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Healthy Smiles Oral Health Center

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Reviews Healthy Smiles Oral Health Center

Healthy Smiles Oral Health Center Reviews (2)

October 8, 2014
Two siblings were seen on 02/18/2014 for preventative cleanings, fluoride and exams. The children both have federal insurance policies through their father. These two insurances are [redacted] and [redacted]. Two [redacted] claims were generated and mailed on 2/19/14 for...

patient #1. The first claim had the exam; the second claim had the prophy and fluoride. The same happened for patient #2.On 03/25/2014 [redacted] paid for the exam but denied requesting more information from the subscriber, for patient #1. For patient #2, [redacted] paid the prophy, and fluoride, but denied for more information from the subscriber for the exam. A statement was mailed to the guarantor on 3/27/14 along with our" COB letter". This letter states that the balance is the responsibility of the guarantor until we are notified, and confirm the requested info has been given to the insurance co.The information [redacted] requested was provided by the subscriber. The subscriber then notified our office on 4/11/14. Once a patient updates a COB with [redacted], the claim is reprocessed and reconsidered for payment.While waiting for the subscriber to update information, [redacted] was billed on 3/27/14. The guarantor is usually sent a statement when the primary requests further info from the subscriber because the secondary insurance won't pay until they receive the amounts paid by other parties involved. I know that [redacted] sends an estimated payment for federal policies while the primary is tied up in a COB (coordination of benefits) issue. [redacted] paid for the exam for patient #1 on 4/28/14. This line item now has a zero balance due. On 5/12/14, [redacted] also paid an estimated portion for the prophy and fluoride for patient #1. [redacted] made an estimated payment because they didn't have the primary payers EOB. This resulted in leaving a balance due from the subscriber of $35. We had not heard back from [redacted], so a claim was resent on 6/6/14. Our claim and [redacted]'s EOB crossed in the mail. [redacted]'s EOB stated that the charges were applied to the deductible. This was posted to the account on 6/12/14. The claim that we sent on 6/6/14 denied as a duplicate and posted to the account on 7/8/14. The guarantor (Father) received a current statement on 7/11/14, and 8/8/14 that had aged 30 days for a balance of $35.00.I received an email from an employee at Healthy Smiles on 8/21/14, stating that she spoke to mom about these accounts. She asked that the claims be resent to [redacted] because she feels that she shouldnot owe a balance for preventative services.[redacted] usually sends EOB info to the secondary insurance carrier, subscriber and Provider. On 9/2/14, | resent the EOB, and claim to [redacted] for the remaining balance for Patient #1 as requested by the Healthy Smiles employee.The same steps were taken for patient #2. This patient only had a $9 balance, for the exam. [redacted] paid this balance on 9/29/14. Patient #2 has a zero balance. The last time a statement was generated and mailed for these patients, was 8/8/14.We are currently waiting for a response from [redacted] for patient #1. The balance is sitting in the insurance bucket, so a statement does not print, but also so the balance does not age.Vicki R.
CPC Pt Accts Manager

Review: I have been receiving a bill from them for two months and I have called them trying to get an answer as to why I am being charged for my daughters routine dental cleaning. I have [redacted], and a secondary insurance which is [redacted] and we are allowed a dental cleaning twice a year and I have never been charged for a routine cleaning for my two daughters until now. There were no X-rays taken. Everytime I call I get the run around. I have talked to my insurance carriers and they tell me that they paid on it and I should have no out of pocket expense. I have been trying to talk with someone at this dental office about this bill but no one gets back to me.Desired Settlement: There should be no charge for these routine cleanings.

Business

Response:

October 8, 2014Two siblings were seen on 02/18/2014 for preventative cleanings, fluoride and exams. The children both have federal insurance policies through their father. These two insurances are [redacted] and [redacted]. Two [redacted] claims were generated and mailed on 2/19/14 for patient #1. The first claim had the exam; the second claim had the prophy and fluoride. The same happened for patient #2.On 03/25/2014 [redacted] paid for the exam but denied requesting more information from the subscriber, for patient #1. For patient #2, [redacted] paid the prophy, and fluoride, but denied for more information from the subscriber for the exam. A statement was mailed to the guarantor on 3/27/14 along with our" COB letter". This letter states that the balance is the responsibility of the guarantor until we are notified, and confirm the requested info has been given to the insurance co.The information [redacted] requested was provided by the subscriber. The subscriber then notified our office on 4/11/14. Once a patient updates a COB with [redacted], the claim is reprocessed and reconsidered for payment.While waiting for the subscriber to update information, [redacted] was billed on 3/27/14. The guarantor is usually sent a statement when the primary requests further info from the subscriber because the secondary insurance won't pay until they receive the amounts paid by other parties involved. I know that [redacted] sends an estimated payment for federal policies while the primary is tied up in a COB (coordination of benefits) issue. [redacted] paid for the exam for patient #1 on 4/28/14. This line item now has a zero balance due. On 5/12/14, [redacted] also paid an estimated portion for the prophy and fluoride for patient #1. [redacted] made an estimated payment because they didn't have the primary payers EOB. This resulted in leaving a balance due from the subscriber of $35. We had not heard back from [redacted], so a claim was resent on 6/6/14. Our claim and [redacted]'s EOB crossed in the mail. [redacted]'s EOB stated that the charges were applied to the deductible. This was posted to the account on 6/12/14. The claim that we sent on 6/6/14 denied as a duplicate and posted to the account on 7/8/14. The guarantor (Father) received a current statement on 7/11/14, and 8/8/14 that had aged 30 days for a balance of $35.00.I received an email from an employee at Healthy Smiles on 8/21/14, stating that she spoke to mom about these accounts. She asked that the claims be resent to [redacted] because she feels that she shouldnot owe a balance for preventative services.[redacted] usually sends EOB info to the secondary insurance carrier, subscriber and Provider. On 9/2/14, | resent the EOB, and claim to [redacted] for the remaining balance for Patient #1 as requested by the Healthy Smiles employee.The same steps were taken for patient #2. This patient only had a $9 balance, for the exam. [redacted] paid this balance on 9/29/14. Patient #2 has a zero balance. The last time a statement was generated and mailed for these patients, was 8/8/14.We are currently waiting for a response from [redacted] for patient #1. The balance is sitting in the insurance bucket, so a statement does not print, but also so the balance does not age.Vicki R.CPC Pt Accts Manager

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Description: Dentists

Address: P.O. Box 1146, Martinsburg, West Virginia, United States, 25402

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