Ham Lake Dental Association PA

Initial Business Response /* (1000, 8, 2015/09/09) */
September 8,
Revdex.com of Minnesota
S River Ridge Circle
Burnsville, MN
Re: Case# ***
I can understand ***'s frustration with thinking something is covered at 100% and finding out later that it
wasn't true*** was confrontational when I tried to talk to herWhen I attempted to tell her what I could do to help, she hung up on me
I did look into her concernWe try to call the patient's insurance company, in this case ***, and ask for a breakdown of benefits as a service to our patientsUnfortunately, The guardian representative told us that the preventive services were covered at 100%, both in and out of networkWhat they should have said was that out of network benefits are paid based on a fee schedule that the insurance company set up but does not shareIt turns out to be about 56% of the usual and customary preventive fees for this area
I apologize for accepting what the insurance company told us as trueWe have already taken the $off of her family's accountI will contact the patient in writing to notify her of this resolution
Sincerely,
Manager
P.SPlease see attached information for reference
The rest of this letter is just to let you know that we really did try to get the correct information from the insurance company and are just as frustrated as the patient about not getting accurate information
We called for a benefit breakdown on 8/ 6/and I called again 9/2/re: Patient's son, date of service 8/6/I talked to July at *** ***I was told again today that the preventive coverage for this group #*** was 100% in and out of networkI asked why it wasn't paid at 100% and July told me she didn't know and would transfer me to claims
At which point I was transferred to MarjorieMarjorie said that the claim was paid at 100%I asked why the patient still owed a balance and she they paid 100% of the Usual & Customary Fee, a *** fee scheduleI told her the information she just gave me does NOT match the information that we received when gathering the benefit information when the patients family was seen, or the information July had just given me before I was transferred to herMarjorie said that is the way it was paidI asked how I should explain this to the patient and the Revdex.com because I have a complaint that we gave the patient the wrong informationMarjorie put me on hold a couple of times during this conversation and then said because my call was after the date of service she wouldn't be able to do anything about itI asked her to check for 6/16/for a benefit call & she said there wasn't oneI told her I would pull the charts and get the name of the person we talked to and call her backShe said that she did see a call on 8/6/and will request that the call be pulled & reviewedShe assured me I would be called within hours to let me know if an adjustment will be madeI gave Marjorie my office phone number and my cell phone number
I called the Revdex.com and left a message to let you know that we would not be able to respond before 9/5/because we are waiting for a response from *** Insurance
9/4/I Received a note from Ed at ***, who returned my call in regards to Patients benefit call on 8/6/At seconds into the conversation the representative said that it was covered at 100% of out of network fee scheduleThey feel they processed the claim correctly and no correction will be made
9/8/I called *** Insurance again to see if I could get a copy of what the insurance is calling the out of network fee scheduleI talked to Ian and he verified our TIN and address and doctor name then said he would transfer me to provider services in order to get the fee schedule...The call rang and rang, then we were disconnected