Circle Pines Dental

Patient was seen in late 2016, treatment planning was done for dental treatment, pre-estimates were submitted to the insurance plans she had in Two important facts need highlighted about pre-estimates of insurance benefits - and these both come directly from the insurance companies From [redacted] 's Dental insurance, on their estimate paperwork, it says in bold "Estimated plan payment based on Patient's current eligibility and contract benefits Submission of other claims or changes in eligibility or contract may Alter Final Payment." Basically, no guarantees that they will actually pay what they say they will Second consideration is that when a person has two insurance plans being used, for pre-estimates of payment, Insurance companies do NOT coordinate benefits So you can reliably know what the Primary insurance says they'll pay, but the Secondary Insurance is still a guess because it doesn't coordinate its estimate with the Primary [redacted] is pointing out that her primary Insurance with Delta Delta indicated a $write-off, which would be the case if she only had one insurance she was receiving benefits from In cases with two insurances, the Dental Insurance Companies require us the providers to determine insurance write-offs from the secondary insurance This is their rule, not ours We have contracts to follow their rules, and we choose to be in compliance with our contractual obligations This has been double checked with Delta Dental multiple times in [redacted] 's case, and every representative from Delta we have spoken with informs us that write offs are determined from the secondary insurance [redacted] directed us to submit her treatments to both insurance companies [redacted] 's secondary insurance indicates the write-off amount on her treatment to be $0.We informed her via email to her correct email address that we estimated her portion to be $ That email is copied to this After insurance payments, that is in fact the current amount owed Even if there was a write off, she would still owe towards her treatment, but instead months later we still haven't been payed anything from her personally for our time and costs to provide her treatments that she gets the benefit of using every day.Thank you for your help in closing this matter.John [redacted] , DDS

I am rejecting this response because:
The dollar amount of $that I have referenced is not the write off amount like Dr*** has indicatedRather, that amount is what my primary insurance indicated that my patient responsibility should be after they had paid their portion of the dental billThis is shown on the two attached explanation of benefits, as I had work done on two different dates of services and that requires two separate billingsThe combined amount is $The write off amount is the difference between the combined billed amount from the dentist of $and the combined allowed amount from my Delta policy of $This write off amount is instead $It is apparent to me that Dr*** is confusedThis dentist office is an in network provider for Delta Dental, and as such, they are not allowed to charge the patient more that what the policy calls the allowed amountAttached is my dental bill for $2163, charging me $more than what my policy has deemed the allowed amountWhen I call and speak with Delta Dental, they tell me that I have been billed by the dental office out of complianceThis is a practice called Balance billing, which goes against contract with them, and is also against MN State Statute 62KThe statute reads: “A network provider is prohibited from billing an enrollee for any amount in excess of the allowable amount the health carrier has contracted for with the provider as total payment for the health care serviceA network provider is permitted to bill an enrollee the approved co-payment, deductible, or coinsurance.”
Regardless to what the dentist has referenced to pre-estimation of benefits, and payments changing at any point, this amount in the above paragraph is in fact what was charged to me after services were performed on January 9th and 10thAs for paying my bill, I attempted to pay my bill after services were performed on January 10thI was told by the receptionist, Erica, that it had to be run through both of my insurances first which could take up to months (days for each policy)So I was instructed not to make a payment to them because as Dr*** put it, the pre-estimated amount was just a ‘guess.’ I went in to pay what I estimated to be my remaining payment on March 13th, after receiving a payment check from my secondary insuranceThis was well within the days for processing, and I still hadn’t received a bill from themIt was at this time I learned of the email sent to me (what date) that had filtered through my spam folderThere had been no previous mention to me of an email, that I never responded to, or a phone conversation had about what my bill balance would now be after using a secondary insuranceTelling me, the amount I would owe would be of $This email also has no explanation of how they arrived at that dollar amountI have never known anyone to use a secondary insurance, and for the patient responsibility to increase from what the primary insurance deemed it to beThis email also states that the services weren’t covered by either of my insurance companies, when it was indeed covered by my primary insuranceAfter reviewing explanation of benefits from my secondary insurance it shows the allowed amount to the patient to be $1741.85, but I am not being billed that amount eitherClearly something is wrong here when my parent’s in Iowa, whom I never have given their address to the dentist office, gets a bill on March 18th but I still haven’t gotten one
I have tried over and over to communicate all of this with the dental office staff; yet they have been adamant that I am incorrectI’ve spent hours on the phone with both of my insurance companies; yet they are adamant that they don’t have to accept the write-off amount from Delta Dental as that amount is determined by my secondary insurance previously stated to be $I was further more contacted on March 15th by them about an appointment for a future cleaning sessionThey informed me they were going to cancel it, and after this matter had been settled I could re-schedule itI feel that they lack any customer service, and have continuously handled my account without professional courtesyYet, one thing from Dr*** statement was correctThe pre-estimation of benefits is NOT coordinated between a primary and secondary insuranceIsn’t it odd that my secondary insurance estimated to the exact penny what the amount they would pay would be, when he stipulated they couldn’t do that? The reason for this is because Circle Pines Dental submitted my claim to my secondary insurance as claim instead of separate claims for each date of serviceThey lead them to believe they were my acting primary insurance when they weren’tIn fact, there was no mention of a primary insurance even on the explanation of benefitsThis allowed them to process my claim incorrectly, and yet the dental office still maintains I am in the wrong
The attached photos are the bill from Circle Pines Dental as well as explanation of benefits from my primary insurance, Delta Dental, and an explanation of benefits from my secondary insurance, Blue Dental

Patient was seen in late 2016, treatment planning was done for dental treatment, pre-estimates were submitted to the insurance plans she had in 2016.  Two important facts need highlighted about pre-estimates of insurance benefits - and these both come directly from the insurance...

companies.  From [redacted]'s Dental insurance, on their estimate paperwork, it says in bold "Estimated plan payment based on Patient's current eligibility and contract benefits.  Submission of other claims or changes in eligibility or contract may Alter Final Payment."  Basically, no guarantees that they will actually pay what they say they will.  Second consideration is that when a person has two insurance plans being used, for pre-estimates of payment, Insurance companies do NOT coordinate benefits.  So you can reliably know what the Primary insurance says they'll pay, but the Secondary Insurance is still a guess because it doesn't coordinate its estimate with the Primary.  [redacted] is pointing out that her primary Insurance with Delta Delta indicated a $731.44 write-off, which would be the case if she only had one insurance she was receiving benefits from.  In cases with two insurances, the Dental Insurance Companies require us the providers to determine insurance write-offs from the secondary insurance.  This is their rule, not ours.  We have contracts to follow their rules, and we choose to be in compliance with our contractual obligations.  This has been double checked with Delta Dental multiple times in [redacted]'s case, and every representative from Delta we have spoken with informs us that write offs are determined from the secondary insurance.  [redacted] directed us to submit her treatments to both insurance companies.  [redacted]'s secondary insurance indicates the write-off amount on her treatment to be $0.We informed her via email to her correct email address that we estimated her portion to be $1060.34.  That email is copied to this.  After insurance payments, that is in fact the current amount owed.  Even if there was a write off, she would still owe towards her treatment, but instead months later we still haven't been payed anything from her personally for our time and costs to provide her treatments that she gets the benefit of using every day.Thank you for your help in closing this matter.John [redacted], DDS