Ms. [redacted] first presented to our office on April 18, 2016 for a new patient examination and 1 full mouth x-rays. She returned 10 our office on April 25, 2016 for a diagnosis appointment where we spent time n the conference room explaining to Ruth the work that needed to be done and how much...
time and money it would cost to complete said work. She was given a treatment plan which she signed and we began work on the upper right side. We did a 4 surface filling and pulp cap on tooth #2, and a 2 surface filling and pulp cap on tooth #4. After the old filling and decay was removed from the tooth #3 it was deemed non-restorable and Dr. Guba explained to Ms. [redacted] that #3 would need to be extracted. We referred her to Dr. [redacted] for the extraction. I filled the dental insurance claim electronically the same day. United Healthcare paid $93.00 on May 2, 2016 for services rendered on April 18, 2016, and paid $133.30 on May 9, 2016 for services rendered on Ap[ril 25, 2016. I took the appropriate contractural discounts for Ms. [redacted] totaling $394.00I sent estiments totaling 11 in number to Ms. [redacted] for the balance owned. None of our requests for payment was ever answered.Please find enclosed the chart notes, ledge, copy of pre-treatment and post treatment x-rays showing the work that was done, and signed treatment plan for Ms. [redacted].If you need any additional information please do not hesitate to contact us. Thank you for your time and consideration in taking care of this matter.Guba Dental
Ms. [redacted] first presented to our office on April 18, 2016 for a new patient examination and 1 full mouth x-rays. She returned 10 our office on April 25, 2016 for a diagnosis appointment where we spent time n the conference room explaining to Ruth the work that needed to be done and how much...
time and money it would cost to complete said work. She was given a treatment plan which she signed and we began work on the upper right side. We did a 4 surface filling and pulp cap on tooth #2, and a 2 surface filling and pulp cap on tooth #4. After the old filling and decay was removed from the tooth #3 it was deemed non-restorable and Dr. Guba explained to Ms. [redacted] that #3 would need to be extracted. We referred her to Dr. [redacted] for the extraction. I filled the dental insurance claim electronically the same day. United Healthcare paid $93.00 on May 2, 2016 for services rendered on April 18, 2016, and paid $133.30 on May 9, 2016 for services rendered on Ap[ril 25, 2016. I took the appropriate contractural discounts for Ms. [redacted] totaling $394.00I sent estiments totaling 11 in number to Ms. [redacted] for the balance owned. None of our requests for payment was ever answered.Please find enclosed the chart notes, ledge, copy of pre-treatment and post treatment x-rays showing the work that was done, and signed treatment plan for Ms. [redacted].If you need any additional information please do not hesitate to contact us. Thank you for your time and consideration in taking care of this matter.Guba Dental