Falls Oral Surgery

(Revdex.com Copied from original documentSee attached file.)February 21, [redacted] Revdex.com [redacted] Re: [redacted] Complaint # [redacted] To Whom It May Concern,This letter is in response to the complaint filed by [redacted] regarding services provided by our office and her insurance coverage for the surgery Ms [redacted] was seen in our office for an examination for the removal of her third molars on June 7, After determining that her teeth were impacted, our office contacted her medical insurance to verify if they would consider payment for the proposed surgery We were advised of the amount of coverage that was expected for her care We advised her of the amount of deposit that our office expected on the day of surgery, which was the amount that her insurance would not cover She paid that amount when she arrived for surgery, prior to being taken to the surgical suite We filed the claim to [redacted] medical and when the payment was received, it was determined that they had made an error in their allowable fees for the general anesthesiaYou may or may not be familiar with medical coding On January 1, the coding changed from [redacted] to [redacted] With this, the format for coding and billing for general anesthesia changedThis led to [redacted] was not paying our claims correctlyIn addition, after years of no fee increases, we had negotiated a small fee increase with [redacted] for our general anesthesia claims Compounding this “storm” was the changing of personnel on ***’s side and having to begin anew We were in contact with our representatives to negotiate a correct allowable fee for this new code It took several months for them to finally resolve this issue We did try to explain this situation to Ms [redacted] when she called on August 12, and DrH [redacted] did give her the phone number for our representative so that she could explain to her that our claims were not being paid correctly On that day that she requested a refund We did call [redacted] to determine the correct amount and did forward a refund check to her in the amount of overpayment that was given to our office over the phone After the claim was corrected, the balance was paid in full by her medical insurance *** We did file the claim then with her dental carrier ( [redacted] ) for possible secondary coverage of her portionThey sent her explanation of benefits showing that money was being “taken back” by [redacted] and additional payment being paid The problem was her claim was on a bulk check with other patient payments listed as well The amounts listed as payments on that check did not total correctly so I called to get clarification on the correct amount that should be applied to each account on the bulk check It was not easy to determine so I was asked to FAX the explanation so that they could explain the correct payment We called several times to try to resolve this confusion Ms [redacted] called and was on the phone with me for over minutes asking about getting a refund back I tried to explain to her what was happening with the check and that it had not been deposited until we were advised of the correct amount to apply to her account She was difficult to speak with because of interrupting as I tried to explain this to her and she was threatening our office to call the police and call the Revdex.com and swearing When I told her that I could not allow her to threaten and swear at me, she stated that she was threatening me and would call the police if I hung up on her She was going to explain to them that we stole her money On February 14, 2017, I did get to speak to Barbara at [redacted] and she was able to explain the correct amount of payment, it was posted and the overpayment was sent to Ms [redacted] I did call her and leave a message that we were sending her a refund of $and that amount would make her responsibility $total, as listed on her explanation of benefits Our office made every attempt to have the insurance process her claim correctly and sent the refund to her as soon as we were able to I feel that we have refunded her in a timely fashion and at this point she has received her deposit paid minus the $that she was responsible for.Respectfully,Michael [redacted] H [redacted] , DDSKimberly M***, Office Insurance Coordinator

I am rejecting this response because:
I paid on June 30th and did not get my complete refund until February that is not timely I received my EOBs from *** *** and they refused to refund me at that moment The office kept telling me they were not right yet when I called *** *** they stated they had to go by that The lastest lie they said that the dollar payment was incorrect yet *** *** said it was It took almost two months from the date of me receiving my EOB to get the refund Guess what it was right after all Yes I did interrupt the rude office worker Kim She never answered my question of why they cannot refund my money then bill me when corrected if I owed more than dollars like every other doctor does that I have been toShe kept giving me the same story of my EOB I received was wrong, which it was not I did not swear at her, I did say that their hold message was a *explicitive lie,* since they say they treat people as they want to be treated, yet they stole my money Which I would say stealing is not giving back someone what is rightfully theirs which they were doing Yes I did warn her that I was going to take action and contact authorities which I did the Revdex.com, attorney generals office, an organization that deals with medical fraud, and local news stationsI still am pursuing to make sure their business practices are investigated I did receive my refund almost months after the fact and there customer service is not friendly or professional at allWorking in customer service before myself you work together to find a timely solution and remember the customer is always rightIn this case I really was right I also find it funny that the refund in question for this time period came after I contacted the above authorities

(Revdex.com Copied from original document. See attached file.)February 21, 2017[redacted]Revdex.com[redacted]Re: [redacted]Complaint #[redacted]To Whom It May Concern,This letter is in response to the complaint filed by [redacted] regarding services...

provided by our office and her insurance coverage for the surgery.  Ms. [redacted] was seen in our office for an examination for the removal of her third molars on June 7, 2016.  After determining that her teeth were impacted, our office contacted her medical insurance to verify if they would consider payment for the proposed surgery.  We were advised of the amount of coverage that was expected for her care.  We advised her of the amount of deposit that our office expected on the day of surgery, which was the amount that her insurance would not cover.  She paid that amount when she arrived for surgery, prior to being taken to the surgical suite.  We filed the claim to [redacted] medical and when the payment was received, it was determined that they had made an error in their allowable fees for the general anesthesia. You may or may not be familiar with medical coding.  On January 1, 2016 the coding changed from [redacted] to [redacted].  With this, the format for coding and billing for general anesthesia changed. This led to [redacted] was not paying our claims correctly. In addition, after 10 years of no fee increases, we had negotiated a small fee increase with [redacted] for our general anesthesia claims.  Compounding this “storm” was the changing of personnel on [redacted]’s side and having to begin anew.   We were in contact with our representatives to negotiate a correct allowable fee for this new code.  It took several months for them to finally resolve this issue.  We did try to explain this situation to Ms. [redacted] when she called on August 12, 2016 and Dr. H[redacted] did give her the phone number for our representative so that she could explain to her that our claims were not being paid correctly.  On that day that she requested a refund.  We did call [redacted] to determine the correct amount and did forward a refund check to her in the amount of overpayment that was given to our office over the phone.  After the claim was corrected, the balance was paid in full by her medical insurance [redacted].  We did file the claim then with her dental carrier ([redacted])  for possible secondary coverage of her portion. They sent her explanation of benefits showing that money was being “taken back” by [redacted] and additional payment being paid.  The problem was her claim was on a bulk check with other patient payments listed as well.  The amounts listed as payments on that check did not total correctly so I called to get clarification on the correct amount that should be applied to each account on the bulk check.  It was not easy to determine so I was asked to FAX the explanation so that they could explain the correct payment.  We called several times to try to resolve this confusion.  Ms. [redacted] called and was on the phone with me for over 30 minutes asking about getting a refund back.  I tried to explain to her what was happening with the check and that it had not been deposited until we were advised of the correct amount to apply to her account.  She was difficult to speak with because of interrupting as I tried to explain this to her and she was threatening our office to call the police and call the Revdex.com and swearing.  When I told her that I could not allow her to threaten and swear at me, she stated that she was threatening me and would call the police if I hung up on her.  She was going to explain to them that we stole her money.  On February 14, 2017, I did get to speak to Barbara at [redacted] and she was able to explain the correct amount of payment, it was posted and the overpayment was sent to Ms. [redacted].  I did call her and leave a message that we were sending her a refund of $112.82 and that amount would make her responsibility $4.00 total, as listed on her explanation of benefits.  Our office made every attempt to have the insurance process her claim correctly and sent the refund to her as soon as we were able to.  I feel that we have refunded her in a timely fashion and at this point she has received her deposit paid minus the $4.00 that she was responsible for.Respectfully,Michael * H[redacted], DDSKimberly M[redacted], Office Insurance Coordinator