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[redacted] is mistaken that she is owed any money by my office. She was treated by me in 2011, and received high quality dental care. She had 2 forms of insurance coverage at the time: 1 through her employer, and 1 through her husband. My office manager submitted claims to both insurance companies. [redacted] did not pay any co-pay out of pocket for this treatment. Sometimes, the secondary insurance company does not pay anything if they feel what the primary insurance company has paid is adequate. In this case, both insurance companies did pay toward her 2011 services. That does this mean that [redacted] had a "refund due". It is unlawful for a patient to financially benefit from an insurance payment that is solely intended for healthcare services. [redacted] is inappropriately stating that my office should have issued her a check so she could use the secondary insurance payment for personal spending, which is never done. My staff assistant may have gotten confused during a conversation with [redacted] because she looked at the account quickly, but there is no doubt that [redacted] is not entitled to any money. Just to make certain that the secondary insurance company paid the claim properly, I contacted them on March [redacted], and sent the claim back to them for re-review to verify that they paid toward these services according to their fee structure. If the claim was overpaid in any way, the money will be returned by me to the secondary insurance company, and not to [redacted].
In 2013, [redacted] also received high quality dental treatment. At this time, she had only 1 form of insurance. That insurance claim has been submitted, and [redacted] has not yet made a copayment for this service. The secondary coverage for the 2011 service in no way can be used toward a 2013 procedure. In addition, [redacted] signed a statement that she would incur a $50 fee for each missed appointment. I have that statement in hand. To date, [redacted] has missed a total of 3 appointments. I am not obligated to remind her of this, as she signed up to this provision when she agreed to be treated, and is still accountable for it. Just to be clear, the secondary coverage for the 2011 service cannot be used for missed appointment fees either. My office did mistakenly issue a $58 check to [redacted] in all the commotion and confusion, before it was clear the last payment on the account was a secondary insurance payment, and not a payment by [redacted]. Since it was back in 2011, a bit of investigation was required to make certain we had the facts straight.
In summary, my business is actually due money from [redacted], and not the other way around. Money paid to medical practitioners for specific medical procedures is not available for personal spending, just because it came from a secondary insurance company. This is not legal, nor does it make any sense. I am still waiting for an official response from the secondary insurance company, and I will return any excess money to them if they made an error and overpaid the claim. I will not violate my contractual obligations with the insurance providers by applying payments that are designates for specific services to patient refunds, or any other unintended purpose.
border-width: medium; border-style: none; border-image: none; background: none repeat scroll 0% 0% whitesmoke; padding: 0in 6.75pt 5.25pt;">
[redacted] is mistaken that she is owed any money by my office. She was treated by me in 2011, and received high quality dental care. She had 2 forms of insurance coverage at the time: 1 through her employer, and 1 through her husband. My office manager submitted claims to both insurance companies. [redacted] did not pay any co-pay out of pocket for this treatment. Sometimes, the secondary insurance company does not pay anything if they feel what the primary insurance company has paid is adequate. In this case, both insurance companies did pay toward her 2011 services. That does this mean that [redacted] had a "refund due". It is unlawful for a patient to financially benefit from an insurance payment that is solely intended for healthcare services. [redacted] is inappropriately stating that my office should have issued her a check so she could use the secondary insurance payment for personal spending, which is never done. My staff assistant may have gotten confused during a conversation with [redacted] because she looked at the account quickly, but there is no doubt that [redacted] is not entitled to any money. Just to make certain that the secondary insurance company paid the claim properly, I contacted them on March [redacted], and sent the claim back to them for re-review to verify that they paid toward these services according to their fee structure. If the claim was overpaid in any way, the money will be returned by me to the secondary insurance company, and not to [redacted].
In 2013, [redacted] also received high quality dental treatment. At this time, she had only 1 form of insurance. That insurance claim has been submitted, and [redacted] has not yet made a copayment for this service. The secondary coverage for the 2011 service in no way can be used toward a 2013 procedure. In addition, [redacted] signed a statement that she would incur a $50 fee for each missed appointment. I have that statement in hand. To date, [redacted] has missed a total of 3 appointments. I am not obligated to remind her of this, as she signed up to this provision when she agreed to be treated, and is still accountable for it. Just to be clear, the secondary coverage for the 2011 service cannot be used for missed appointment fees either. My office did mistakenly issue a $58 check to [redacted] in all the commotion and confusion, before it was clear the last payment on the account was a secondary insurance payment, and not a payment by [redacted]. Since it was back in 2011, a bit of investigation was required to make certain we had the facts straight.
In summary, my business is actually due money from [redacted], and not the other way around. Money paid to medical practitioners for specific medical procedures is not available for personal spending, just because it came from a secondary insurance company. This is not legal, nor does it make any sense. I am still waiting for an official response from the secondary insurance company, and I will return any excess money to them if they made an error and overpaid the claim. I will not violate my contractual obligations with the insurance providers by applying payments that are designates for specific services to patient refunds, or any other unintended purpose.