I am rejecting this response because:
The time frame for the pre-authorization was approved for 6 months. The date of the pre-authorization letter is April 3, 2013 and began on that date to 7/3/2013. It is not the pre-authorization that is in dispute, it is the time period of 5 months that passed before the billing person billed the dental insurance. Because the plan is considered a "self funded" plan according to the State of California Department of Insurance, the employer is responsible for payment. I'm not disagreeing that I owe my portion but the billing department NEGLIGENTLY handled the billing unprofessionaly and inadequate, thus why the claim never got paid. By the time she submitted the claim which was on 11/18/2013 and not 11/11/2013, the insurance with Premier had switched and resulted in further delaying the process of the claim. By the time the employer received the claim for review it was almost 9 months later, I cannot obtain access to the records of when the claim was submitted to the employer for payment but regardless, sitting on a claim and waiting 5 months after a procedure had been done and approved for, with a prior authorization seems pointless. If the doctor's office can't comply with due diligence in submitting claims on a timely basis and then expects the patient to pay for the entire balance appears negligent. I have tried to talk to the [redacted], the biller for a reduced amount to help offset the now full amount but I got nowhere. I have tried to make payments and have towards the balance but still feel that it is high and don't feel that I should be responsible for something that is an in-house billing error. I also realize that as a "cash considered" consumer I should not have to pay for what they would charge an insurance and should get a discount because now it's considered a cash payment but I also asked about that and got nowhere. I just want whats fair and never agreed to the amount because the insurance had approved the crown and was charged a high amount and now I'm paying the price for someone's mistake and inadequacy.
I am rejecting this response because:
The time frame for the pre-authorization was approved for 6 months. The date of the pre-authorization letter is April 3, 2013 and began on that date to 7/3/2013. It is not the pre-authorization that is in dispute, it is the time period of 5 months that passed before the billing person billed the dental insurance. Because the plan is considered a "self funded" plan according to the State of California Department of Insurance, the employer is responsible for payment. I'm not disagreeing that I owe my portion but the billing department NEGLIGENTLY handled the billing unprofessionaly and inadequate, thus why the claim never got paid. By the time she submitted the claim which was on 11/18/2013 and not 11/11/2013, the insurance with Premier had switched and resulted in further delaying the process of the claim. By the time the employer received the claim for review it was almost 9 months later, I cannot obtain access to the records of when the claim was submitted to the employer for payment but regardless, sitting on a claim and waiting 5 months after a procedure had been done and approved for, with a prior authorization seems pointless. If the doctor's office can't comply with due diligence in submitting claims on a timely basis and then expects the patient to pay for the entire balance appears negligent. I have tried to talk to the [redacted], the biller for a reduced amount to help offset the now full amount but I got nowhere. I have tried to make payments and have towards the balance but still feel that it is high and don't feel that I should be responsible for something that is an in-house billing error. I also realize that as a "cash considered" consumer I should not have to pay for what they would charge an insurance and should get a discount because now it's considered a cash payment but I also asked about that and got nowhere. I just want whats fair and never agreed to the amount because the insurance had approved the crown and was charged a high amount and now I'm paying the price for someone's mistake and inadequacy.