Evan Mondshine DDS PC

[redacted]                   [redacted]               [redacted]   We are in receipt of...

your email correspondence to us of 07/**/2017 regarding a complaint submitted to the New York Revdex.com by our patient, Janice Dixon.  We have had several conversations with [redacted] regarding this matter and we thought it was resolved on 07/**/2017 when we issued her a refund check in the amount of $34.80.  Based on her complaint to you, we now realize she was not due any refund from our office, but we are not seeking repayment from the patient at this time.   The patient commenced treatment with our office on 12/**/2016.  The patient responsibility for that visit, per the Cigna Dental EOB, totaled $31.00.  At that time, we provided the patient with the treatment plan for a 3-unit bridge with an estimated out of pocket expense of $825.00 which the patient paid on 12/**/2016.  The claim for the bridge was submitted to her insurance carrier, Cigna Dental, and it was processed by them on 05/**/2017.  In that EOB, they note a patient responsibility of $709.20, but failed to include an $89.00 contracted amount for procedure code D2950 in the patient responsibility total.  Our billed amount for the procedure was $175.00. Based on the contract and agreed upon fee schedule rates we maintain with the insurance carrier (Cigna), we are permitted to charge the patient the contracted amount reduced by the amount eligible for coverage under the patient’s plan.  In this instance, the patient’s plan did not provide any coverage for this procedure code and we are allowed to bill the patient for the total contracted amount.  This information has been documented with Cigna under reference #[redacted] per our telephone conversation with them on 07/**/2017.  Therefore, the amount of $34.80 we refunded to the patient on 07/**/2017 was incorrect.   The corrected net amount due is as follows:   [redacted]                                              *  [redacted]                            [redacted]            [redacted]            [redacted]
           [redacted]                                         **   [redacted]
    Since we inadvertently missed that the patient owed us the $89.00 and calculated her $50.00 annual deductible into our calculation, the refund of $34.80 we processed on 7/**/17 was incorrect.  We are not going to stop payment on the check we issued, but the patient now owes our office a total of $39.00.  Based on these accurate and verified computations, we do not owe the patient the $115.75 she is seeking.       Copies of the relevant EOB’s are attached for your review.  Please contact us if any additional information is required for this complaint.   Thank you,   Evan M[redacted] DDS