Burlington Oral & Facial Surgery Center, LLC

Thank you very much for the patient and hard workThough I still feel uncomfortable with this dental center, since this should be the last time I dealt with them, and I signed the document during the visit from the legal point, I choose to pay $instead and move on this issueI have dealt with a couple of dentist in the past years and this one is the only one I feel badIn my view, I still insist my opinion that "They misled the patient at the time I sign the document" Regards,

I am very sorry that this patient has confusion about his insurance coverages We understand they can be difficult to figure out and we provided the most detailed explanation to him that we could over several discussionsHis daughter had a procedure performed at our office After her evaluation appointment we reviewed her treatment plan with him in detail We explained to him that, as a courtesy, we assist our patients with checking their insurance policy benefits and in claim submission The particulars of his policy and benefits however constitute a relationship between him and his insurance company We informed him that we will submit a claim to his insurance companies on his behalf, however as noted by his insurance plan all benefits are subject to reviewWe explained that we are not responsible for the final processing decision by the insurance companies We collect an estimated patient balance on the day of surgery.His daughter, our patient, had two [redacted] insurance policies available One was through her father and the other through her mother The [redacted] website indicated on the day of her evaluation that there was a deductible of $that had not been met on the father’s policy and an additional $deductible through the mother’s policy The father’s policy indicated there was $of benefits remaining and the policy through her mother indicated there was $available We provided him the estimate based on those available funds and the policies coordinating benefitsWe were very clear in a lengthy conversation that this was just an estimate based on the information provided by [redacted] that day and not a guarantee of coverage When contacting [redacted] , it is stated both telephonically and online that the benefits indicated are not a guarantee of coverageHe then indicated that he would be getting a new [redacted] insurance plan in the following weeks but wanted his daughter’s surgery performed as soon as possible so she would be recovered before school starts He scheduled her surgery appointment for the day after the evaluation and we explained that we could postpone the surgery if he would like to utilize his [redacted] benefits We also offered to submit prior authorizations to [redacted] for a better idea of coverage but we would have to postpone the surgery until we receive correspondence which can take several weeks He wanted the surgery date to remain the following day and asked if we could submit the claim to [redacted] when the policy becomes active We explained that this would be tantamount to insurance fraud and we would not submit it that way Treatment performed must be submitted only to policies that are effective at the time of service.After the surgery he returned to the office with his estimation of benefits from [redacted] which he obtained online It showed that the first plan paid out what was estimated but the benefits were fully utilized on the second plan and that he owed a total of $for the procedure The $he owes in addition to his $deductibles from the two policies is due to his [redacted] policies processing claims from other providers that were not applied toward his benefits during the initial verification and eligibility checkAgain we emphasized at the initial appointment that this is an estimate and not a guarantee of coverage and that claims from other providers can affect his available benefitsBased on information from [redacted] , the mother’s policy was the primary one to bill and the father’s was the secondary We billed the primary policy under the correct treating provider’s name After it was processed and paid by the primary [redacted] policy, [redacted] then reprocessed the claim under the secondary policy and incorrectly indicated another treating provider who is on our office’s tax ID number The change in the treating provider for the secondary policy was not made by our office and does not affect the patient’s out of pocket expense.He signed documentation indicating that he understood his estimation of coverage was just an estimate and not a guarantee and that he would be responsible for charges not paid by his insurance company We understand that it can be very confusing trying to sort out and make sense of insurance benefits and coverages and also asked him to contact his insurance company for detailed answers to his questions Again I am sorry that he is confused about the specifics of his insurance policies It can truly be hard to understand insurance coverages, but after multiple lengthy conversations I do not believe that we could have explained it any better

Thank you very much for the patient and hard work. Though I still feel uncomfortable with this dental center, since this should be the last time I dealt with them, and I signed the document during the visit from the legal point, I choose to pay $200 instead and move on this issue. I have dealt with a couple of dentist in the past 15 years and this one is the only one I feel bad. In my view, I still insist my opinion that "They misled the patient at the time I sign the document".
Regards,

We understand that the charge appears confusing on the Explanation of Benefits.  Our fee for his daughter’s examination was $100 and it is noted as $100 every time the insurance code for the exam is listed.  The place where he sees $200 is due to a duplicate submission when the claim was processed through the secondary insurance policy.  This sometimes happens and it may be that when they ran it through the secondary policy at [redacted], someone  hit enter twice instead of once.  The Explanation of Benefits also indicates that it was a duplicate submission.  The examination fee didn’t change and the duplicate submission does not affect his insurance coverage or amount due.  To his second question about adding deductibles, again we provide the estimated out of pocket expense based on the rules set forth by each insurance company.  This isn’t something that we can control or change.  Adding the deductibles is the way [redacted] processes the claim when coordinating insurances and we are merely providing an estimate of what is due.  We have nothing to do with their decision to add the deductibles.  It appears that many of his concerns are related to insurance processing and I recommend that he contact his insurance company for more clarification.  His insurance company makes the rules we abide when submitting claims and they may be better able to help him understand the often very confusing claims process.

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted]. Please add your rejection comments below. 
Thanks a lot for helping to process this complaint. I still have 2 remaining issues.1) This center can charge the same service at the price they prefer. Please take a look at 3 attached pdf files. The price of  the first claim(100-1.pdf, [redacted]) is $100. The price of the second claim(100-1-2.pdf, [redacted]) is $100. These are correct. Then they filed another claim(100-2.pdf) for the same service and the price becomes $200.2) Simply add 2 deductibles are wrong and misleading. I understand in the legal point I need to pay the extra $200 point, but still feel sad to this unprofessional attitude.
Regards,
[redacted]

I am very sorry that this patient has confusion about his insurance coverages.  We understand they can be difficult to figure out and we provided the most detailed explanation to him that we could over several discussions. His daughter had a procedure performed at our office.  After...

her evaluation appointment we reviewed her treatment plan with him in detail.  We explained to him that, as a courtesy, we assist our patients with checking their insurance policy benefits and in claim submission.  The particulars of his policy and benefits however constitute a relationship between him and his insurance company.  We informed him that we will submit a claim to his insurance companies on his behalf, however as noted by his insurance plan all benefits are subject to review. We explained that we are not responsible for the final processing decision by the insurance companies.  We collect an estimated patient balance on the day of surgery.His daughter, our patient, had two [redacted] insurance policies available.  One was through her father and the other through her mother.  The [redacted] website indicated on the day of her evaluation that there was a deductible of $50 that had not been met on the father’s policy and an additional $100 deductible through the mother’s policy.  The father’s policy indicated there was $865 of benefits remaining and the policy through her mother indicated there was $1050 available.  We provided him the estimate based on those available funds and the policies coordinating benefits. We were very clear in a lengthy conversation that this was just an estimate based on the information provided by [redacted] that day and not a guarantee of coverage.  When contacting [redacted], it is stated both telephonically and online that the benefits indicated are not a guarantee of coverage. He then indicated that he would be getting a new [redacted] insurance plan in the following weeks but wanted his daughter’s surgery performed as soon as possible so she would be recovered before school starts.  He scheduled her surgery appointment for the day after the evaluation and we explained that we could postpone the surgery if he would like to utilize his [redacted] benefits.  We also offered to submit prior authorizations to [redacted] for a better idea of coverage but we would have to postpone the surgery until we receive correspondence which can take several weeks.  He wanted the surgery date to remain the following day and asked if we could submit the claim to [redacted] when the policy becomes active.  We explained that this would be tantamount to insurance fraud and we would not submit it that way.  Treatment performed must be submitted only to policies that are effective at the time of service.After the surgery he returned to the office with his estimation of benefits from [redacted] which he obtained online.  It showed that the first plan paid out what was estimated but the benefits were fully utilized on the second plan and that he owed a total of $350 for the procedure.  The $200 he owes in addition to his $150 deductibles from the two policies is due to his [redacted] policies processing claims from other providers that were not applied toward his benefits during the initial verification and eligibility check. Again we emphasized at the initial appointment that this is an estimate and not a guarantee of coverage and that claims from other providers can affect his available benefits. Based on information from [redacted], the mother’s policy was the primary one to bill and the father’s was the secondary.  We billed the primary policy under the correct treating provider’s name.  After it was processed and paid by the primary [redacted] policy, [redacted] then reprocessed the claim under the secondary policy and incorrectly indicated another treating provider who is on our office’s tax ID number.  The change in the treating provider for the secondary policy was not made by our office and does not affect the patient’s out of pocket expense.He signed documentation indicating that he understood his estimation of coverage was just an estimate and not a guarantee and that he would be responsible for charges not paid by his insurance company.  We understand that it can be very confusing trying to sort out and make sense of insurance benefits and coverages and also asked him to contact his insurance company for detailed answers to his questions.  Again I am sorry that he is confused about the specifics of his insurance policies.  It can truly be hard to understand insurance coverages, but after multiple lengthy conversations I do not believe that we could have explained it any better.