Thank you for submitting a copy of the statement. As I had mentioned I was not given any kind of a statement from the day of the appointment or at any time sent out to us in the mail. After review, this refund check for $ is a check that was sent to DrYezerski's office in error by Humana and Humana called to make sure he was aware that this payment should be sent directly to us for the $ 85.00.
The check arrived in today's mail.
Thank you for your help!
*** ***
Complaint ID *** This message is in response to a recent complaint by one of my patients Complaint ID ***The patient called my office to schedule an appointment for a tooth extractionWhen he scheduled his appointment he was asked, as are all our patients, if there was any dental
insuranceHis response was that he had Delta Dental and asked if we were a participating providerHe was informed at that we were a Premier provider of Delta Dental and not a PPO ProviderHe asked what the difference wasHe was told that a Premier Plan typically pays at a lower rate but, not alwaysAn example was given of a PPO Plan paying at 100% when the Premier may only pay only 80%We wouldn't know until we obtained his benefits from Delta DentalHe was informed that we would get his benefits from Delta and collect according to his benefits at the time of his appointmentHe was in agreement at the time of schedulingThe patient paid the estimated out of pocket amount of $at time of discharge, reluctantlyHis total cost was $He was also Informed that we would file his claim with Delta Dental, which we did, and as of today, April 20, 2017, we have not heard from DeltaThe patient was also informed that over payment made by the patient would be refundedWe do refunds twice a month
Complaint ID *** As I stated in my previous response, we ask all of our patients what type of dental insurance they have just to avoid problems such as we are currently experiencingWe told him we were a Premier Provider and not a PPO provider, and we would obtain benefits and collect accordinglyThere was no intent made to deceive our patient which is why we inform them from the initial call to avoid any surprisesWe collected in accordance with the benefits obtained from his insurance company which is what we stated we would doAs of today 5/3/we have not heard from Delta in response to the claim filedUpon calling Delta they stated that the claim had been processed and a check was issued in the amount of$leaving the patient with a copay of $Once we actually do receive payment, any over payment by our patient will be refunded immediatelyAs previously stated, we want to avoid any conflict with patients., which is why we obtain insurance information with their initial phone callWe believe that our office personnel did everything reasonably expected to inform this individual of the status of his insurance situation As you can see from the attached copy he acknowledged our payment policy and understood he was responsible for understanding his insurance benefitsTherefor we feel there is no justification in further negotiation our fee after the factAs of this writing May 4, 2017, he is being sent a refund of $in keeping with his insurance coverage policyAs you folks at the Revdex.com can probably discern, over the last years you have seen perhaps one other complaint about our originationI believe that fact alone will support that the failure to properly comprehend insurance coverage was not of our making
Consumer responded via phone:The main frustration for the consumer was that the office never disclosed to him that his coverage would not have been 100%. He feels it is not right and still feels like he was taken advantage off. He feels the business should have told him this information before any services took place so he could continue down his list and find a dentist that offered 100% coverage.
Dear Ms. [redacted],
This note is in response to the complaint submitted to the Revdex.com on August 16, 2016 and September 11, 2015. The complaint was assigned ID [redacted].
Please see enclosed a copy of the patients walk out statement for date of service June 18, 2015 which does indicate that a receipt for 5115.00 by check #[redacted] was issued. Also, enclosed is a copy of the refund check dated and sent on September 11, 2015 for the amount of $85.
On September 11, 2015 a representative from Humana called upon members' request. We informed them of receiving the Explanation of Benefits and payment, and that the patient would be receiving a refund in the amount of $85.
Sincerely,
D. Yezerski, D.D.S.
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.
Regards,
[redacted]
when I called around looking for an oral surgeon I told the deceptionist what kind of insurance I had. why on earth would I use an oral surgeon that only took part of my insurance if they would of stated they did not take my insurance or there would be a co pay I would have continued looking for another oral surgeon. they did not say a word about money or a co pay until I was standing there bleeding after the surgery. my point is I told them what kind of insurance I had, instead of confusing me withdelta dental premier or ppo just simply state with the insurance I had if I used their services there would be an out of pocket expense to me. and I would have said thank you and continued to the next name on my delta website list. the lady I talked to deceived me so I would use their services. this 225.00 expense was totally un expected and put in the hole.
This note is in response to the complaint submitted to the Revdex.com on August 16, 2016. The complaint was assigned [redacted]. During my first encounter with the individual she was with her daughter who essentially spoke for her. I found the daughter to be abrupt, argumentative, difficult to...
communicate with, and generally unpleasant. During our second meeting the daughter was verbally abusive to my staff including the comment made to my receptionist the "if she would lose weight she might be able to do a better job." When I once again spoke with the individual's daughter I found her unpleasant and argumentative. I came quickly to believe our personalities were not compatible and that her care would be best provided by another individual. I shared my belief with the ladies and recommended they make other arrangements for her care to be provided by a person more tailored to their preference, and then excused myself. I trust this helps shed light on what turned out to be a basic personality conflict.
We just spoke and I've attached the two documents as you requested. The canceled check is made to his office for $115.00. The day I was in for services they could not give me a receipt because their office equipment was not up and running the way it should and they couldn't give me a receipt. The other attachment is a copy of my provider's claim for the exact same amount on 6/18/2015 for $ 115.00.
After just speaking with Human's Fraud Dept about this issue, they called Dr. Yezerski's office while I was waiting on the phone, and they told them that they were aware of the claim that was submitted and would be sending me a refund for the amount of $ 115.00 that had been billed through Humana.
I'm not really sure if I can believe them at this point. So we'll give it a week or so and I will be in touch with you when and if I receive it in the mail.
Thank you again for your help!
Respectfully,
[redacted]
Thank you for submitting a copy of the statement. As I had mentioned I was not given any kind of a statement from the day of the appointment or at any time sent out to us in the mail. After review, this refund check for $ is a check that was sent to DrYezerski's office in error by Humana and Humana called to make sure he was aware that this payment should be sent directly to us for the $ 85.00.
The check arrived in today's mail.
Thank you for your help!
*** ***
Complaint ID *** This message is in response to a recent complaint by one of my patients Complaint ID ***The patient called my office to schedule an appointment for a tooth extractionWhen he scheduled his appointment he was asked, as are all our patients, if there was any dental
insuranceHis response was that he had Delta Dental and asked if we were a participating providerHe was informed at that we were a Premier provider of Delta Dental and not a PPO ProviderHe asked what the difference wasHe was told that a Premier Plan typically pays at a lower rate but, not alwaysAn example was given of a PPO Plan paying at 100% when the Premier may only pay only 80%We wouldn't know until we obtained his benefits from Delta DentalHe was informed that we would get his benefits from Delta and collect according to his benefits at the time of his appointmentHe was in agreement at the time of schedulingThe patient paid the estimated out of pocket amount of $at time of discharge, reluctantlyHis total cost was $He was also Informed that we would file his claim with Delta Dental, which we did, and as of today, April 20, 2017, we have not heard from DeltaThe patient was also informed that over payment made by the patient would be refundedWe do refunds twice a month
Complaint ID *** As I stated in my previous response, we ask all of our patients what type of dental insurance they have just to avoid problems such as we are currently experiencingWe told him we were a Premier Provider and not a PPO provider, and we would obtain benefits and collect accordinglyThere was no intent made to deceive our patient which is why we inform them from the initial call to avoid any surprisesWe collected in accordance with the benefits obtained from his insurance company which is what we stated we would doAs of today 5/3/we have not heard from Delta in response to the claim filedUpon calling Delta they stated that the claim had been processed and a check was issued in the amount of$leaving the patient with a copay of $Once we actually do receive payment, any over payment by our patient will be refunded immediatelyAs previously stated, we want to avoid any conflict with patients., which is why we obtain insurance information with their initial phone callWe believe that our office personnel did everything reasonably expected to inform this individual of the status of his insurance situation As you can see from the attached copy he acknowledged our payment policy and understood he was responsible for understanding his insurance benefitsTherefor we feel there is no justification in further negotiation our fee after the factAs of this writing May 4, 2017, he is being sent a refund of $in keeping with his insurance coverage policyAs you folks at the Revdex.com can probably discern, over the last years you have seen perhaps one other complaint about our originationI believe that fact alone will support that the failure to properly comprehend insurance coverage was not of our making
Consumer responded via phone:The main frustration for the consumer was that the office never disclosed to him that his coverage would not have been 100%. He feels it is not right and still feels like he was taken advantage off. He feels the business should have told him this information before any services took place so he could continue down his list and find a dentist that offered 100% coverage.
Dear Ms. [redacted],
This note is in response to the complaint submitted to the Revdex.com on August 16, 2016 and September 11, 2015. The complaint was assigned ID [redacted].
Please see enclosed a copy of the patients walk out statement for date of service June 18, 2015 which does indicate that a receipt for 5115.00 by check #[redacted] was issued. Also, enclosed is a copy of the refund check dated and sent on September 11, 2015 for the amount of $85.
On September 11, 2015 a representative from Humana called upon members' request. We informed them of receiving the Explanation of Benefits and payment, and that the patient would be receiving a refund in the amount of $85.
Sincerely,
D. Yezerski, D.D.S.
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.
Regards,
[redacted]
when I called around looking for an oral surgeon I told the deceptionist what kind of insurance I had. why on earth would I use an oral surgeon that only took part of my insurance if they would of stated they did not take my insurance or there would be a co pay I would have continued looking for another oral surgeon. they did not say a word about money or a co pay until I was standing there bleeding after the surgery. my point is I told them what kind of insurance I had, instead of confusing me withdelta dental premier or ppo just simply state with the insurance I had if I used their services there would be an out of pocket expense to me. and I would have said thank you and continued to the next name on my delta website list. the lady I talked to deceived me so I would use their services. this 225.00 expense was totally un expected and put in the hole.
This note is in response to the complaint submitted to the Revdex.com on August 16, 2016. The complaint was assigned [redacted]. During my first encounter with the individual she was with her daughter who essentially spoke for her. I found the daughter to be abrupt, argumentative, difficult to...
communicate with, and generally unpleasant. During our second meeting the daughter was verbally abusive to my staff including the comment made to my receptionist the "if she would lose weight she might be able to do a better job." When I once again spoke with the individual's daughter I found her unpleasant and argumentative. I came quickly to believe our personalities were not compatible and that her care would be best provided by another individual. I shared my belief with the ladies and recommended they make other arrangements for her care to be provided by a person more tailored to their preference, and then excused myself. I trust this helps shed light on what turned out to be a basic personality conflict.
We just spoke and I've attached the two documents as you requested. The canceled check is made to his office for $115.00. The day I was in for services they could not give me a receipt because their office equipment was not up and running the way it should and they couldn't give me a receipt. The other attachment is a copy of my provider's claim for the exact same amount on 6/18/2015 for $ 115.00.
After just speaking with Human's Fraud Dept about this issue, they called Dr. Yezerski's office while I was waiting on the phone, and they told them that they were aware of the claim that was submitted and would be sending me a refund for the amount of $ 115.00 that had been billed through Humana.
I'm not really sure if I can believe them at this point. So we'll give it a week or so and I will be in touch with you when and if I receive it in the mail.
Thank you again for your help!
Respectfully,
[redacted]