J Helen Lee D.D.S. PC

Dear [redacted]:
Thank you so much for giving me an opportunity to explain and report objectively regarding the concern presented to you in...

regard to the credit/ balance from one of my patient.  It is important for me and my practice to receive the outcome in which the patient can be happy with us.
Having said that, please review my letter and supportive information with the mind-set of no other than making a good resolution with our beloved patient.
According to our record, we received your call for the first time at 3:50 P.M. on Friday, May 30, 2014  and with the subsequent e-mail sent to us on the following Monday, June 2nd, 2014 regarding this matter.
A thorough investigation was conducted of the patient’s two letters addressed to me as well as your e-mail which the complaint sent to you.  I have broken down to two categories after the discovery through investigation.  First, the investigation showed that the involved personnel, Jeanne  kept all the records of conversations that took place with the patient, and the patient's dental insurance representatives along with their names and dates to expedite the benefit payment process for every treatment that were rendered to the patient.
Second, [redacted] had been handling insurance benefit claim for the patient from the beginning.  She has been working in the dental field handling administrative works for over 35 years. She provided me all the necessary documentation in regards to this complaint. The documentation she provided will give the patient a clearer position and understanding without any misconception and the steps she has taken to resolve his requests.
I.  WRTTEN PROGRESS REPORT REGARDING PATIENT' S CLAIM TO HIS DENTAL INSURANCE COMPANY
On November 15, 2013, the patient called to schedule an appointment for Monday, November 18, 2013 at 11 A.M.  He requested if he could be seen any earlier, it is okay to call him.
On November 18, 2013, the following dental treatment was provided to the patient. An X-ray for four (4) bite wing was taken to provide his insurance company for Prophylaxis-adult. The dental codes are [redacted], [redacted], and [redacted]. No payment was made by the patient. We received a check from his insurance company on December 2, 2013 for the amount of $153.60 with the patient responsibility for the amount of $38.40.
On December 2, 2013, the patient came to my office for deep cleaning of his teeth. At that time, a panoramic x-ray was taken to provide for his dental insurance company.  The total treatment for four quadrant Scaling and Root planing and panoramic x-ray was $1152.00.
On the same date, the patient was concerned taking a panoramic x-ray after taking four bitewings from his first visit on November 18, 2013.  Our hygienist and the front desk personnel explained to him that it is required by his dental insurance company for the verification of the bone loss for him to receive the allotted benefit. It is customary for the dental insurance company to request for the Perio scaling & Root Planing- 4 quads on any patients.
The patient paid his estimated portions of the treatments in the amount of $642.60. And the dental claim was sent to his insurance company expectant for the collection of his benefit.  
On December 30, 2013 we received a letter from the patient with a copy of his EOB (Explanation of Benefits) from his insurance for the treatments done on December 2, 2013. The patient stated that his responsibility of payment was $ 544.20. And he would like to receive the refund on the difference that he paid on December 2, 2013. Our staff, [redacted] called the patient and explained to him that we have not received any check from his insurance company yet. 
On January 9, 2014, [redacted] called the patient’s insurance company and spoke with Anne and told her that we have not received the check from the dental insurance company for the treatment provided on December 2, 2013.  Anne said that we would have to wait at least 30 days before resuming the claim.
On March 20, 2014, we received a second letter from the patient requesting for refund. [redacted] informed the patient that we are still waiting for the payment from his insurance company. She also called his insurance company and spoke with [redacted] about the status of the benefit payment process.  He said that the check was never cashed and it will take another 7- 10 days to issue a new check.
[redacted] called the patient to relay the message on the same day. No one picked up the phone, so she left a message with an update information regarding the delay in the process and to call back if there are any question.
On April 11, 2014 [redacted] called the patient’s dental insurance company and spoke to [redacted]. She informed [redacted] that the Stop payment was put on April 4, 2014.  The dental insurance company will issue a new check within 20-30 business days.  [redacted] asked if it is okay for the patient to call her to verify it in case he has a question directly to them.  [redacted] said that it was absolutely fine for him to call to check the progress of the claim. This information was relayed to the patient. 
On April 19, 2014, the patient’s insurance company issued a new check which we received on April 29, 2014 in the amount of $451.80.
On April 30, 2014, on the same day we received a check for the treatment provided on December 2, 2013, we mailed out the statement of his account immediately, showing patient's family balance/credit  from September 1, 2009 to this date with a hand written detail notes containing  of - printed ledger for each family member, a copy of EOB, and Statement of Account.
II. ADDITIONAL EXPLANATION TO/FOR THE PATIENT
It is quite unusual for us to have this much delays in getting benefit back from the insurance companies.  Although it was not reported in Part I, our staffs tried at least six to seven times to find out the cause of delay.  We were informed at one point from the dental insurance if the credit card payment will be oaky with us, but we turned it down because it is our customary to receive checks from insurance companies and we make copies of Benefit Of Explanation for our records. 
I believe and admit our staffs have a room to do a more efficient job with this patient. But handling over 2000 patients with 400 plus numbers of the dental insurance policies, sometimes it leaves us to step back and wait until the insurance checks find their ways to come to us. With so many years of such similar situations, I am confident to say that our staffs are well trained and prepared to give a full respect to all the patients who come to our practice, whether they come for good will treatments or pay, with or without dental insurances. 
I personally had to take about three months out-of- office situations while hiring dentists from temp agencies because of the health of my parents for the past seven months.  I was informed by our staffs that they thought this matter could be ironed out once they received a payment from the insurance company. So they decided not to tell me about the two letters that came from the patient.  Their thought was that it would be better for me to keep more focused taking care of my parents and once all is done for the patient’s claim, they were going to inform me soon after.
As much as I was not happy when I saw two letters from the patient at the same time on June 2, 2014 after your call was made, I am also grateful to realize the beautiful hearts of our staffs who went beyond their scope of responsibilities 
In conclusion, I sent a reimbursement check for the amount due on this date directly to the complainant as well as a brief synopsis of events and actions taken by me. I am also attaching a copy of the letter sent to the complainant.
I thank you sincerely for your time in helping to rebuild our relationship with our patient and his family whom we cherish very much!
Best Regard and many blessings,
 
J Helen Lee, DDS

Review: I received treatment at [redacted] dental care on 12/02/2013 and was told that I owe them $642.00 as my portion . I paid the amount using my credit card . I received explanation of benefit from my dental insurance that state I have to pay only $451.80. I sent the statement with a letter to the dental office asking reimbursement . The office called my home and left message stating that they did not receive the money from the insurance and will pay me back when they received . I checked with the insurance and told that they were paid in full. I when online and checked the status and it confirmed that they were paid by insurance . I send another letter in March of 2014 stating that I need my money back or respond to my letter in writing why they are not making payment . They again called my home and left message and stated that they are still figuring out since they did not cash the check. This process took more than four months . It does appear that they did not take my two written request seriously and kept my money . I am knowledgable about how the health insurance works and followed the appropriate channel and gave then sufficient time but did not get concrete response . This does not appear to me right . If this happened to me ,it might happen to others as well and I want this to stop.Desired Settlement: I want a written explanation and refund of the excess amount they collected as soon as possible . They held my money for more than 4 months despite I reminded them twice in writing that they need to refund me .Thank you

Business

Response:

Dear [redacted]:

Thank you so much for giving me an opportunity to explain and report objectively regarding the concern presented to you in regard to the credit/ balance from one of my patient. It is important for me and my practice to receive the outcome in which the patient can be happy with us.

Having said that, please review my letter and supportive information with the mind-set of no other than making a good resolution with our beloved patient.

According to our record, we received your call for the first time at 3:50 P.M. on Friday, May 30, 2014 and with the subsequent e-mail sent to us on the following Monday, June 2nd, 2014 regarding this matter.

A thorough investigation was conducted of the patient’s two letters addressed to me as well as your e-mail which the complaint sent to you. I have broken down to two categories after the discovery through investigation. First, the investigation showed that the involved personnel, Jeanne kept all the records of conversations that took place with the patient, and the patient's dental insurance representatives along with their names and dates to expedite the benefit payment process for every treatment that were rendered to the patient.

Second, [redacted] had been handling insurance benefit claim for the patient from the beginning. She has been working in the dental field handling administrative works for over 35 years. She provided me all the necessary documentation in regards to this complaint. The documentation she provided will give the patient a clearer position and understanding without any misconception and the steps she has taken to resolve his requests.

I. WRTTEN PROGRESS REPORT REGARDING PATIENT' S CLAIM TO HIS DENTAL INSURANCE COMPANY

On November 15, 2013, the patient called to schedule an appointment for Monday, November 18, 2013 at 11 A.M. He requested if he could be seen any earlier, it is okay to call him.

On November 18, 2013, the following dental treatment was provided to the patient. An X-ray for four (4) bite wing was taken to provide his insurance company for Prophylaxis-adult. The dental codes are [redacted], [redacted], and [redacted]. No payment was made by the patient. We received a check from his insurance company on December 2, 2013 for the amount of $153.60 with the patient responsibility for the amount of $38.40.

On December 2, 2013, the patient came to my office for deep cleaning of his teeth. At that time, a panoramic x-ray was taken to provide for his dental insurance company. The total treatment for four quadrant Scaling and Root planing and panoramic x-ray was $1152.00.

On the same date, the patient was concerned taking a panoramic x-ray after taking four bitewings from his first visit on November 18, 2013. Our hygienist and the front desk personnel explained to him that it is required by his dental insurance company for the verification of the bone loss for him to receive the allotted benefit. It is customary for the dental insurance company to request for the Perio scaling & Root Planing- 4 quads on any patients.

The patient paid his estimated portions of the treatments in the amount of $642.60. And the dental claim was sent to his insurance company expectant for the collection of his benefit.

On December 30, 2013 we received a letter from the patient with a copy of his EOB (Explanation of Benefits) from his insurance for the treatments done on December 2, 2013. The patient stated that his responsibility of payment was $ 544.20. And he would like to receive the refund on the difference that he paid on December 2, 2013. Our staff, [redacted] called the patient and explained to him that we have not received any check from his insurance company yet.

On January 9, 2014, [redacted] called the patient’s insurance company and spoke with Anne and told her that we have not received the check from the dental insurance company for the treatment provided on December 2, 2013. Anne said that we would have to wait at least 30 days before resuming the claim.

On March 20, 2014, we received a second letter from the patient requesting for refund. [redacted] informed the patient that we are still waiting for the payment from his insurance company. She also called his insurance company and spoke with [redacted] about the status of the benefit payment process. He said that the check was never cashed and it will take another 7- 10 days to issue a new check.

[redacted] called the patient to relay the message on the same day. No one picked up the phone, so she left a message with an update information regarding the delay in the process and to call back if there are any question.

On April 11, 2014 [redacted] called the patient’s dental insurance company and spoke to [redacted]. She informed [redacted] that the Stop payment was put on April 4, 2014. The dental insurance company will issue a new check within 20-30 business days. [redacted] asked if it is okay for the patient to call her to verify it in case he has a question directly to them. [redacted] said that it was absolutely fine for him to call to check the progress of the claim. This information was relayed to the patient.

On April 19, 2014, the patient’s insurance company issued a new check which we received on April 29, 2014 in the amount of $451.80.

On April 30, 2014, on the same day we received a check for the treatment provided on December 2, 2013, we mailed out the statement of his account immediately, showing patient's family balance/credit from September 1, 2009 to this date with a hand written detail notes containing of - printed ledger for each family member, a copy of EOB, and Statement of Account.

II. ADDITIONAL EXPLANATION TO/FOR THE PATIENT

It is quite unusual for us to have this much delays in getting benefit back from the insurance companies. Although it was not reported in Part I, our staffs tried at least six to seven times to find out the cause of delay. We were informed at one point from the dental insurance if the credit card payment will be oaky with us, but we turned it down because it is our customary to receive checks from insurance companies and we make copies of Benefit Of Explanation for our records.

I believe and admit our staffs have a room to do a more efficient job with this patient. But handling over 2000 patients with 400 plus numbers of the dental insurance policies, sometimes it leaves us to step back and wait until the insurance checks find their ways to come to us. With so many years of such similar situations, I am confident to say that our staffs are well trained and prepared to give a full respect to all the patients who come to our practice, whether they come for good will treatments or pay, with or without dental insurances.

I personally had to take about three months out-of- office situations while hiring dentists from temp agencies because of the health of my parents for the past seven months. I was informed by our staffs that they thought this matter could be ironed out once they received a payment from the insurance company. So they decided not to tell me about the two letters that came from the patient. Their thought was that it would be better for me to keep more focused taking care of my parents and once all is done for the patient’s claim, they were going to inform me soon after.

As much as I was not happy when I saw two letters from the patient at the same time on June 2, 2014 after your call was made, I am also grateful to realize the beautiful hearts of our staffs who went beyond their scope of responsibilities

In conclusion, I sent a reimbursement check for the amount due on this date directly to the complainant as well as a brief synopsis of events and actions taken by me. I am also attaching a copy of the letter sent to the complainant.

I thank you sincerely for your time in helping to rebuild our relationship with our patient and his family whom we cherish very much!

Best Regard and many blessings,

J Helen Lee, DDS