Columbia Dentistry-Children

Initial Business Response /* (1000, 5, 2015/08/17) */
Contact Name and Title: *** Burris,Prac Mgr
Contact Phone: XXX-XXX-XXXX
Contact Email: ***@columbiadentistryforchildren.com
Thank you for sharing your concerns with usI am sorry you are frustrated with our process in regards to
filing claims with *** *** *** *** when a secondary insurance is involvedWe appreciate the feedback as we continue to improve our patient experience
We submit dental claims to our patient's primary and secondary insurance company as a courtesyWe are an in-network Premier provider with *** *** but considered out of network with *** *** *** *** *** *** Since *** sends their payments to the subscriber directly, we collect the total balance up front at the time of service
In cases of secondary insurance with *** as primary, we need a copy of the Explanation of Benefits (EOB) from the parent once payment is issued to their homeWe take the EOB and process a secondary claim and send the documentation to the secondary insurance company
In the case of *** Dental as a secondary insurance payer, we submitted the secondary claims with a notation to send payment directly to subscriberHowever, *** remitted payment directly to our office for two of the claimsSince the full balance was collected at the time of service, the secondary payment by *** Dental to our office created a credit on the account both timesWe reimbursed the subscriber by sending a refund check in the amount of payment made by secondary insurance
Timing of refund checks on those two claims:
Secondary payment received on 4/7/15, refund check issued on 4/10/
Secondary payment received on 4/30/15, refund check issued on 6/15/15*
*This refund should have been sent in May since we typically process our refunds at the end of each monthOnce the parent called to alert us that the refund had not been received, the refund was issuedWe have since made changes to our process in processing refunds to avoid this delay from happening in the future
In another instance for the subscriber's daughter, the primary EOB was faxed by the mother to our office on 6/22/The fax was not properly routed upon receipt, and went unrecognized until the mother called to inquireOnce we realized the error after the mother's phone call, the secondary claim was submitted on 7/30/Secondary payment should be sent to the subscriber directly based on the noted claimShould it be sent to our office, a refund will be issued for the full amount of the secondary insurance paymentWe have since made improvements to our process for managing the incoming faxes, which came from this particular experience
We understand that the process of filing primary and secondary claims in the instance that *** is primary can be dauntingHowever, we clearly communicate the process of filling with *** *** *** *** at the time of service, as well as the process for the secondary claimsWe do our best to process both primary and secondary claims as well as account refunds in a timely and efficient manner as a courtesy to our patients and familiesIn this case, our best was not achieved and we have made changes to improve our process
Resolution: We apologize for the frustration the process has caused, and have made two changes in our existing internal processing because of itThe parent is able to process their own primary and secondary claims to their insurance company directly if they prefer