This letter is a follto a complaint received in our office regarding [redacted] The patient came to our office for the first time on 4/16/as a new patientBefore this visit front office staff always calls the patient's insurance to verify it and to get a breakdown of their benefitsThe representative (Kelly) that we spoke with stated the patient had no waiting periodThat is all we have to go by is what the rep tells usWith that said the patient was given a quote (see quote — enclosed paperwork)At the bottom of the quote we always highlight and let the patient know that we will submit their claim to their insurance and that it is an estimate only and never a guarantee of paymentThat is the first thing you hear when verifying insurance from any insurance companyWe never ever make any promises to any patient that this is a guarantee of benefitsThat is why we have each and every patient sign our treatment planWe scan each one into the patient's document center and send the original home with the patientsAfter the insurance submitted their payment that is when we found out the patient had a waiting periodEveryone should know their insurance policy when they get their insurance booklet and read it to know all of the stipulations of their planAs this patient should have known she had a waiting periodI mailed a statement to the patient asking her to give our office a call to discuss what the insurance changes were and why they did not pay for the procedure for date of service of 5/19/When the patient called she was very upset, rightfully soI explained to the patient that she had a waiting period for major work and we were not aware of this until the claim was deniedThe patient was verbally abusive to me and told me she refused to pay the billShe said a few more choice words then hung up on meI was trying to explain to the patient that I would take 10% off of her bill and allow her to set up a monthly payment plan in which she could affordShe refused any helpI wrote Debra a letter regarding her account on 5/11/(see attached letter) and tried to work out a plan for her to pay the balance over timeI did explain to her once it is so far past due our administrative office will take over her account and I will not be able to help her further and it will be forwarded to a collection agencyThe insurance sent a denial of payment on 6/11/and that is when our office mailed out the first statement to the patientOur office has gone above and beyond with this patient in trying to help her to resolve her account and to keep it in good standingThe patient has complained in her letter that she was not satisfied with her crownAs of to date the patient has never called our office with any issues regarding her crownEven though her account is in bad standing we would never refuse a patient treatment to fix an issueSo our office believes her complaint as to not being happy with the crown should not be in question Please see the copied ledger notes from the patient's account that I made on the date insurance denied her claim: - Wed - Jun 11, - When verifying ins they told me there was no waiting periodAfter claim was submitted and paid by ins, they stated it was not paid due to waiting periodTold pt that they are responsible for knowing their insPt is refusing to pay bill due to her waiting period and she told me she will not pay it that it is our fault and hung up on meI have a signed tx plan and we do always point out that it is an estimate only and not a guarantee of bens being paidThere was no flag on her acct regarding the waiting period but a flag has been madeI never got the chance to tell her that I was willing to set up payment arrangements with herI mailed a letter to pt to give her another chance to speak to me regarding her accountI offered her a ten percent discount to help her out/ch Should you need any further information from our office, please feel free to contact us either by mail or by phone Sincerely, Carrie ***-Office Supervisor DrNickolaus [redacted] DDS
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below
Regards,
[redacted]
Let's get one thing clear, they did tell me they ran my insurance and showed me on a printout that I would only have to pay $395. I feel I was conned, I did not have to have the crown replaced at this time, I was told it would need to be done in the future but if I did it now I would not risk having it break. I told the dentist there was no way because I was losing my job and could not pay for it. The girl at the front desk showed me a dental insurance I could take out but I would have to pay $600+ for the crown. I again said no but she said she would run the crown on my insurance to see what they would cover. I waited a few minutes and said to forget it and left, she told me she would call me. Later she called and told me she ran my insurance and I would only have to pay $395. I asked if I could come get it in writing, not over the phone. I went back in and asked her if I could put it on my Care Credit card as I would a year to break the payments down. I knew it would be a long time before I would have a job and I would never have taken on debt I could not pay. I fully understood they had run the crown on my insurance as she circled the amount I would have to pay, telling me the bill might be more than the $395 but the quote will be all I have to pay. They keep saying I should know my insurance, well I told them I was working a temp job when I first called them and I did not know what it would pay, only that I would get a free cleaning, I explained I have a regular dentist. I had initially only planned to have my teeth cleaned but the dentist told me I needed a filling replaced, I had explained I was losing my job so they had told me what it would cost and that is what happened.
Basically, they are calling me a liar as they are not addressing the fact that I left because it was taking a long time to supposedly run it through my insurance and they called me to tell me the good news that my insurance would pay $395.
Most importantly, I have attached a picture of the quote she gave me and as you can see, she only circled and highlighted the $395 and put an X where I signed. She did not highlight the guarantee line and that would be because she did not want me to think my insurance might not pay because I had adamantly told them I did not have the money for this work and if there was a risk I would not have had the crown replaced.
Look closely at their copy of the quote, you will see that you can see grey marks under the yellow showing they have a copy of the original but they have tried to deceive by highlighting after the fact and stating that they "always" highlight that line and explain it is not a guarantee. I understood they had run it through my insurance and was told I would not have to pay any more irregardless of what insurance paid.
I am sorry this is so long but I know what happened and when I go to so much trouble to make sure what I am going to have to pay and then 2 months later get a bill in the mail, I need for you to understand what happened. I am still unemployed.
Thank you,
[redacted]
mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt'>This letter is a follow-up to a complaint received in our office regarding [redacted].
The patient came to our office for the first time on 4/16/14 as a new patient. Before this visit front office staff always calls the patient's insurance to verify it and to get a breakdown of their benefits. The representative (Kelly) that we spoke with stated the patient had no waiting period. That is all we have to go by is what the rep tells us. With that said the patient was given a quote (see quote — enclosed paperwork). At the bottom of the quote we always highlight and let the patient know that we will submit their claim to their insurance and that it is an estimate only and never a guarantee of payment. That is the first thing you hear when verifying insurance from any insurance company. We never ever make any promises to any patient that this is a guarantee of benefits. That is why we have each and every patient sign our treatment plan. We scan each one into the patient's document center and send the original home with the patients. After the insurance submitted their payment that is when we found out the patient had a waiting period. Everyone should know their insurance policy when they get their insurance booklet and read it to know all of the stipulations of their plan. As this patient should have known she had a waiting period. I mailed a statement to the patient asking her to give our office a call to discuss what the insurance changes were and why they did not pay for the procedure for date of service of 5/19/14. When the patient called she was very upset, rightfully so. I explained to the patient that she had a waiting period for major work and we were not aware of this until the claim was denied. The patient was verbally abusive to me and told me she refused to pay the bill. She said a few more choice words then hung up on me. I was trying to explain to the patient that I would take 10% off of her bill and allow her to set up a monthly payment plan in which she could afford. She refused any help. I wrote Debra a letter regarding her account on 5/11/14 (see attached letter) and tried to work out a plan for her to pay the balance over time. I did explain to her once it is so far past due our administrative office will take over her account and I will not be able to help her further and it will be forwarded to a collection agency. The insurance sent a denial of payment on 6/11/14 and that is when our office mailed out the first statement to the patient. Our office has gone above and beyond with this patient in trying to help her to resolve her account and to keep it in good standing.
The patient has complained in her letter that she was not satisfied with her crown. As of to date the patient has never called our office with any issues regarding her crown. Even though her account is in bad standing we would never refuse a patient treatment to fix an issue. So our office believes her complaint as to not being happy with the crown should not be in question.
Please see the copied ledger notes from the patient's account that I made on the date insurance denied her claim:
- Wed - Jun 11, 2014 - When verifying ins they told me there was no waiting period. After claim was submitted and paid by ins, they stated it was not paid due to waiting period. Told pt that they are responsible for knowing their ins. Pt is refusing to pay bill due to her waiting period and she told me she will not pay it that it is our fault and hung up on me. I have a signed tx plan and we do always point out that it is an estimate only and not a guarantee of bens being paid. There was no flag on her acct regarding the waiting period but a flag has been made. I never got the chance to tell her that I was willing to set up payment arrangements with her. I mailed a letter to pt to give her another chance to speak to me regarding her account. I offered her a ten percent discount to help her out/ch
Should you need any further information from our office, please feel free to contact us either by mail or by phone.
Sincerely,
Carrie [redacted]-Office Supervisor
Dr. Nickolaus [redacted] DDS
This letter is a follto a complaint received in our office regarding [redacted] The patient came to our office for the first time on 4/16/as a new patientBefore this visit front office staff always calls the patient's insurance to verify it and to get a breakdown of their benefitsThe representative (Kelly) that we spoke with stated the patient had no waiting periodThat is all we have to go by is what the rep tells usWith that said the patient was given a quote (see quote — enclosed paperwork)At the bottom of the quote we always highlight and let the patient know that we will submit their claim to their insurance and that it is an estimate only and never a guarantee of paymentThat is the first thing you hear when verifying insurance from any insurance companyWe never ever make any promises to any patient that this is a guarantee of benefitsThat is why we have each and every patient sign our treatment planWe scan each one into the patient's document center and send the original home with the patientsAfter the insurance submitted their payment that is when we found out the patient had a waiting periodEveryone should know their insurance policy when they get their insurance booklet and read it to know all of the stipulations of their planAs this patient should have known she had a waiting periodI mailed a statement to the patient asking her to give our office a call to discuss what the insurance changes were and why they did not pay for the procedure for date of service of 5/19/When the patient called she was very upset, rightfully soI explained to the patient that she had a waiting period for major work and we were not aware of this until the claim was deniedThe patient was verbally abusive to me and told me she refused to pay the billShe said a few more choice words then hung up on meI was trying to explain to the patient that I would take 10% off of her bill and allow her to set up a monthly payment plan in which she could affordShe refused any helpI wrote Debra a letter regarding her account on 5/11/(see attached letter) and tried to work out a plan for her to pay the balance over timeI did explain to her once it is so far past due our administrative office will take over her account and I will not be able to help her further and it will be forwarded to a collection agencyThe insurance sent a denial of payment on 6/11/and that is when our office mailed out the first statement to the patientOur office has gone above and beyond with this patient in trying to help her to resolve her account and to keep it in good standingThe patient has complained in her letter that she was not satisfied with her crownAs of to date the patient has never called our office with any issues regarding her crownEven though her account is in bad standing we would never refuse a patient treatment to fix an issueSo our office believes her complaint as to not being happy with the crown should not be in question Please see the copied ledger notes from the patient's account that I made on the date insurance denied her claim: - Wed - Jun 11, - When verifying ins they told me there was no waiting periodAfter claim was submitted and paid by ins, they stated it was not paid due to waiting periodTold pt that they are responsible for knowing their insPt is refusing to pay bill due to her waiting period and she told me she will not pay it that it is our fault and hung up on meI have a signed tx plan and we do always point out that it is an estimate only and not a guarantee of bens being paidThere was no flag on her acct regarding the waiting period but a flag has been madeI never got the chance to tell her that I was willing to set up payment arrangements with herI mailed a letter to pt to give her another chance to speak to me regarding her accountI offered her a ten percent discount to help her out/ch Should you need any further information from our office, please feel free to contact us either by mail or by phone Sincerely, Carrie ***-Office Supervisor DrNickolaus [redacted] DDS
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below
Regards,
[redacted]
Let's get one thing clear, they did tell me they ran my insurance and showed me on a printout that I would only have to pay $395. I feel I was conned, I did not have to have the crown replaced at this time, I was told it would need to be done in the future but if I did it now I would not risk having it break. I told the dentist there was no way because I was losing my job and could not pay for it. The girl at the front desk showed me a dental insurance I could take out but I would have to pay $600+ for the crown. I again said no but she said she would run the crown on my insurance to see what they would cover. I waited a few minutes and said to forget it and left, she told me she would call me. Later she called and told me she ran my insurance and I would only have to pay $395. I asked if I could come get it in writing, not over the phone. I went back in and asked her if I could put it on my Care Credit card as I would a year to break the payments down. I knew it would be a long time before I would have a job and I would never have taken on debt I could not pay. I fully understood they had run the crown on my insurance as she circled the amount I would have to pay, telling me the bill might be more than the $395 but the quote will be all I have to pay. They keep saying I should know my insurance, well I told them I was working a temp job when I first called them and I did not know what it would pay, only that I would get a free cleaning, I explained I have a regular dentist. I had initially only planned to have my teeth cleaned but the dentist told me I needed a filling replaced, I had explained I was losing my job so they had told me what it would cost and that is what happened.
Basically, they are calling me a liar as they are not addressing the fact that I left because it was taking a long time to supposedly run it through my insurance and they called me to tell me the good news that my insurance would pay $395.
Most importantly, I have attached a picture of the quote she gave me and as you can see, she only circled and highlighted the $395 and put an X where I signed. She did not highlight the guarantee line and that would be because she did not want me to think my insurance might not pay because I had adamantly told them I did not have the money for this work and if there was a risk I would not have had the crown replaced.
Look closely at their copy of the quote, you will see that you can see grey marks under the yellow showing they have a copy of the original but they have tried to deceive by highlighting after the fact and stating that they "always" highlight that line and explain it is not a guarantee. I understood they had run it through my insurance and was told I would not have to pay any more irregardless of what insurance paid.
I am sorry this is so long but I know what happened and when I go to so much trouble to make sure what I am going to have to pay and then 2 months later get a bill in the mail, I need for you to understand what happened. I am still unemployed.
Thank you,
[redacted]
mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt'>This letter is a follow-up to a complaint received in our office regarding [redacted].
The patient came to our office for the first time on 4/16/14 as a new patient. Before this visit front office staff always calls the patient's insurance to verify it and to get a breakdown of their benefits. The representative (Kelly) that we spoke with stated the patient had no waiting period. That is all we have to go by is what the rep tells us. With that said the patient was given a quote (see quote — enclosed paperwork). At the bottom of the quote we always highlight and let the patient know that we will submit their claim to their insurance and that it is an estimate only and never a guarantee of payment. That is the first thing you hear when verifying insurance from any insurance company. We never ever make any promises to any patient that this is a guarantee of benefits. That is why we have each and every patient sign our treatment plan. We scan each one into the patient's document center and send the original home with the patients. After the insurance submitted their payment that is when we found out the patient had a waiting period. Everyone should know their insurance policy when they get their insurance booklet and read it to know all of the stipulations of their plan. As this patient should have known she had a waiting period. I mailed a statement to the patient asking her to give our office a call to discuss what the insurance changes were and why they did not pay for the procedure for date of service of 5/19/14. When the patient called she was very upset, rightfully so. I explained to the patient that she had a waiting period for major work and we were not aware of this until the claim was denied. The patient was verbally abusive to me and told me she refused to pay the bill. She said a few more choice words then hung up on me. I was trying to explain to the patient that I would take 10% off of her bill and allow her to set up a monthly payment plan in which she could afford. She refused any help. I wrote Debra a letter regarding her account on 5/11/14 (see attached letter) and tried to work out a plan for her to pay the balance over time. I did explain to her once it is so far past due our administrative office will take over her account and I will not be able to help her further and it will be forwarded to a collection agency. The insurance sent a denial of payment on 6/11/14 and that is when our office mailed out the first statement to the patient. Our office has gone above and beyond with this patient in trying to help her to resolve her account and to keep it in good standing.
The patient has complained in her letter that she was not satisfied with her crown. As of to date the patient has never called our office with any issues regarding her crown. Even though her account is in bad standing we would never refuse a patient treatment to fix an issue. So our office believes her complaint as to not being happy with the crown should not be in question.
Please see the copied ledger notes from the patient's account that I made on the date insurance denied her claim:
- Wed - Jun 11, 2014 - When verifying ins they told me there was no waiting period. After claim was submitted and paid by ins, they stated it was not paid due to waiting period. Told pt that they are responsible for knowing their ins. Pt is refusing to pay bill due to her waiting period and she told me she will not pay it that it is our fault and hung up on me. I have a signed tx plan and we do always point out that it is an estimate only and not a guarantee of bens being paid. There was no flag on her acct regarding the waiting period but a flag has been made. I never got the chance to tell her that I was willing to set up payment arrangements with her. I mailed a letter to pt to give her another chance to speak to me regarding her account. I offered her a ten percent discount to help her out/ch
Should you need any further information from our office, please feel free to contact us either by mail or by phone.
Sincerely,
Carrie [redacted]-Office Supervisor
Dr. Nickolaus [redacted] DDS