Dr. Robert M. Zitofsky

Review: On **/**/2013, My husband [redacted] Had services provided by Dr. [redacted] under the impression that his dental insurance was covering for this services. I [redacted]. (wife) spoke with [redacted] (office secretary) prior my husbands visit in which she informed me that she verified our dental insurance and that we were covered, and my husband could come in on date scheduled. We have been receiving bills, but we do not owe them anything. Yesterday **/**/13, Ann informed me that she did not know if our dental insurance was going to cover specific services. They went ahead and provided services not knowing if payment were going to be received to bill my husband, who was unaware and he was never informed he will have to pay out of packet for the work being provided. My husband was mislead into getting services not covered by the insurance. We have been harassed into paying $**0.00 dollars and Now by a lawyer stating that we are being sued and we have to pay for their attorney. My husband was misinformed, we were told our insurance will pay. If there is something not covered by the insurance the provider should have explained to my husband and gotten agreement by my husband to do the work. They told him, everything was fine and not to worry about it. In the mean time, they sent us a bill, which we did not agree. I thank you in advance for your prompt attention to this matter. We dod not owe them any money, my husband never agreed to services provided not being covered by the insurance.

Business

Response:

To Whom it May Concern;

RE: [redacted]

I would like to personally respond to Mrs. [redacted]' s complaint concerning her husband's invoice as follows: On April **, 2013, Mr. [redacted] presented

to my office in severe pain. I examined him promptly and quickly determined that Mr. [redacted] was in need of immediate treatment. Without divulging the specific details of Mr. [redacted]'s condition, I performed

the procedures necessary to treat the patient's severe pain as well as the spread of an active infection. The statement contained in Mrs. [redacted]'s complaint which claims that her husband

was misled into receiving services not covered by his insurance is simply untrue.

We are a participating provider with Mr. [redacted]'s insurance company. As such, we agree to a set fee schedule of covered procedures. It does not mean, however,

that the insurance company has agreed to pay 100% of the fee set by their schedule.

As per our office policy, the patient's benefits were verified. Mr. [redacted] Insurance was active at the time of his visit and we processed the claim for that day's services accordingly.

Mr. [redacted] insurance company covered some of the treatment, but claimed that Mr. [redacted] was responsible for payment of $150.00.

Dvnamic Dental Arts of Rockland

At the time ofregistration, Mr. [redacted] was informed that insurance companies (depending on the company and the specific plan held by the patient) may not pay for 100% of the treatment received. Mr. [redacted]

was informed that he may be responsible for all or some of the visit. We provided Mr. [redacted] with two forms to that effect:

(1) our "Office Polley" form; and (2) our "Possible co-pay and coinsurance" disclosure fonn, which Mr. [redacted] reviewed and then signed.

With regard to billing, prior to sending a claim to our outside billing agent, we send our patients a series of three gentle reminder letters:

a 30-letter; a 60-day letter, and a 90-day letter. had Mr. [redacted] responded to any of these communications, I would have happily addressed his

concerns regarding the statement of his account. Unfortunately, I never had that opportunity.

Sincerely,

Re: Possible Co-pay and Coinsurance

Our office is notifying you that yon may be responsible for a coinsurance as well as your nonnal co­ pay based on tlle services rendered

on the day of your visit. We will bill the visit to your insurance carrier and balance bill you for uny additional co-pay/coinsurance or deductible applied to your visit Loday. Please be aware that we arc only billing you based on the guidelines of your individual

insurance policy.

Office policy - please read

Please understand that payment is due at the time of service unless prior arrangements have been made. We will accept most insurance plans as full or

partial payment depending upon the plan's guidelines. We also accept MasterCard/Visa. Rerturned checks will be charged a $35 fee.

As you know, it is ultimately your responsibility to make certain that this office is paid for the services

it renders to you or your dependents. We, therefore, kindly ask that student proof for college students is presented to this office at the time

of your child's dental visit. If student proof is not submitted to this office prior to work being performed, then we

must collect our fee directly from you at the time of the appointment. Of course, once student proof is obtained, this office will immediately

submit it to your insurance company so that you can be reimbursed as quickly as possible.

The office reserves the right to charge $50 for a broken appointment. We request two business days notice if you cannot keep

your appointment. Please be on time for your appointment as the office makes every attempt to remain on schedule.

Please sign below that you have read and understand the office policy.