Long Family Dental

Long Family Dental [redacted] December 20, [redacted] ** ***Re: Claim ID [redacted] To Whom It May Concern,We have received the information regarding the complaint filed against our office by our former patient identified under this claim number [redacted] The patient is disputing the charges for services provided to her in our office on October 12, The patient was previously a patient in our office in She had an appointment on April 14, 2014, and then another appointment was scheduled on October 20, 2014, and the patient did not show up or call to cancel this appointment She came back to our office for an appointment on March 13, At that time, the patient was seen for pain in her TMJ area, and we took impressions for an occlusal night guard At this appointment, she also signed the financial policy for our office that states that the patient will be responsible for all charges not covered by insurance She returned to our office on March 21, 2017, and told us that her last cleaning was the one she had in our office in April of At this time, the hygienist took her periodontal measurements, and they were generalized 4mm pockets in the posterior with moderate bleeding on probing Subgingival calculus was also noted Since there was no bone loss, she was diagnosed with moderate gingivitis An initial cleaning code [redacted] was performed at this visit, and the patient was made known that she needed to return for the second gingivitis appointment, also to be coded ***, in two week after gingival tissue was less inflamed The patient was scheduled to return on April 6, 2017, for the gingivitis cleaning, to deliver her night guard, and to take impression our free Whitening for Life bleaching trays At the appointment on April 6, she signed a consent form for our Whitening for Life program In that consent form, it is stated that in order to continue to receive free whitening, she must maintain a recall schedule that is consistent with the intervals of cleaning that our dentist and hygienist have prescribed In this case, since she was not diagnosed with periodontal disease, she was scheduled to be seen in six month intervals for her cleanings At this appointment, it was noted that she had generalized improvement since her gingivitis appointment She was encouraged to continue good home care and was scheduled for her 6-month recall cleaning in October Both cleanings (from March and April 6, 2017) were coded as [redacted] prophylaxis cleanings Both cleanings were filed and paid by the patient’s insurance The patient returned for her 6-month recall appointment on October 12, 2017, and it was reiterated to her that she needed to continue good home care to prevent periodontal disease This visit was also coded as a [redacted] prophylaxis cleaning and was filed to her insurance However, the insurance denied the claim because it was the patient’s third cleaning appointment for the benefit year, and the insurance will only cover two such visits per year When I called the patient regarding her balance on November 28, 2017, she told me that our office did not make it known to her that insurance would not cover a third cleaning visit She also told me that she had called her insurance company prior to her visit on October and that they specifically told her that another cleaning would be covered in the year I explained to her that insurance will usually cover cleanings twice in a calendar year or twice in a 12-month period I also educated her that since she had been diagnosed with moderate gingivitis, she needed the additional cleaning to keep from moving into a periodontal disease diagnosis I also indicated to her that regular 6-month cleanings were important to the maintenance and prevention of gum disease Our office policy is to recommend the best treatment for our patient’s oral health not based on what insurance states will be covered Again, this information was clearly stated in the financial policy that she signed when she came to our office on March 13, 2017.Since the treatment performed was conducive to the sustaining of her oral health condition, and since she had previously both agreed to the treatment and to the office financial policy regarding insurance and patient responsibility, our office uphold the charges on the patient’s account.We have received a signed HIPAA release from the patient that allows me to release this information to you I am happy to personally answer any questions Thank you for your time.Sincerely, [redacted] Insurance Coordinator [redacted]

I received your phone message regarding our request to respond to the above-mentioned claim and the need for our patient to sign a HIPAA release form.  Thank you for forwarding a request to our patient for this information.  I had contacted her on December 20 also requesting for her to...

sign a HIPAA release, but at this time, I have not received anything from her. I have a detailed clinical response to her allegations, and it is the preferred way that I would like to address this complaint.  However, due to the Christmas holiday, and our office being closed, I am requesting additional time to allow her to sign the HIPAA release.  In the event that we do not receive a HIPAA release, I will rewrite another response that does not include the same level of clinical detail.  The letter notifying our office of this complaint was dated December 11, but it was not received in our office until December 18, and it allowed 10 days for response.  We would like to respond to the complaint, but, based on the information I have reviewed regarding this case, we are upholding the charges. In addition to requesting more time for our response, I would also like to ask a question regarding the legal nature of this complaint.  Since our office is upholding these charges because there was nothing wrongfully done, can I still pursue collection on this amount?  In our office, if a debt is not paid within a certain timeframe, we notify the patient that their account is to be turned over to an outside agency for collection.  Is this something that can still be done since a complaint has been made? I appreciate your time and assistance as I have not dealt with a case like this before. Merry Christmas!?Sincerely, [redacted]Insurance and Billing CoordinatorLong Family Dental[redacted]

Long Family Dental[redacted]December 20, 2017[redacted]Re: Claim ID [redacted]To Whom It May Concern,We have received the information regarding the complaint filed against our office by our former patient identified under this claim number [redacted].  The patient is disputing the charges for services provided to her in our office on October 12, 2017.  The patient was previously a patient in our office in 2014.  She had an appointment on April 14, 2014, and then another appointment was scheduled on October 20, 2014, and the patient did not show up or call to cancel this appointment.  She came back to our office for an appointment on March 13, 2017.  At that time, the patient was seen for pain in her TMJ area, and we took impressions for an occlusal night guard.  At this appointment, she also signed the financial policy for our office that states that the patient will be responsible for all charges not covered by insurance.  She returned to our office on March 21, 2017, and told us that her last cleaning was the one she had in our office in April of 2014.  At this time, the hygienist took her periodontal measurements, and they were generalized 4mm pockets in the posterior with moderate bleeding on probing.  Subgingival calculus was also noted.  Since there was no bone loss, she was diagnosed with moderate gingivitis.  An initial cleaning code [redacted] was performed at this visit, and the patient was made known that she needed to return for the second gingivitis appointment, also to be coded [redacted], in two week after gingival tissue was less inflamed.   The patient was scheduled to return on April 6, 2017, for the gingivitis 2 cleaning, to deliver her night guard, and to take impression our free Whitening for Life bleaching trays.  At the appointment on April 6, she signed a consent form for our Whitening for Life program.  In that consent form, it is stated that in order to continue to receive free whitening, she must maintain a recall schedule that is consistent with the intervals of cleaning that our dentist and hygienist have prescribed.  In this case, since she was not diagnosed with periodontal disease, she was scheduled to be seen in six month intervals for her cleanings.  At this appointment, it was noted that she had generalized improvement since her gingivitis 1 appointment.  She was encouraged to continue good home care and was scheduled for her 6-month recall cleaning in October.  Both cleanings (from March 21 and April 6, 2017) were coded as [redacted] prophylaxis cleanings.  Both cleanings were filed and paid by the patient’s insurance.  The patient returned for her 6-month recall appointment on October 12, 2017, and it was reiterated to her that she needed to continue good home care to prevent periodontal disease.  This visit was also coded as a [redacted] prophylaxis cleaning and was filed to her insurance.  However, the insurance denied the claim because it was the patient’s third cleaning appointment for the benefit year, and the insurance will only cover two such visits per year.  When I called the patient regarding her balance on November 28, 2017, she told me that our office did not make it known to her that insurance would not cover a third cleaning visit.  She also told me that she had called her insurance company prior to her visit on October 12 and that they specifically told her that another cleaning would be covered in the year.  I explained to her that insurance will usually cover cleanings twice in a calendar year or twice in a 12-month period.  I also educated her that since she had been diagnosed with moderate gingivitis, she needed the additional cleaning to keep from moving into a periodontal disease diagnosis.  I also indicated to her that regular 6-month cleanings were important to the maintenance and prevention of gum disease.  Our office policy is to recommend the best treatment for our patient’s oral health not based on what insurance states will be covered.  Again, this information was clearly stated in the financial policy that she signed when she came to our office on March 13, 2017.Since the treatment performed was conducive to the sustaining of her oral health condition, and since she had previously both agreed to the treatment and to the office financial policy regarding insurance and patient responsibility, our office uphold the charges on the patient’s account.We have received a signed HIPAA release from the patient that allows me to release this information to you.  I am happy to personally answer any questions.  Thank you for your time.Sincerely,[redacted]Insurance Coordinator[redacted]