Green Mountain Oral Surgery, LLC

Dr [redacted] is an oral surgeon in Rutland VTThe patient was seen on 7/20/for a consultation and evaluation for the removal of impacted wisdom teethOn 7/13/we verified insurance coverage with [redacted] ***They stated that the patient had coverage for full and partial bone impacted teeth with general anesthesiaNo prior approval was needed and the effective date was 9/3/and spoke with ***The patient was informed of the estimateThe surgery was performed on 7/27/under general anesthesiaThe removal of the teeth was very difficult and the anesthesia time went over the estimateThe insurance was billed accordinglyHowever, [redacted] denied the claim on 9/3/and refused to pay since we were out of network and the balance was the patient's responsibilityI sent an appeal on the behalf of the patient stating we were not informed of this when we called to confirm coverage on 7/3/A statement was sent along with the Explanation of BenefitsThe patient called since the statement was sent to his father (policyholder) and the insurance carrier states that in his policy booklet it stated no out of network coverageI told the patient that we filed an appeal on his behalf and he should call the insurance company also and file a complaint with them and express his concern regarding the misinformed informationOn 9/22/an appeal was sent again on two separate forms at [redacted] requestOn 10/8/ [redacted] has the dispute and is in processOn 11/14/patients dad called and said “he’s a man and responsible for his own balance.” I switched billing statement and responsibility to patient’s informationThe patient called stated he wouldn’t have had surgery if he didn’t have coverageUnfortunately, we are not contracted with his insurance companyAgain, I referred him to contact ***, explain his situation and file an appeal with themHe then hung up on meI spoke to [redacted] at [redacted] and she states it’s still under review and the decision can take up to daysStatement balance was mailed out patientOn 11/17/we received a Revdex.com letter that the patient filed a complaintI called the Revdex.com and spoke to [redacted] about the situation regarding the insurance company and coverage is not allowed out of network [redacted] stated to respond to this complaint via email or faxI called [redacted] to check on the status once again [redacted] representative, said the decision is forthcoming and benefits will be denied for services not rendered with participating providerWe can lon longer appeal on patient’s behalfThe patient can appeal the balance is the patient’s responsibilityI told her that we have been reported to the Revdex.comShe wasn’t concerned and stated once again the patient should have reviewed their policy manualThis Is a very unfortunate situationWe offer all of patient’s quality care and because in this se their insurance misrepresented their coverage we are to blame

Dr [redacted] is an oral surgeon in Rutland VT. The patient was seen on 7/20/15 for a consultation and evaluation for the removal of impacted wisdom teeth. On 7/13/15 we verified insurance coverage with [redacted]. They stated that the patient had coverage for full and partial bone...

impacted teeth with general anesthesia. No prior approval was needed and the effective date was 9/3/13 and spoke with [redacted]. The patient was informed of the estimate. The surgery was performed on 7/27/15 under general anesthesia. The removal of the teeth was very difficult and the anesthesia time went over the estimate. The insurance was billed accordingly. However, [redacted] denied the claim on 9/3/15 and refused to pay since we were out of network and the balance was the patient's responsibility. I sent an appeal on the behalf of the patient stating we were not informed of this when we called to confirm coverage on 7/3/15. A statement was sent along with the Explanation of Benefits. The patient called since the statement was sent to his father (policyholder) and the insurance carrier states that in his policy booklet it stated no out of network coverage. I told the patient that we filed an appeal on his behalf and he should call the insurance company also and file a complaint with them and express his concern regarding the misinformed information. On 9/22/15 an appeal was sent again on two separate forms at [redacted] request. On 10/8/15 [redacted] has the dispute and is in process. On 11/14/15 patients dad called and said “he’s a man and responsible for his own balance.” I switched billing statement and responsibility to patient’s information. The patient called stated he wouldn’t have had surgery if he didn’t have coverage. Unfortunately, we are not contracted with his insurance company. Again, I referred him to contact [redacted], explain his situation and file an appeal with them. He then hung up on me. I spoke to [redacted] at [redacted] and she states it’s still under review and the decision can take up to 90 days. Statement balance was mailed out patient. On 11/17/15 we received a Revdex.com letter that the patient filed a complaint. I called the Revdex.com and spoke to [redacted] about the situation regarding the insurance company and coverage is not allowed out of network. [redacted] stated to respond to this complaint via email or fax. I called [redacted] to check on the status once again. [redacted] representative, said the decision is forthcoming and benefits will be denied for services not rendered with participating provider. We can lon longer appeal on patient’s behalf. The patient can appeal the balance is the patient’s responsibility. I told her that we have been reported to the Revdex.com. She wasn’t concerned and stated once again the patient should have reviewed their policy manual. This Is  a very unfortunate situation. We offer all of patient’s quality care and because in this se their insurance misrepresented their coverage we are to blame.