We submit the claim to the patient's insurance company for payment for the services rendered. After we receive the insurance benefit portion, a statement is sent to the patent for the final patient responsibility.
Alternative restorations:
It is common for insurance companies to pay benefits for the least expensive alternative for treatment. For this patient, resin fillings were the best restoration for the condition of the teeth. The alternative restoration in this specific patient's situation would be amalgam fillings. Incidentally, the resin and amalgam fillings are the same restorative fee, and in this case, the exact same out-of-pocket cost to the patient. The third alternative is milled indirect restorations which would have been several thousand dollars of out-of-pocket patient responsibility for the patient.
Offered Solution:
During the second conversation between our patient and our office manager regarding the higher than expected patient responsibility, our office manager offered a resolution to give a 10% credit for the fees incurred and the adjusted balance could be split into two monthly payments. The patient found this to not be an acceptable resolution and stated that, "the matter will be taken to the next level". In light of the above explanation, we believe the offered resolution is fair for both parties considering the confusion stems from the patient's own dental insurance coverage.