Dr. Phillip M. Palella DDS PC

Complaint: [redacted] I am rejecting this response because the receptionist explicitly stated that my insurance was updated in the system in MarchI'm not sure why she stated this if it's not true, but I'm relying on the information provided to me to be accurate and trueI do not know how their system works or how they update information, and it is not my responsibility to knowI did my part by notifying them of the change in insurance and was, in turn, assured by a Modetn Dental employee that they had current insurance information Sincerely, Bailey ***

Initial Business Response / [redacted] (1000, 5, 2015/07/23) */ The bill is coming from two exams and two x-rays that were not covered by your insuranceMost insurance plans cover these at 100%; therefore, nothing was collected at the time of serviceHowever, after submitting the claims to insurance, we received notification that they were not covered services due to frequency of the exams and your yearly deductible that applied to the x-raysTherefore, leaving you with a balance for these exams/x-raysThere can be a delay in receiving this information from insurance, sometimes notice takes up to months to correctly process the claim, which is why there was a delay in the bill you've received

Initial Business Response /* (1000, 5, 2015/07/23) */
The bill is coming from two exams and two x-rays that were not covered by your insurance. Most insurance plans cover these at 100%; therefore, nothing was collected at the time of service. However, after submitting the claims to insurance, we...

received notification that they were not covered services due to frequency of the exams and your yearly deductible that applied to the x-rays. Therefore, leaving you with a balance for these exams/x-rays. There can be a delay in receiving this information from insurance, sometimes notice takes up to 4 months to correctly process the claim, which is why there was a delay in the bill you've received.

Complaint: [redacted]
I am rejecting this response because the receptionist explicitly stated that my insurance was updated in the system in March. I'm not sure why she stated this if it's not true, but I'm relying on the information provided to me to be accurate and true. I do not know how their system works or how they update information, and it is not my responsibility to know. I did my part by notifying them of the change in insurance and was, in turn, assured by a Modetn Dental employee that they had current insurance information.
Sincerely,
Bailey [redacted]

We are in-network with all Aetna PPO dental plans. We have never been in-network with any Aetna HMO plans. Aetna does not notify us of any plan changes until a claim is submitted on behalf of the patient. I believe there was miscommunication in regards to the confirmation of the insurance. We...

confirmed that you still had Aetna; which is accurate. Where the miscommunication came, was that while you were still insured with Aetna, you had chosen to change your plan to an HMO rather than a PPO. Therefore, while confirming Aetna was still the dental carrier without notifying us of the change from PPO to HMO, we unknowingly could not provide accurate estimates for your insurance coverage. We do not have an automatic eligibility services, nor does Aetna communicate with us regarding policy changes, until a claim is processed. If there is a change such as going from PPO to HMO, we need to know. Either this is providing us with a new group number, or ID number, or simply stating that it is now an HMO policy. None of this information was provided to us. This is why there was a discrepancy. Because we never have been nor ever will be in-network with HMO insurances, we understand that they do not provide any out of network benefits for the patients. We would have let you know immediately that there are not any out-of-network benefits for you. If the patient knew there was a new HMO policy, it is important we are made aware. This would've resolved the issue immediately. HMO insurances are very specific with their coverage and make the patient select their specific provider and are often limited to their coverage. This should be discussed with the insurance plan administrator. The plan administrator should provide the patient with their dental benefits. While the balance was a surprise to the patient who was unaware of her new insurance benefits, the services were still rendered at our office. Normally, if a patient chooses to come to our office with an HMO or no insurance, we charge our standard office fees which would be as follows: Recall Cleaning/Exam for $119 and a 2-Surface filling for $292, or a total of $411. However, as an effort to reconcile, we honored in-network Aetna PPO fees for the services rendered. Therefore, the services were discounted to a total of $236. This is a discount of $175. While, I know the patient prefers to pay nothing for the services, we are unable to accommodate more than the discount we had already provided. We try our best to provide accurate information to the patient; however, it is the patient's responsibility to be aware of their insurance coverage. We verify benefits as a courtesy to the patient, but we always make the patient aware it is only based off of the information you provide and still an estimate at best.