We will not be posting any of patient records on this forumIt can be sent directly to Mr [redacted] upon his request and signed patient release formHis insurance company sent a few request asking for additional documentation which a few of them were repeated one, which we provided themThat is what Mr [redacted] is talking aboutIt took them days to reject the determination of benefit because of lack of coordination and loss of records and request of the same copies Mr [redacted] has never talked about the fact that his policy was cancelling and he wanted to do his procedure before the end of year Or we would have patiently waited to get a response from his insurance carrier.As we have mentioned above this is a very common procedure and is not denied by most other carriersDenial of this procedure by insurance company does not prove that he did not need itIt only means that they do not want to pay the claim.Insurance companies are famous about collecting premiums and not paying claims.This case is a very good example of it.We would be glad to accommodate Mr [redacted] and come to a middle grounds with him as the nature of this complaint is purely financialHe may contact our office directly
[redacted] has been a patient of our practice since He is a pleasant and responsible patient and we have had a great pleasure to be at his services.He has always followed our treatment recommendations This time was not an exception when we told him about his moderate gum recessions on few of his upper teeth and made a recommendation to prevent it from getting worst by doing gum graft surgery He agreed and we sent out a pre-authorization request to his insurance company (on October 12th, 20016)He came for his cleaning on December we discussed his treatment and told him his authorization is not back and his Insurance Company had asked for additional information which we had provided He scheduled his procedure to be done on December 29th hoping the authorization would be in (this was the last day of the year that office was open)He wanted to use his benefits since he had already met his deductible before the end of the year On that day we reviewed the procedure and told him pre-authorization request is not back after days We also told him we don't see a problem with this procedure coverage as most other insurance companies cover this procedure routinely It was at his discretion if he wanted to do the procedureMr [redacted] wanted to do the procedure before the year end and to use his dental benefit since he had met his deductibleHe read and signed the informed consent and we completed the procedureHe came back in January for poand suture removal and there was no issue about his claim payment as we were still waiting to getting paid It was not until January 31st when we found out his procedure was denied Then we sent him a statementMr [redacted] did not reply to our multiple correspondences His account was sent to collection on April 10thIt was at that time that he called and inquired about his accountWe are ready to release his signed consent for his dental procedure upon his request of release of record We have also found that he does not have coverage with this insurance Company and that could mean he wanted to do the procedure before his insurance expiration.We informed Mr [redacted] this procedure is covered by majority of insurances Unfortunately his particular insurance Company denied itThis does not mean he did not need the procedure but it means his policy had limitation of coverage It is unfortunate that we lost him as a great patient [redacted] , DDS, AFAAIDAdvanced Smile Center [redacted] ***Austin, TX 78728512-244-
Mrs*** was seen on May 15th for toothache after being in pain for a whileShe was x-rayed and was told she needs to have a few bad teeth removedShe got a prescription for infection and pain (narcotics)She was scheduled to have two teeth removed on May 18th due to the long lasting
infectionIt was explained to her that is for her best interest and safety to be on antibiotics for few days prior to extractionLater on she called and asked for sedation She was offered nsedation to control her anxiety and pain in addition to local anesthesiaMrs*** declined the sedation due to the cost She was seen on her appointment and the teeth were extracted under local anesthesia using plenty of Lidocain within a safe margin but she kept complaining due to her sever anxietyHad she selected the sedation, she would have not even remembering her tooth extractionShe was given prescription strength Motrin (mg) She did not complain nor did she ask for anything differentHer friend called and complained which we could not give her much information due to HIPA privacy actWe asked if Mrs*** could stop by to pick up prescription for narcotics as these drugs can not be called inPatient picked up prescription that dayHad Mrs*** asked for narcotics , she would have given itIt was doctor's discretion to write anti-inflammatory drug like Motrin 800mg to control the post op discomfort and inflammation
Complaint: ***
I am rejecting this response because:Unfortunately, the events detailed are not accurate I would not have given consent to this procedure if I was informed that there was not consent for the procedure Upon further investigating from the insurance company, they sent an inquiry about the procedure which I forwarded to the dental office They assured me that this was something that they were resolving I do not give consent for any of my personal information (as mentioned in Dr***'s response of my consent) to be released to be open to the public I will take a copy to be mailed to my home address Specifically, my insurance company, Aetna notated this on the denial of this claim:"Your plan only provides coverage for services and supplies that we find to be necessary for the diagnosis, care or treatment of the condition involvedBased upon consulting dentist review of submitted documentation, there appears to be no evidence of a mucogingival defect that would require treatmentMembers should not be billed for this serviceFor reconsideration, please ask your provider to resubmit this claim with additional information."
Regards,
*** ***
[redacted] has been a patient of our practice since 2004. He is a pleasant and responsible patient and we have had a great pleasure to be at his services.He has always followed our treatment recommendations . This time was not an exception when we told him about his moderate gum recessions on few...
of his upper teeth and made a recommendation to prevent it from getting worst by doing gum graft surgery. He agreed and we sent out a pre-authorization request to his insurance company (on October 12th, 20016). He came for his cleaning on December 22. we discussed his treatment and told him his authorization is not back and his Insurance Company had asked for additional information which we had provided . He scheduled his procedure to be done on December 29th hoping the authorization would be in (this was the last day of the year that office was open). He wanted to use his benefits since he had already met his deductible before the end of the year. On that day we reviewed the procedure and told him pre-authorization request is not back after 78 days . We also told him we don't see a problem with this procedure coverage as most other insurance companies cover this procedure routinely. It was at his discretion if he wanted to do the procedure. Mr. [redacted] wanted to do the procedure before the year end and to use his dental benefit since he had met his deductible. He read and signed the informed consent and we completed the procedure. He came back in January for post-op and suture removal and there was no issue about his claim payment as we were still waiting to getting paid. It was not until January 31st when we found out his procedure was denied . Then we sent him a statement. Mr. [redacted] did not reply to our multiple correspondences . His account was sent to collection on April 10th. It was at that time that he called and inquired about his account. We are ready to release his signed consent for his dental procedure upon his request of release of record. We have also found that he does not have coverage with this insurance Company and that could mean he wanted to do the procedure before his insurance expiration.We informed Mr. [redacted] this procedure is covered by majority of insurances . Unfortunately his particular insurance Company denied it. This does not mean he did not need the procedure but it means his policy had limitation of coverage . It is unfortunate that we lost him as a great patient. [redacted], DDS, AFAAIDAdvanced Smile Center[redacted]Austin, TX 78728512-244-7677
We will not be posting any of patient records on this forum. It can be sent directly to Mr. [redacted] upon his request and signed patient release form. His insurance company sent a few request asking for additional documentation which a few of them were repeated one, which we provided them. That is what Mr. [redacted] is talking about. It took them 78 days to reject the determination of benefit because of lack of coordination and loss of records and request of the same copies . Mr. [redacted] has never talked about the fact that his policy was cancelling and he wanted to do his procedure before the end of year . Or we would have patiently waited to get a response from his insurance carrier.As we have mentioned above this is a very common procedure and is not denied by most other carriers. Denial of this procedure by insurance company does not prove that he did not need it. It only means that they do not want to pay the claim.Insurance companies are famous about collecting premiums and not paying claims.This case is a very good example of it.We would be glad to accommodate Mr. [redacted] and come to a middle grounds with him as the nature of this complaint is purely financial. He may contact our office directly.
We will not be posting any of patient records on this forumIt can be sent directly to Mr [redacted] upon his request and signed patient release formHis insurance company sent a few request asking for additional documentation which a few of them were repeated one, which we provided themThat is what Mr [redacted] is talking aboutIt took them days to reject the determination of benefit because of lack of coordination and loss of records and request of the same copies Mr [redacted] has never talked about the fact that his policy was cancelling and he wanted to do his procedure before the end of year Or we would have patiently waited to get a response from his insurance carrier.As we have mentioned above this is a very common procedure and is not denied by most other carriersDenial of this procedure by insurance company does not prove that he did not need itIt only means that they do not want to pay the claim.Insurance companies are famous about collecting premiums and not paying claims.This case is a very good example of it.We would be glad to accommodate Mr [redacted] and come to a middle grounds with him as the nature of this complaint is purely financialHe may contact our office directly
[redacted] has been a patient of our practice since He is a pleasant and responsible patient and we have had a great pleasure to be at his services.He has always followed our treatment recommendations This time was not an exception when we told him about his moderate gum recessions on few of his upper teeth and made a recommendation to prevent it from getting worst by doing gum graft surgery He agreed and we sent out a pre-authorization request to his insurance company (on October 12th, 20016)He came for his cleaning on December we discussed his treatment and told him his authorization is not back and his Insurance Company had asked for additional information which we had provided He scheduled his procedure to be done on December 29th hoping the authorization would be in (this was the last day of the year that office was open)He wanted to use his benefits since he had already met his deductible before the end of the year On that day we reviewed the procedure and told him pre-authorization request is not back after days We also told him we don't see a problem with this procedure coverage as most other insurance companies cover this procedure routinely It was at his discretion if he wanted to do the procedureMr [redacted] wanted to do the procedure before the year end and to use his dental benefit since he had met his deductibleHe read and signed the informed consent and we completed the procedureHe came back in January for poand suture removal and there was no issue about his claim payment as we were still waiting to getting paid It was not until January 31st when we found out his procedure was denied Then we sent him a statementMr [redacted] did not reply to our multiple correspondences His account was sent to collection on April 10thIt was at that time that he called and inquired about his accountWe are ready to release his signed consent for his dental procedure upon his request of release of record We have also found that he does not have coverage with this insurance Company and that could mean he wanted to do the procedure before his insurance expiration.We informed Mr [redacted] this procedure is covered by majority of insurances Unfortunately his particular insurance Company denied itThis does not mean he did not need the procedure but it means his policy had limitation of coverage It is unfortunate that we lost him as a great patient [redacted] , DDS, AFAAIDAdvanced Smile Center [redacted] ***Austin, TX 78728512-244-
Mrs*** was seen on May 15th for toothache after being in pain for a whileShe was x-rayed and was told she needs to have a few bad teeth removedShe got a prescription for infection and pain (narcotics)She was scheduled to have two teeth removed on May 18th due to the long lasting
infectionIt was explained to her that is for her best interest and safety to be on antibiotics for few days prior to extractionLater on she called and asked for sedation She was offered nsedation to control her anxiety and pain in addition to local anesthesiaMrs*** declined the sedation due to the cost She was seen on her appointment and the teeth were extracted under local anesthesia using plenty of Lidocain within a safe margin but she kept complaining due to her sever anxietyHad she selected the sedation, she would have not even remembering her tooth extractionShe was given prescription strength Motrin (mg) She did not complain nor did she ask for anything differentHer friend called and complained which we could not give her much information due to HIPA privacy actWe asked if Mrs*** could stop by to pick up prescription for narcotics as these drugs can not be called inPatient picked up prescription that dayHad Mrs*** asked for narcotics , she would have given itIt was doctor's discretion to write anti-inflammatory drug like Motrin 800mg to control the post op discomfort and inflammation
Complaint: ***
I am rejecting this response because:Unfortunately, the events detailed are not accurate I would not have given consent to this procedure if I was informed that there was not consent for the procedure Upon further investigating from the insurance company, they sent an inquiry about the procedure which I forwarded to the dental office They assured me that this was something that they were resolving I do not give consent for any of my personal information (as mentioned in Dr***'s response of my consent) to be released to be open to the public I will take a copy to be mailed to my home address Specifically, my insurance company, Aetna notated this on the denial of this claim:"Your plan only provides coverage for services and supplies that we find to be necessary for the diagnosis, care or treatment of the condition involvedBased upon consulting dentist review of submitted documentation, there appears to be no evidence of a mucogingival defect that would require treatmentMembers should not be billed for this serviceFor reconsideration, please ask your provider to resubmit this claim with additional information."
Regards,
*** ***
[redacted] has been a patient of our practice since 2004. He is a pleasant and responsible patient and we have had a great pleasure to be at his services.He has always followed our treatment recommendations . This time was not an exception when we told him about his moderate gum recessions on few...
of his upper teeth and made a recommendation to prevent it from getting worst by doing gum graft surgery. He agreed and we sent out a pre-authorization request to his insurance company (on October 12th, 20016). He came for his cleaning on December 22. we discussed his treatment and told him his authorization is not back and his Insurance Company had asked for additional information which we had provided . He scheduled his procedure to be done on December 29th hoping the authorization would be in (this was the last day of the year that office was open). He wanted to use his benefits since he had already met his deductible before the end of the year. On that day we reviewed the procedure and told him pre-authorization request is not back after 78 days . We also told him we don't see a problem with this procedure coverage as most other insurance companies cover this procedure routinely. It was at his discretion if he wanted to do the procedure. Mr. [redacted] wanted to do the procedure before the year end and to use his dental benefit since he had met his deductible. He read and signed the informed consent and we completed the procedure. He came back in January for post-op and suture removal and there was no issue about his claim payment as we were still waiting to getting paid. It was not until January 31st when we found out his procedure was denied . Then we sent him a statement. Mr. [redacted] did not reply to our multiple correspondences . His account was sent to collection on April 10th. It was at that time that he called and inquired about his account. We are ready to release his signed consent for his dental procedure upon his request of release of record. We have also found that he does not have coverage with this insurance Company and that could mean he wanted to do the procedure before his insurance expiration.We informed Mr. [redacted] this procedure is covered by majority of insurances . Unfortunately his particular insurance Company denied it. This does not mean he did not need the procedure but it means his policy had limitation of coverage . It is unfortunate that we lost him as a great patient. [redacted], DDS, AFAAIDAdvanced Smile Center[redacted]Austin, TX 78728512-244-7677
We will not be posting any of patient records on this forum. It can be sent directly to Mr. [redacted] upon his request and signed patient release form. His insurance company sent a few request asking for additional documentation which a few of them were repeated one, which we provided them. That is what Mr. [redacted] is talking about. It took them 78 days to reject the determination of benefit because of lack of coordination and loss of records and request of the same copies . Mr. [redacted] has never talked about the fact that his policy was cancelling and he wanted to do his procedure before the end of year . Or we would have patiently waited to get a response from his insurance carrier.As we have mentioned above this is a very common procedure and is not denied by most other carriers. Denial of this procedure by insurance company does not prove that he did not need it. It only means that they do not want to pay the claim.Insurance companies are famous about collecting premiums and not paying claims.This case is a very good example of it.We would be glad to accommodate Mr. [redacted] and come to a middle grounds with him as the nature of this complaint is purely financial. He may contact our office directly.