Capital Endodontics, LLC

Patient, [redacted] was referred to our office by her general dentist Since we are a referral based office and we not affiliated at all with other referring offices, we have no knowledge of a patients insurance or coverage before they are seen We first saw [redacted] for an exam only in which we recommend an Apicoectomy Surgery At the time of check out we did as the patient for a copy of her Medical Insurance card as we would be happy to look into her benefits with her Medical Insurance to see if they would possibly cover anything at our office We never told the patient we DO OR DO NOT accept her Medical Insurance as we accept most all Insurance plans but rather it will depend on her OWN INDIVIDUAL policy if they cover In or Out of NetworkWhen we called on the patients benefits we were told based on our Tax ID# showing we are out of network there are no benefits for the specific codes we called in question on Unfortunately because we are out of network with her Medical Insurance, they will NOT nor are they obligated to tell us if there is coverage In Network We did call the patient on 1/27/BEFORE Apicoectomy was completed to let her know we did contact her Medical Insurance and was told there would be no coverage for the procedure here at our officeIt is ULTIMATELY the patients responsibility to look into their own insurance and being proactive on finding out if there would be coverage possibly elsewhere We did inform patient there would be partial coverage with her Dental Insurance and based off those benefits we were quoted over the phone from her Dental Insurance, we would be collecting the ESTIMATED out of pocket the day of service HOWEVER if there would be any difference after insurance processes, the patient is responsible for that balance Calling on Insurance benefits and being quoted benefit info over the phone is NEVER a guarantee that is 100% correct and that payment would be made as well as prior authorizations Also, there can always be a chance of a pending claim from other dental offices that we are not made aware of from either the patient, referring office, or insurance company After discussing the estimate with the patient on 1/27/we were told she would contact us if she decides to cancel her appointment We saw the patient for the Apicoectomy procedure which originally was going to involve retrograde fillings but it changed to retrograde fillingsBecause of this change we did have to recalculate the patients estimate while she was in the operatory Ultimately this meant the total cost of treatment BEFORE Insurance would be $lessThe new calculation was made and the estimated out of pocket based on the info we were able to receive form her insurance company was collected the day of serviceAfter the patients visit, we did leave a message for patient on 2/15/with a follow up call to find out how she was doing and if she had any problems or concerns Our office received a call back from the patient on 2/17/ONLY in regards to her Insurance Patient was upset when she called and stated that she wasn’t aware that our office was out of network with her Medical InsuranceWe informed the patient that we DID infact tell her we are out of network with her Medical Insurance when we called her on 1/27/to go over her estimate and it was ALSO noted on her estimate form she sign and dated when she came in for her treatment appointment Patient stated she found out from her Medical Insurance that had she gone somewhere In Network she would of have coverage and feels she should have been told that by our office and doesn’t feel she should have to pay her co-insurance after only the Dental benefits We tried to explain to the patient on the phone that unfortunately because her Medical insurance is NOT obligated NOR did they tell us there would be coverage in network, there is nothing we can doAgain this is the patients responsibility to be proactive and call on her benefits BEFORE a procedure, to find out the full information that may not be told to our office The patient then called us back on 4/3/stating she was having some problems with the toothWe had an assistant speak with her and per our records the patient was informed to call us back if things got worse, did not improve, or if she had any questions We never heard back from the patient going forward in regards to any problems she was having per our records If the patient had called us back, it would be noted in our records We NEVER refused to see the patient back and had we known she was still having problems, we would have asked her to schedule a recheck appointment to come in so we can take a look at what’s going on On 3/23/17, our office received the payment and explanation of benefits from the patients insurance company After the payment from the patients insurance company, there was a balance remaining and a statement was mailed to the patient that same day We also mailed a statement to patient on 4/20/along with leaving a message for her to call us in regards to the balanceA Final Statement was mailed to the patient on 5/16/and another message left for patient to contact us Patient did not call us back until 6/1/in regards to the balanceThe patient was very upset about the balance and felt that we were unethical and lied to her Patient asked to set up a payment plan and I did inform her that the payment plan we offer is Care Credit which she can apply for either online or by phone and as long as the balance is over $it would be interest free for either months or months of her choosing, as long as she is approvedPtstated she would not be approved for itI asked patient how much she would be able to pay monthly and was told $I informed ptwe unfortunately cannot work with that as it would take years for the balance to be paid off in fullI did tell patient we could offer $a monthPtbecame very upset and said that we can just send it to collections then because she cannot pay that much and doesn’t feel she should be paying at allPatient also stated she would be letting her lawyer know and hung up on me I wanted to inform the patient I would review her estimate again and balance but she ended up hanging up on me before I could tell her that I did still review the information after I spoke with patient and realized we DID have a calculation error on our behalf of $on her estimate The remaining portion she would still be responsible for as that was from a pending claim from patients general dental office we were NOT made aware and for that reason was not included on her estimate in the amount used of her dental maximum I tried calling the patient back and it was forwarded to voicemailI left a message for the patient to call me back and also mailed patient a new statement showing that we will take care of the $that we mis-calculated for her but she will still be responsible for the remaining balance thereafter We received another call that afternoon stating it was the patient on the phoneI had the phone call transferred to me and after speaking with the women on the phone I asked if this was [redacted] that I was speaking with and was told no, it was her mother I informed patient mother that due to HIPAA I CANNOT speak to her in regards to her daughters account without the permission from [redacted] I was told from the patients mother that she knows how HIPAA works and will have her daughter, her, and her attorney, MsWashington, call me on way callI informed her that would be fine but I never heard back from anyoneBefore patients mother hung up on me she stated it is illegal to force someone to apply for a credit card as a payment option and that we were offered a $payment today when her daughter called that we declinedI told patients mother again I cannot discuss the account with her due to HIPAA unless her daughter calls me to give permission Patients mother then hung up on meUltimately the patient was made aware up front what we were told from her insurance company and that we are out of network with her Medical Insurance She was also given adequate time to contact her insurance companies herself and check on her coverage and benefits Had she have called her Medical Insurance beforehand, she may have been told there would be coverage for this procedure if she goes In Network Again this is something that some insurance companies will NOT tell us nor are they obligated to since we’re out of network We have reached out to the patient on multiple occasions to discuss the balance are willing to take care of a portion of the balance that was our error for miscalculation We also did contact the patient the same day she called on 4/3/in regards to some problems she was having and advised patient on what to doWe never heard back from patient about further problems After receiving this letter today in the mail, I tried calling patient againIt rang once and was forwarded to voicemailI asked that patient contact me as soon as possibleI wanted to address any problems the patient is having first off with the tooth and get her scheduled for a recheck appointment I was going to then also discuss the balance with her and let her know we will take care of a portion of the balance due to our own error but she will still be responsible for a portion of the balance and explain why I will let you know if we hear from the patient or if we get permission from her to speak to her motherThank you [redacted] * Billing SpecialistPhone: (608) 442-Ext #***Billing Fax: (608) 442-[redacted] www.capitalendo.com

Patient, [redacted] was referred to our office by her general dentist.? Since we are a referral based office and we not affiliated at all with other referring offices, we have no knowledge of a patients insurance or coverage before they are seen.? We first saw [redacted] for an exam only in which we recommend an Apicoectomy Surgery.? At the time of check out we did as the patient for a copy of her Medical Insurance card as we would be happy to look into her benefits with her Medical Insurance to see if they would possibly cover anything at our office.? We never told the patient we DO OR DO NOT accept her Medical Insurance as we accept most all Insurance plans but rather it will depend on her OWN INDIVIDUAL policy if they cover In or Out of NetworkWhen we called on the patients benefits we were told based on our Tax ID# showing we are out of network there are no benefits for the specific codes we called in question on.? Unfortunately because we are out of network with her Medical Insurance, they will NOT nor are they obligated to tell us if there is coverage In Network.? We did call the patient on 1/27/BEFORE Apicoectomy was completed to let her know we did contact her Medical Insurance and was told there would be no coverage for the procedure here at our officeIt is ULTIMATELY the patients responsibility to look into their own insurance and being proactive on finding out if there would be coverage possibly elsewhere.? We did inform patient there would be partial coverage with her Dental Insurance and based off those benefits we were quoted over the phone from her Dental Insurance, we would be collecting the ESTIMATED out of pocket the day of service HOWEVER if there would be any difference after insurance processes, the patient is responsible for that balance? Calling on Insurance benefits and being quoted benefit info over the phone is NEVER a guarantee that is 100% correct and that payment would be made as well as prior authorizations.? Also, there can always be a chance of a pending claim from other dental offices that we are not made aware of from either the patient, referring office, or insurance company.? ? After discussing the estimate with the patient on 1/27/we were told she would contact us if she decides to cancel her appointment.? We saw the patient for the Apicoectomy procedure which originally was going to involve retrograde fillings but it changed to retrograde fillingsBecause of this change we did have to recalculate the patients estimate while she was in the operatory.? Ultimately this meant the total cost of treatment BEFORE Insurance would be $lessThe new calculation was made and the estimated out of pocket based on the info we were able to receive form her insurance company was collected the day of service.? After the patients visit, we did leave a message for patient on 2/15/with a follow up call to find out how she was doing and if she had any problems or concerns.? Our office received a call back from the patient on 2/17/ONLY in regards to her Insurance? Patient was upset when she called and stated that she wasn’t aware that our office was out of network with her Medical InsuranceWe informed the patient that we DID infact tell her we are out of network with her Medical Insurance when we called her on 1/27/to go over her estimate and it was ALSO noted on her estimate form she sign and dated when she came in for her treatment appointment.? Patient stated she found out from her Medical Insurance that had she gone somewhere In Network she would of have coverage and feels she should have been told that by our office and doesn’t feel she should have to pay her co-insurance after only the Dental benefits.? We tried to explain to the patient on the phone that unfortunately because her Medical insurance is NOT obligated NOR did they tell us there would be coverage in network, there is nothing we can doAgain this is the patients responsibility to be proactive and call on her benefits BEFORE a procedure, to find out the full information that may not be told to our office.? ? ? The patient then called us back on 4/3/stating she was having some problems with the toothWe had an assistant speak with her and per our records the patient was informed to call us back if things got worse, did not improve, or if she had any questions.? We never heard back from the patient going forward in regards to any problems she was having per our records.? If the patient had called us back, it would be noted in our records? We NEVER refused to see the patient back and had we known she was still having problems, we would have asked her to schedule a recheck appointment to come in so we can take a look at what’s going on.? ? On 3/23/17, our office received the payment and explanation of benefits from the patients insurance company.? After the payment from the patients insurance company, there was a balance remaining and a statement was mailed to the patient that same day.? We also mailed a statement to patient on 4/20/along with leaving a message for her to call us in regards to the balanceA Final Statement was mailed to the patient on 5/16/and another message left for patient to contact us.? Patient did not call us back until 6/1/in regards to the balanceThe patient was very upset about the balance and felt that we were unethical and lied to her.? Patient asked to set up a payment plan and I did inform her that the payment plan we offer is Care Credit which she can apply for either online or by phone and as long as the balance is over $it would be interest free for either months or months of her choosing, as long as she is approvedPtstated she would not be approved for itI asked patient how much she would be able to pay monthly and was told $I informed ptwe unfortunately cannot work with that as it would take years for the balance to be paid off in fullI did tell patient we could offer $a monthPtbecame very upset and said that we can just send it to collections then because she cannot pay that much and doesn’t feel she should be paying at allPatient also stated she would be letting her lawyer know and hung up on me.? I wanted to inform the patient I would review her estimate again and balance but she ended up hanging up on me before I could tell her that.? I did still review the information after I spoke with patient and realized we DID have a calculation error on our behalf of $on her estimate.? The remaining portion she would still be responsible for as that was from a pending claim from patients general dental office we were NOT made aware and for that reason was not included on her estimate in the amount used of her dental maximum.? I tried calling the patient back and it was forwarded to voicemailI left a message for the patient to call me back and also mailed patient a new statement showing that we will take care of the $that we mis-calculated for her but she will still be responsible for the remaining balance thereafter.? ? We received another call that afternoon stating it was the patient on the phoneI had the phone call transferred to me and after speaking with the women on the phone I asked if this was [redacted] that I was speaking with and was told no, it was her mother.? I informed patient mother that due to HIPAA I CANNOT speak to her in regards to her daughters account without the permission from [redacted] I was told from the patients mother that she knows how HIPAA works and will have her daughter, her, and her attorney, MsWashington, call me on way callI informed her that would be fine but I never heard back from anyoneBefore patients mother hung up on me she stated it is illegal to force someone to apply for a credit card as a payment option and that we were offered a $payment today when her daughter called that we declinedI told patients mother again I cannot discuss the account with her due to HIPAA unless her daughter calls me to give permission.? Patients mother then hung up on me.? Ultimately the patient was made aware up front what we were told from her insurance company and that we are out of network with her Medical Insurance.? She was also given adequate time to contact her insurance companies herself and check on her coverage and benefits.? Had she have called her Medical Insurance beforehand, she may have been told there would be coverage for this procedure if she goes In Network.? Again this is something that some insurance companies will NOT tell us nor are they obligated to since we’re out of network? We have reached out to the patient on multiple occasions to discuss the balance are willing to take care of a portion of the balance that was our error for miscalculation.? We also did contact the patient the same day she called on 4/3/in regards to some problems she was having and advised patient on what to doWe never heard back from patient about further problems.? After receiving this letter today in the mail, I tried calling patient againIt rang once and was forwarded to voicemailI asked that patient contact me as soon as possibleI wanted to address any problems the patient is having first off with the tooth and get her scheduled for a recheck appointment.? I was going to then also discuss the balance with her and let her know we will take care of a portion of the balance due to our own error but she will still be responsible for a portion of the balance and explain why.? ? I will let you know if we hear from the patient or if we get permission from her to speak to her mother.? Thank you.? ? [redacted] *? Billing SpecialistPhone:? (608) 442-Ext #***Billing Fax:? (608) 442-[redacted] www.capitalendo.com

Our office is a Specialty Dental Office that sees patients based on referrals from patients general dentists We collect the insurance information from the patient or their referring office and create ONLY AN ESTIMATE based on the benefits we are quoted from the patients insurance company
As with any insurance company, gathering benefits is NOT a guarantee it's exact or that payment will be madeAll of our patients sign a financial disclosure along with a an estimate form stating that our office will do the best we are able to, to create an estimate for any procedures that are recommended and we will collected the ESTIMATED out of pocket the date of service, HOWEVER if there is anything remaining as patient portion after we receive the insurance EOB/payment, the patient IS RESPONSIBLE FOR THE BALANCE On our statements, it does state that payment is due within business daysI did speak with this patient over the phone on April 28, concerning her balanceI offered her a our payment option we use, Care CreditI also informed her that I realize this balance was unexpected and we can offer her to pay within days instead of Patient only offered to pay $a month which would take almost years to pay her balance offUnfortunately that is not something we can work with She was also made aware that because we are out of network with her insurance we gathered the benefit info we were able too however the percentage they pay is based on their own allowable feesBecause we are NOT in network with her insurance they are not obligated to tell us those allowed amounts This was made aware to the patient on her estimate as well that we are out of network We have tried contacting the patient by phone on two different occasions since our last conversation on 4/28/and also emailed her twiceThe patient is declining to speak with us over the phone to discuss the situation I'd be happy to send you copies of the signed and dated financial disclosure and estimate form if you would like. Thank you. *** ***
Capital Endodontics(608) [email protected]

Our office is a Specialty Dental Office that sees patients based on referrals from patients general dentists We collect the insurance information from the patient or their referring office and create ONLY AN ESTIMATE based on the benefits we are quoted from the patients insurance company
As with any insurance company, gathering benefits is NOT a guarantee it's exact or that payment will be madeAll of our patients sign a financial disclosure along with a an estimate form stating that our office will do the best we are able to, to create an estimate for any procedures that are recommended and we will collected the ESTIMATED out of pocket the date of service, HOWEVER if there is anything remaining as patient portion after we receive the insurance EOB/payment, the patient IS RESPONSIBLE FOR THE BALANCE On our statements, it does state that payment is due within business daysI did speak with this patient over the phone on April 28, concerning her balanceI offered her a our payment option we use, Care CreditI also informed her that I realize this balance was unexpected and we can offer her to pay within days instead of Patient only offered to pay $a month which would take almost years to pay her balance offUnfortunately that is not something we can work with She was also made aware that because we are out of network with her insurance we gathered the benefit info we were able too however the percentage they pay is based on their own allowable feesBecause we are NOT in network with her insurance they are not obligated to tell us those allowed amounts This was made aware to the patient on her estimate as well that we are out of network We have tried contacting the patient by phone on two different occasions since our last conversation on 4/28/and also emailed her twiceThe patient is declining to speak with us over the phone to discuss the situation I'd be happy to send you copies of the signed and dated financial disclosure and estimate form if you would like. Thank you. *** ***
Capital Endodontics(608) [email protected]

Patient, *** *** was referred to our office by her general dentist.? Since we are a referral based office and we not affiliated at all with other referring offices, we have no knowledge of a patients insurance or coverage before they are seen.? We first saw *** for an exam
only in which we recommend an Apicoectomy Surgery.? At the time of check out we did as the patient for a copy of her Medical Insurance card as we would be happy to look into her benefits with her Medical Insurance to see if they would possibly cover anything at our office.? We never told the patient we DO OR DO NOT accept her Medical Insurance as we accept most all Insurance plans but rather it will depend on her OWN INDIVIDUAL policy if they cover In or Out of NetworkWhen we called on the patients benefits we were told based on our Tax ID# showing we are out of network there are no benefits for the specific codes we called in question on.? Unfortunately because we are out of network with her Medical Insurance, they will NOT nor are they obligated to tell us if there is coverage In Network.? We did call the patient on 1/27/BEFORE Apicoectomy was completed to let her know we did contact her Medical Insurance and was told there would be no coverage for the procedure here at our officeIt is ULTIMATELY the patients responsibility to look into their own insurance and being proactive on finding out if there would be coverage possibly elsewhere.? We did inform patient there would be partial coverage with her Dental Insurance and based off those benefits we were quoted over the phone from her Dental Insurance, we would be collecting the ESTIMATED out of pocket the day of service HOWEVER if there would be any difference after insurance processes, the patient is responsible for that balance? Calling on Insurance benefits and being quoted benefit info over the phone is NEVER a guarantee that is 100% correct and that payment would be made as well as prior authorizations.? Also, there can always be a chance of a pending claim from other dental offices that we are not made aware of from either the patient, referring office, or insurance company.? ? After discussing the estimate with the patient on 1/27/we were told she would contact us if she decides to cancel her appointment.? We saw the patient for the Apicoectomy procedure which originally was going to involve retrograde fillings but it changed to retrograde fillingsBecause of this change we did have to recalculate the patients estimate while she was in the operatory.? Ultimately this meant the total cost of treatment BEFORE Insurance would be $lessThe new calculation was made and the estimated out of pocket based on the info we were able to receive form her insurance company was collected the day of service.? After the patients visit, we did leave a message for patient on 2/15/with a follow up call to find out how she was doing and if she had any problems or concerns.? Our office received a call back from the patient on 2/17/ONLY in regards to her Insurance? Patient was upset when she called and stated that she wasn’t aware that our office was out of network with her Medical InsuranceWe informed the patient that we DID infact tell her we are out of network with her Medical Insurance when we called her on 1/27/to go over her estimate and it was ALSO noted on her estimate form she sign and dated when she came in for her treatment appointment.? Patient stated she found out from her Medical Insurance that had she gone somewhere In Network she would of have coverage and feels she should have been told that by our office and doesn’t feel she should have to pay her co-insurance after only the Dental benefits.? We tried to explain to the patient on the phone that unfortunately because her Medical insurance is NOT obligated NOR did they tell us there would be coverage in network, there is nothing we can doAgain this is the patients responsibility to be proactive and call on her benefits BEFORE a procedure, to find out the full information that may not be told to our office.? ? ? The patient then called us back on 4/3/stating she was having some problems with the toothWe had an assistant speak with her and per our records the patient was informed to call us back if things got worse, did not improve, or if she had any questions.? We never heard back from the patient going forward in regards to any problems she was having per our records.? If the patient had called us back, it would be noted in our records? We NEVER refused to see the patient back and had we known she was still having problems, we would have asked her to schedule a recheck appointment to come in so we can take a look at what’s going on.? ? On 3/23/17, our office received the payment and explanation of benefits from the patients insurance company.? After the payment from the patients insurance company, there was a balance remaining and a statement was mailed to the patient that same day.? We also mailed a statement to patient on 4/20/along with leaving a message for her to call us in regards to the balanceA Final Statement was mailed to the patient on 5/16/and another message left for patient to contact us.? Patient did not call us back until 6/1/in regards to the balanceThe patient was very upset about the balance and felt that we were unethical and lied to her.? Patient asked to set up a payment plan and I did inform her that the payment plan we offer is Care Credit which she can apply for either online or by phone and as long as the balance is over $it would be interest free for either months or months of her choosing, as long as she is approvedPtstated she would not be approved for itI asked patient how much she would be able to pay monthly and was told $I informed ptwe unfortunately cannot work with that as it would take years for the balance to be paid off in fullI did tell patient we could offer $a monthPtbecame very upset and said that we can just send it to collections then because she cannot pay that much and doesn’t feel she should be paying at allPatient also stated she would be letting her lawyer know and hung up on me.? I wanted to inform the patient I would review her estimate again and balance but she ended up hanging up on me before I could tell her that.? I did still review the information after I spoke with patient and realized we DID have a calculation error on our behalf of $on her estimate.? The remaining portion she would still be responsible for as that was from a pending claim from patients general dental office we were NOT made aware and for that reason was not included on her estimate in the amount used of her dental maximum.? I tried calling the patient back and it was forwarded to voicemailI left a message for the patient to call me back and also mailed patient a new statement showing that we will take care of the $that we mis-calculated for her but she will still be responsible for the remaining balance thereafter.? ? We received another call that afternoon stating it was the patient on the phoneI had the phone call transferred to me and after speaking with the women on the phone I asked if this was *** that I was speaking with and was told no, it was her mother.? I informed patient mother that due to HIPAA I CANNOT speak to her in regards to her daughters account without the permission from ***I was told from the patients mother that she knows how HIPAA works and will have her daughter, her, and her attorney, MsWashington, call me on way callI informed her that would be fine but I never heard back from anyoneBefore patients mother hung up on me she stated it is illegal to force someone to apply for a credit card as a payment option and that we were offered a $payment today when her daughter called that we declinedI told patients mother again I cannot discuss the account with her due to HIPAA unless her daughter calls me to give permission.? Patients mother then hung up on me.? Ultimately the patient was made aware up front what we were told from her insurance company and that we are out of network with her Medical Insurance.? She was also given adequate time to contact her insurance companies herself and check on her coverage and benefits.? Had she have called her Medical Insurance beforehand, she may have been told there would be coverage for this procedure if she goes In Network.? Again this is something that some insurance companies will NOT tell us nor are they obligated to since we’re out of network? We have reached out to the patient on multiple occasions to discuss the balance are willing to take care of a portion of the balance that was our error for miscalculation.? We also did contact the patient the same day she called on 4/3/in regards to some problems she was having and advised patient on what to doWe never heard back from patient about further problems.? After receiving this letter today in the mail, I tried calling patient againIt rang once and was forwarded to voicemailI asked that patient contact me as soon as possibleI wanted to address any problems the patient is having first off with the tooth and get her scheduled for a recheck appointment.? I was going to then also discuss the balance with her and let her know we will take care of a portion of the balance due to our own error but she will still be responsible for a portion of the balance and explain why.? ? I will let you know if we hear from the patient or if we get permission from her to speak to her mother.? Thank you.? ? *** *** *? Billing SpecialistPhone:? (608) 442-Ext #***Billing Fax:? (608) 442-1002***www.capitalendo.com

Patient, [redacted] was referred to our office by her general dentist.  Since we are a referral based office and we not affiliated at all with other referring offices, we have no knowledge of a patients insurance or coverage before they are seen.  We first saw [redacted] for an exam...

only in which we recommend an Apicoectomy Surgery.  At the time of check out we did as the patient for a copy of her Medical Insurance card as we would be happy to look into her benefits with her Medical Insurance to see if they would possibly cover anything at our office.  We never told the patient we DO OR DO NOT accept her Medical Insurance as we accept most all Insurance plans but rather it will depend on her OWN INDIVIDUAL policy if they cover In or Out of Network. When we called on the patients benefits we were told based on our Tax ID# showing we are out of network there are no benefits for the specific codes we called in question on.  Unfortunately because we are out of network with her Medical Insurance, they will NOT nor are they obligated to tell us if there is coverage In Network.  We did call the patient on 1/27/17 BEFORE Apicoectomy was completed to let her know we did contact her Medical Insurance and was told there would be no coverage for the procedure here at our office. It is ULTIMATELY the patients responsibility to look into their own insurance and being proactive on finding out if there would be coverage possibly elsewhere.  We did inform patient there would be partial coverage with her Dental Insurance and based off those benefits we were quoted over the phone from her Dental Insurance, we would be collecting the ESTIMATED out of pocket the day of service HOWEVER if there would be any difference after insurance processes, the patient is responsible for that balance.  Calling on Insurance benefits and being quoted benefit info over the phone is NEVER a guarantee that is 100% correct and that payment would be made as well as prior authorizations.  Also, there can always be a chance of a pending claim from other dental offices that we are not made aware of from either the patient, referring office, or insurance company.  After discussing the estimate with the patient on 1/27/17 we were told she would contact us if she decides to cancel her appointment.  We saw the patient for the Apicoectomy procedure which originally was going to involve 4 retrograde fillings but it changed to 3 retrograde fillings. Because of this change we did have to recalculate the patients estimate while she was in the operatory.  Ultimately this meant the total cost of treatment BEFORE Insurance would be $300.00 less. The new calculation was made and the estimated out of pocket based on the info we were able to receive form her insurance company was collected the day of service. After the patients visit, we did leave a message for patient on 2/15/17 with a follow up call to find out how she was doing and if she had any problems or concerns.  Our office received a call back from the patient on 2/17/17 ONLY in regards to her Insurance.  Patient was upset when she called and stated that she wasn’t aware that our office was out of network with her Medical Insurance. We informed the patient that we DID infact tell her we are out of network with her Medical Insurance when we called her on 1/27/17 to go over her estimate and it was ALSO noted on her estimate form she sign and dated when she came in for her treatment appointment.  Patient stated she found out from her Medical Insurance that had she gone somewhere In Network she would of have coverage and feels she should have been told that by our office and doesn’t feel she should have to pay her co-insurance after only the Dental benefits.  We tried to explain to the patient on the phone that unfortunately because her Medical insurance is NOT obligated NOR did they tell us there would be coverage in network, there is nothing we can do. Again this is the patients responsibility to be proactive and call on her benefits BEFORE a procedure, to find out the full information that may not be told to our office.    The patient then called us back on 4/3/17 stating she was having some problems with the tooth. We had an assistant speak with her and per our records the patient was informed to call us back if things got worse, did not improve, or if she had any questions.  We never heard back from the patient going forward in regards to any problems she was having per our records.  If the patient had called us back, it would be noted in our records.  We NEVER refused to see the patient back and had we known she was still having problems, we would have asked her to schedule a recheck appointment to come in so we can take a look at what’s going on.  On 3/23/17, our office received the payment and explanation of benefits from the patients insurance company.  After the payment from the patients insurance company, there was a balance remaining and a statement was mailed to the patient that same day.  We also mailed a statement to patient on 4/20/17 along with leaving a message for her to call us in regards to the balance. A Final Statement was mailed to the patient on 5/16/17 and another message left for patient to contact us.  Patient did not call us back until 6/1/17 in regards to the balance. The patient was very upset about the balance and felt that we were unethical and lied to her.  Patient asked to set up a payment plan and I did inform her that the payment plan we offer is Care Credit which she can apply for either online or by phone and as long as the balance is over $200.00 it would be interest free for either 6 months or 12 months of her choosing, as long as she is approved. Pt. stated she would not be approved for it. I asked patient how much she would be able to pay monthly and was told $20.00. I informed pt. we unfortunately cannot work with that as it would take 2. 5 years for the balance to be paid off in full. I did tell patient we could offer $75.00 a month. Pt. became very upset and said that we can just send it to collections then because she cannot pay that much and doesn’t feel she should be paying at all. Patient also stated she would be letting her lawyer know and hung up on me.  I wanted to inform the patient I would review her estimate again and balance but she ended up hanging up on me before I could tell her that.  I did still review the information after I spoke with patient and realized we DID have a calculation error on our behalf of $375.00 on her estimate.  The remaining portion she would still be responsible for as that was from a pending claim from patients general dental office we were NOT made aware and for that reason was not included on her estimate in the amount used of her dental maximum.  I tried calling the patient back and it was forwarded to voicemail. I left a message for the patient to call me back and also mailed patient a new statement showing that we will take care of the $375.00 that we mis-calculated for her but she will still be responsible for the remaining balance thereafter.  We received another call that afternoon stating it was the patient on the phone. I had the phone call transferred to me and after speaking with the women on the phone I asked if this was [redacted] that I was speaking with and was told no, it was her mother.  I informed patient mother that due to HIPAA I CANNOT speak to her in regards to her daughters account without the permission from [redacted]. I was told from the patients mother that she knows how HIPAA works and will have her daughter, her, and her attorney, Ms. Washington, call me on 3 way call. I informed her that would be fine but I never heard back from anyone. Before patients mother hung up on me she stated it is illegal to force someone to apply for a credit card as a payment option and that we were offered a $20.00 payment today when her daughter called that we declined. I told patients mother again I cannot discuss the account with her due to HIPAA unless her daughter calls me to give permission.  Patients mother then hung up on me. Ultimately the patient was made aware up front what we were told from her insurance company and that we are out of network with her Medical Insurance.  She was also given adequate time to contact her insurance companies herself and check on her coverage and benefits.  Had she have called her Medical Insurance beforehand, she may have been told there would be coverage for this procedure if she goes In Network.  Again this is something that some insurance companies will NOT tell us nor are they obligated to since we’re out of network.  We have reached out to the patient on multiple occasions to discuss the balance are willing to take care of a portion of the balance that was our error for miscalculation.  We also did contact the patient the same day she called on 4/3/17 in regards to some problems she was having and advised patient on what to do. We never heard back from patient about further problems.  After receiving this letter today in the mail, I tried calling patient again. It rang once and was forwarded to voicemail. I asked that patient contact me as soon as possible. I wanted to address any problems the patient is having first off with the tooth and get her scheduled for a recheck appointment.  I was going to then also discuss the balance with her and let her know we will take care of a portion of the balance due to our own error but she will still be responsible for a portion of the balance and explain why.  I will let you know if we hear from the patient or if we get permission from her to speak to her mother. Thank you.  [redacted] Billing SpecialistPhone:  (608) 442-3300 Ext #[redacted]Billing Fax:  (608) 442-1002[redacted]www.capitalendo.com