Crow Family Dentistry

This is really an issue between the patient and her insurance company, [redacted] Our office has just been the unfortunate messengerRegardless, I have a very different recollection of the events that took place, so I will try to address each disparityTo start: I adamantly dispute the patient's claims that she did not want a top retainerI have documentation in a visit with our hygienist on 1-16-that the patient "is concerned that her maxillary teeth are moving, also thinks lower teeth might be moving-has a nightguard but it has broken...will call to discuss this with Dr"I am by nature a very conservative practitioner, and I take great offense to the suggestion that I would have done treatment that the patient did not agree toSecondly: The patient was never told that the treatment would cost $68, and no signed agreement exists that states that amountThe patient's insurance company ( [redacted] ) provided us with documentation that states that they would cover any orthodontic treatment at 50% with no age limitationsThe insurance verification provided by [redacted] did not list any exclusions or limitations to this benefitBased on this information, the patient was advised she would likely owe $for the agreed upon treatment of a new upper and lower retainer (50% of the entire fee of $660)The patient has been our patient for many years and over that time she has signed at least treatment estimates that clearly state: "I understand that the TOTAL PATIENT RESPONSIBILITY is MY LEGAL OBLIGATIONThe estimated Patient Portion is shown only as a convenience to me and is subject to my insurance plan's provisions, limitations and exclusionsI am aware that this may change the amount dueI understand that this is only an ESTIMATE, and IS NOT A GUARANTEE of my insurance company's payment amount." We do our best to help patients navigate their insurance benefits, but it is impossible for our office to be aware of every obscure limitation and exclusion in all insurance plans, as well as the constant changes in every insurance planUnfortunately, in this case that is what happened [redacted] refused to pay the claim due to an "exclusion in the policy"This must be a new "exclusion" by [redacted] , as they have never denied a claim for retainer replacement with our office beforeWhat have we done to help resolve the matter? First of all the front desk has been very apologetic for the surprise denial from [redacted] In addition, over the past months our front desk staff has tried to rebill the claim with [redacted] , they have explained the situation thoroughly with the patient multiple times and have been patient and understanding with the patient when she reported she was unemployedBut now, the patient has been back to work for some time, and she still hasn't even paid what would have been her estimated portion ($330), had her insurance plan paid as we estimatedWhen the patient was in for an appointment on 8-6-15, again our front desk gave her suggestions on how to challenge the decision with [redacted] , perhaps thru her human resources department, or even her union, but instead I received this letter from the Revdex.comAt this point I am willing to continue to make my staff available to help the patient in their pursuit of a resolution with [redacted] , and I am willing to continue to be patient with her ability to make small paymentsI am still undecided if I am willing to continue to see her as a patientThank you for your time,

Complaint: ***I am rejecting this response because:Sincerely,*** *** First of all that statement provided is not at all accurateI asked for a Bottom retainer only" After I was given an estimate for the bottom retainer it came to 165.00,I then said in That cas I'd also be interested in getting a top retainer as wellI had purchased a top night guard from Dr,C*** which after I had it for approxtwo weeks it crackedI informed Dr,C*** that it had cracked,she gave no reply,I paid close to for it but I still use it,I never ever at this time would've asked or agreed to spending That didn't fit my budget and I know what I can afford to pay for,is a long ways from 330, I could understand it if it were a few dollars but to some of us that's a lotOnce I was informed of the huge change in *** I explained that I couldn't afford something that I never said I'd pay,drC*** was out of town for Mothers day,I explained to Betty I'd give the top retainer back until I was able to pay for them,she told me they had no use for them they were made for me,I told her they wouldn't been had I known the ***,she then told me she would talk to Dr.C*** about dropping the added cost because that was not the *** quoted,she said she would let me know when Drc*** returned in a few daysWell I never heard from her so I assumed it was all ok, on 8-5-I went to the office after my cleaning,I was asked what did I plan to do about my bill, I asked what bill for I thought we were even, I had paid the quoted *** for the bottom retainer,I have paid to them to date for the retainer I owe them 70.00,my insurance company informed me had the right procedures been followed by the DrOffice they would've quoted me the correct ***, I hate that we are in this mess,but I pay for my mistakes and should not have to pay for others,I pay my bills and I budgetIf I'm quoted a *** and agree I do expect to pay the amount agreed upon or close to it,with such a lack of money value displayed in this matter I'm not sure I want them to be my dentist either

This is really an issue between the patient and her insurance company, [redacted]. Our office has just been the unfortunate messenger. Regardless, I have a very different recollection of the events that took place, so I will try to address each disparity. To start: I adamantly dispute the...

patient's claims that she did not want a top retainer. I have documentation in a visit with our hygienist on 1-16-14 that the patient "is concerned that her maxillary teeth are moving, also thinks lower teeth might be moving-has a nightguard but it has broken...will call to discuss this with Dr". I am by nature a very conservative practitioner, and I take great offense to the suggestion that I would have done treatment that the patient did not agree to. Secondly: The patient was never told that the treatment would cost $68, and no signed agreement exists that states that amount. The patient's insurance company ([redacted]) provided us with documentation that states that they would cover any orthodontic treatment at 50% with no age limitations. The insurance verification provided by [redacted] did not list any exclusions or limitations to this benefit. Based on this information, the patient was advised she would likely owe $330 for the agreed upon treatment of a new upper and lower retainer (50% of the entire fee of $660). The patient has been our patient for many years and over that time she has signed at least 10 treatment estimates that clearly state: "I understand that the TOTAL PATIENT RESPONSIBILITY is MY LEGAL OBLIGATION. The estimated Patient Portion is shown only as a convenience to me and is subject to my insurance plan's provisions, limitations and exclusions. I am aware that this may change the amount due. I understand that this is only an ESTIMATE, and IS NOT A GUARANTEE of my insurance company's payment amount." We do our best to help patients navigate their insurance benefits, but it is impossible for our office to be aware of every obscure limitation and exclusion in all insurance plans, as well as the constant changes in every insurance plan. Unfortunately, in this case that is what happened. [redacted] refused to pay the claim due to an "exclusion in the policy". This must be a new "exclusion" by [redacted], as they have never denied a claim for retainer replacement with our office before. What have we done to help resolve the matter? First of all the front desk has been very apologetic for the surprise denial from [redacted]. In addition, over the past 8 months our front desk staff has tried to rebill the claim with [redacted], they have explained the situation thoroughly with the patient multiple times and have been patient and understanding with the patient when she reported she was unemployed. But now, the patient has been back to work for some time, and she still hasn't even paid what would have been her estimated portion ($330), had her insurance plan paid as we estimated. When the patient was in for an appointment on 8-6-15, again our front desk gave her suggestions on how to challenge the decision with [redacted], perhaps thru her human resources department, or even her union, but instead I received this letter from the Revdex.com. At this point I am willing to continue to make my staff available to help the patient in their pursuit of a resolution with [redacted], and I am willing to continue to be patient with her ability to make small payments. I am still undecided if I am willing to continue to see her as a patient. Thank you for your time,