Callahan Dental

Complaint ID: *** (***)Ladies and gentlemen,I am in receipt of your correspondence dated April 15, referencing a patient complaint about our businessThe patient filing the complaint has dental insurance that is called a PPO or Preferred Provider OrganizationThis means
that had they gone to a dentist that signed a contractual arrangement with the insurance provider, that dentist would have been required to bill the fees the dental insurance plan setTheir complaint is that we did not make them aware we were not a “network provider" with their plan.Patients present with an infinite number of clinical and administrative questions and we cannot “second guess" and explain what they don't askDental insurance is very confusingHad we known that this patient did not understand we were not a provider in their plan and this was a concern for them, we would have gone out of our way to explain their insurance to them; even if it meant they would seek treatment elsewhereNationally, 90% of all dental insurance plans sold are PPOsHence, 90% of our patients have chosen to see us regardless of insurance reimbursement ratesAgain, we can't explain if the patient doesn't askInsurance companies are required to provide information to employees about their plansThe complainant should have read their plan details that explain what a PPO is, as well have been informed most plans provide an internet listing of what dentists, usually listed by zip code, are part of their planThe patient said they found our practice on the internetThe first paragraph under the heading Insurance on our web site says: “C*** Dental is not a direct participant with any dental insurance plan“All new patients are seen for an entire hour with us for an initial examination and radiographs. They are given ample time to ask any questionsIt is routine policy to move a patient into a private consultation room after this hour to answer insurance questions they haveAdditionally, the only brochure at our front desk, where patients check out is a brochure entitled “Understanding your Dental Insurance” which clearly explains all the benefits and limitations of dental insuranceIn summary, the patient did not understand their insurance plan and we did not know itThey were provided amble time to ask any questions they had about treatment recommendations and administrative concernsIf 90% of dental insurances are PPOs, that means 90% of our patients see us because they choose us and we make every effort to explain any clinical or administrative question they askIf they don't ask, we can only assume they know and understand or it is not a concernThe patient’s complaint is incorrect in that more treatment was provided than a cleaning and the outstanding balance is significantly lessWe cannot, as the complainant requested, reduce their outstanding balanceReducing the patient's insurance copayment responsibility is a criminal actIt is insurance fraud and would result in loss of my dental licensePatients are expected to pay a copaymentThe better the insurance, the less the copaymentYes, I feel bad the patient misunderstoodIf the complainant wants to initiate a conversation with their insurance company and the insurance company sends us a written letter, on their letterhead, with a hand written signature, we can reduce the outstanding balance by 25%The letter needs to clearly state they are acknowledging the write off and they agree not to change the payment sent to us for services renderedWe are only “writing off" part of the copayment, not changing the fees chargedAnything else is insurance fraudSincerely,
Karen MC***, D.D.S.Copy to: *** ***

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***