I will try to address each statement in this patient's letter although it was difficult to decipher. Thispatient first came to us in September of 2013. When she called to make the appointment, she statedshe was referred by other employees from [redacted] who are patients of ours. While it is true we...
saidwe would file her insurance, we would never tell a patient we were a participating provider if we werenot. At the time we were a participant of only one dental plan and it was not her plan. The employeesfrom [redacted] that come to our office know that we are not a participating provider. It is our policy togive patients a copy of their treatment plan with fees. It is also our policy, as it is for most offices, forpatients to pay their deductible and co-pays at the time of appointment. Typically these charges do notapply to preventive, which was patient's first appointment, so contrary to her statement, she did notpay anything the first appointment. Her second appointment totaled 800.00, her co-pay and deductiblewould have been approximately 300.00 for that day but she only paid 100.00. Her third appointment copayshould have been approximately 350.00 but again she only paid 100.00. It was at this appointmentthat our office made an error in a code. But contrary to what patient has stated we did not charge for aroot canal, as she did not have one done. The discrepancy lay in the fact that we inadvertently selectedthe code for a procedure that involves 4 or more teeth when it should have been the code that involves1- 3 teeth. This error only reduced bill by 50.00. We did not know of this error for a very long timebecause patient had given us incorrect insurance information and the claims were going to wrongaddress. We were not paid for first claim until June of 2014, almost a year later. In the meantime, thispatient had a large outstanding balance, which we explained would not be covered 100% by insurance.Even if we had been in network, patient would still have had a portion to pay out of pocket but shemade only one more payment in September 2014 before we sent her a delinquent account letter andthen ultimately sent her account to collections. Patient called our office on 6/3/2015 to complain aboutbill, was very argumentative and kept saying that [redacted] told her we were wrong, I tried asking herwho she spoke with at [redacted] that gave her this information but she wouldn't let me get a word in,then hung up on me. I then called [redacted] and spoke to [redacted], explained the situation to her, and shesaid there were no notes regarding patient's conversation but that she would look at claims to seewhere the problem was, this is when l found out about discrepancy in code. She said other than this,everything is correct and has been paid and that information that patient received saying that sheshould only have had to pay 500.00 out of pocket is not correct. I refiled claim with correct code anddeducted the 50.00 difference from patient's account. I then called and left message for patient,explaining what had transpired. I told her since this corrected claim is 2 years old, insurance may not payon it, and if that was the case, we would write off amount of that procedure (200.00). Patient calledback and wanted me to talk to Dr. [redacted] and have him write off more of remaining balance because wewere too expensive and had scammed her and lied, etc. I told her we did none of those things but that Iwould talk to Dr. [redacted]. Per Dr. [redacted], I called patient back and told her that after we received aresponse from insurance company for this one charge we would adjust her account accordingly, but theremaining balance would stand as is. Patient also claims that she did not know we had referred heraccount to collection until 3 weeks ago, but her account was turned over in November 2014, and thiswas after she had received numerous statements and a delinquent letter from our office.Sincerely,[redacted], Office Manager
I will try to address each statement in this patient's letter although it was difficult to decipher. Thispatient first came to us in September of 2013. When she called to make the appointment, she statedshe was referred by other employees from [redacted] who are patients of ours. While it is true we...
saidwe would file her insurance, we would never tell a patient we were a participating provider if we werenot. At the time we were a participant of only one dental plan and it was not her plan. The employeesfrom [redacted] that come to our office know that we are not a participating provider. It is our policy togive patients a copy of their treatment plan with fees. It is also our policy, as it is for most offices, forpatients to pay their deductible and co-pays at the time of appointment. Typically these charges do notapply to preventive, which was patient's first appointment, so contrary to her statement, she did notpay anything the first appointment. Her second appointment totaled 800.00, her co-pay and deductiblewould have been approximately 300.00 for that day but she only paid 100.00. Her third appointment copayshould have been approximately 350.00 but again she only paid 100.00. It was at this appointmentthat our office made an error in a code. But contrary to what patient has stated we did not charge for aroot canal, as she did not have one done. The discrepancy lay in the fact that we inadvertently selectedthe code for a procedure that involves 4 or more teeth when it should have been the code that involves1- 3 teeth. This error only reduced bill by 50.00. We did not know of this error for a very long timebecause patient had given us incorrect insurance information and the claims were going to wrongaddress. We were not paid for first claim until June of 2014, almost a year later. In the meantime, thispatient had a large outstanding balance, which we explained would not be covered 100% by insurance.Even if we had been in network, patient would still have had a portion to pay out of pocket but shemade only one more payment in September 2014 before we sent her a delinquent account letter andthen ultimately sent her account to collections. Patient called our office on 6/3/2015 to complain aboutbill, was very argumentative and kept saying that [redacted] told her we were wrong, I tried asking herwho she spoke with at [redacted] that gave her this information but she wouldn't let me get a word in,then hung up on me. I then called [redacted] and spoke to [redacted], explained the situation to her, and shesaid there were no notes regarding patient's conversation but that she would look at claims to seewhere the problem was, this is when l found out about discrepancy in code. She said other than this,everything is correct and has been paid and that information that patient received saying that sheshould only have had to pay 500.00 out of pocket is not correct. I refiled claim with correct code anddeducted the 50.00 difference from patient's account. I then called and left message for patient,explaining what had transpired. I told her since this corrected claim is 2 years old, insurance may not payon it, and if that was the case, we would write off amount of that procedure (200.00). Patient calledback and wanted me to talk to Dr. [redacted] and have him write off more of remaining balance because wewere too expensive and had scammed her and lied, etc. I told her we did none of those things but that Iwould talk to Dr. [redacted]. Per Dr. [redacted], I called patient back and told her that after we received aresponse from insurance company for this one charge we would adjust her account accordingly, but theremaining balance would stand as is. Patient also claims that she did not know we had referred heraccount to collection until 3 weeks ago, but her account was turned over in November 2014, and thiswas after she had received numerous statements and a delinquent letter from our office.Sincerely,[redacted], Office Manager