Lourdes Sanchez, DDS, PA

Dear *** ***,Thank you for your letter dated June 17, regarding Revdex.com complaint ID: ***I will start by describing the standard operating procedure for my office:As patients schedule their first appointment, they are asked for insurance information, which at the time is
verifiedWhen services are rendered, a claim is submitted for reimbursement to the appropriate insurance company, it is not customary to confirm coverage during subsequent visits.• The patient is asked to assume responsibility for any balance after all insurance payments have been receivedPatients are asked to sign a document stating that they understand this policy during their first visitBy signing that document, the patient agrees to the terms there statedWe have records of such document signed by the patient (dated 8/27/2012) and her mother, the policy holder (dare: 6/28/2011).The above procedures are standard for medical and dental offices across the countryAs you know, the insurance coverage agreement is between the policy holder and the insurance companyThe patient is responsible for informing the office regarding any changes in coverage.We note that the mother of the patient, who was the policy holder when services were rendered, and her family have been patients in our office since As the patient states in her letter, I take great pride in giving my patients the best possible treatment and also in doing so in an honest and fair wayI have been in practice for years without ever having a patient file a complaint with any entity until this instance.On 9/18/and 9/19/2013, the patient visited the office for treatment and at no time during those days or when she scheduled the appointments over the phone did she mention any change in her coverage policyContrary to the statement in her complaint, she did not present her insurance card upon arrival because that is not customary unless the patient wants to make changes to existing informationServices were rendered and copay quoted based on the information on recordShe paid the estimated copayment and a claim was sent to her insurance company.On 10/05/2013, we received the EOB (explanation of benefits) from the insurance company, which indicated that no payment was adjudicated because the patient's policy had been terminated at the time of service because of her ageIn the EOB, the insurance stated the balance is the patient's responsibilityThe insurance company would have sent the patient a similar communicationAfter receiving the EOB, we attempted to contact the patient and her mother, the policy holder, to discuss the insurance coverage situationNumerous phone calls were made by my secretary (10/08/2013, 10/15/2013, 10/21/2013) and by me (several calls placed) asking the patient to contact us regarding the communication from the insurance companyWe also tried contacting the patient's fatherNot a single message was returned.Given that our efforts to communicate with the patient and the policy holder were unfruitful, a statement for the amount owed was sent to the policy holder's address on record on 10/29/The statement was never returned by the USPSNeither the policy holder nor the patient contacted the office or made paymentThe policy nolder, mother of the patient, sent a letter dated November 11, stating that she would not have agreed to treatment if she knew the total she would incurAfter receiving this letter, I made several additional attempts to contact the patient and her mother to clarify the reason behind the balance and to discuss a way of addressing the situationMy messages were not returnedAt this point, I sent a letter dated 12/13/to the policy holder in which I explained everything related to the situation and included copies of the financial agreement signed by them and the EOB from the insurance companyThis letter was sent via certified mail and receipt requestedIt was returned to the office by the USPS marked "unclaimed" in January 2014.After the unsuccessful attempts to communicate with the patient and her mother, the account was transferred to a collection agency on January 29, The referral was for the following treatment:Services rendered 9/18/and 9/19/2013:Composite restorations (7);Indirect pulp cap (1)Oral surgery referralTotal cost: $1122.00Insurance payment: $
Patient payment: $ Balance: $The patient states in her complaint that at the time of the (September) appointment she and her mother presented the insurance card and asked if she was still eligible because of her age and that she was informed that she was still eligible for services at least for the next daysThe statement is partially inaccurateOur records indicate that the patient visited our office in June At that time, she had last been seen as a patient in September Insurance coverage was checked and confirmed until age during the June visit per her requestIt is not standard procedure to confirm coverage during each visit and it was not done for the two appointments in September We also note that the patient did not inform the office of any changes in coverage during those two September appointments.You are likely aware that coverage for dependents is regulated by federal law and that the age limit is years provided certain conditions are metThat said, the company offering the insurance coverage to its employees determines when a dependent reaching age is no longer eligible for coverageSome companies limit coverage up to the actual birth date, some extend coverage for the full month during which the birthday occurs, and others extend coverage for the full calendar year in which the dependent reaches the age limitIt is the patient's and policy holder's responsibility to know the exact terms of coverage.The patient asks that the office take responsibility for the error that was made by the office assistant and to acknowledge that a mistake was made in not providing her with accurate professional up to-date informationWe respectfully decline to do soThe patient was provided accurate information during the June visitThe patient's birthday is in JulyShe did not inform the office that her coverage had changed when she came to obtain services in September 2013.The patient also asks that the office retract the claim with the credit bureauThis matter has been referred to a collection agency that is handling the matter following applicable federal regulationsFinally, the patient asks that the collection letters she is receiving be stoppedThis office does not control the procedures in place at the collection agencyIf the patient believes the collection agency behavior is inappropriate, she can complain to the Federal Trade Commission.Please let me know if you need any additional information.Thank you,

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this response because: In response
to the correspondence that was sent to *** *** *** on June 26, from
DrLourdes Sanchez, I am not in agreement with her response to my complaint ID
# ***There are not only several inaccuracies mentioned, but DrSanchez
did not address important points that I emphasized in my original
complaint. For starters, her first
bullet on page of her letter identified the following: “As patients schedule their first appointment, they are asked for
insurance information, which at the time is verifiedWhen services are
rendered a claim is submitted for reimbursement to the appropriate insurance
companyIt is not customary to confirm coverage during subsequent visits.”
Despite what DrSanchez stated I
have had to produce my insurance card on many occasions, for verification
When-ever I or other members of my family needed go to the dentist or it may
have been weeks, months or years since we had an appointments and often we had
to display our insurance card just for verificationThis practice was not only
requested by DrSanchez’s office, but also by many of the medical facilities
that we used (doctors, dentist, hospitals, etc.)
In reference
to DrSanchez’s 2nd bullet on page 1, she states, “The patient is asked to assume
responsibility for any balance after all insurance payments have been received
Patients are asked to sign a document stating that they understand this policy
during their first visitBy signing that document, the patient agrees to the
terms there stated, we have records of such document signed by the patient (dated
8/27/12) and her mother, the policy holder (dated 6/28/2011).” Whatever
documents were signed in and have nothing to do with what was said
and done on the days in question 9/18/and 9/19/
In the third
paragraph under the 2nd bullet on page 1, DrSanchez, she mentioned
that I made the appointments by phone and that I did not mention that there was
a change in my coverage policyAs I mentioned in my original complaint I was
with my mother at the time and my appointments were made in personI was with
my mother during her appointment before making the appointments and during that
time we inquired about my age and was told that I had days after my 26th
birthday to receive insurance coverageAt that time my mother showed her the
insurance card on her ownIt was not requested she just wanted the office
assistant to have access to the card/number if she needed it
On page of
her letter, DrSanchez, makes reference to the EOB from the insurance company
This is irrelevant to my complaint, because if we were not given misinformation
in the first place by DrSanchez’s office assistant in the first place we,
would not have made the appointment and therefore there would not have been a
need to submit a payment to the insurance companyThe office assistant was
referencing her own misinformation at the time of my appointment and believed
her day misinformation to be true, therefore when she gave my mother the
payment receipt with $balance due, she also thought there was no balance due
However, after our appointment, when she realized she had either made a mistake
or given us the wrong information, it was then determined that someone had to
pay for the error and in this case the “someone’ was me
Again
referencing the 2nd paragraph, lines 4-6, DrSanchez states, “The policy holder, mother of the patient,
sent a letter dated November 11, stating that she would not have agreed to
treatment if she knew the total she would incur.” This is not true at all
As stated in my original complaint, I nor my mother would have agreed to
treatment, if we were given accurate information concerning my ageInstead of
telling me that I was covered by my insurance company for more days at the
time of my appointment, we should have been told I was not eligible for
coverage, because of my ageThen based on that information, I nor my mother
would have “agreed for treatment”, since our insurance could not have covered
itWhy would we have agreed since, I was not working at the time and my mother
had just lost her job
In reference
to her accusations concerning phone calls and messages, we also left several
messages detailing our feelings on having been sent to the credit bureau and
receiving misinformation from her office that prompted this entire unfortunate situation
In regards to the letters she claims she sent by certified mail, I as well as
my parents work 9-jobs, so if the postal service needed signatures during
that time, most likely no one would have been home to sign for it, if that was
in fact the case, if in fact certified mail was actually sent
In the last
paragraph on page and the first paragraph on page 3, DrSanchez identified
that I was last seen as a patient in September and that insurance coverage
was checked and confirmed until age during the June visit per my
requestShe then goes on to say that, “It
is not standard procedure to confirm coverage during each visit and it was not
done for the two appointments in September 2013.” Whether DrSanchez
considers this “standard procedure” or not, before my scheduled appointment my
mother and I asked DrSanchez’s office assistant if I was too old to receive
dental service and she said “no” and that I had days until I was ineligible
This simple
inquiry just required a “yes” or “no” answer and we were told “no” and whether
it was “standard procedure” or not, my mother showed her the insurance card so
that she could call it in or verify it, if she needed to, as the office
assistant has done on many occasionsDuring this time, my mother also asked Dr
Sanchez’s office assistant, what was the balance on both of the office visits,
so she could pay themShe wanted to pay them so that I wasn’t left with an
outstanding balance to payAfter my mother was given the amount, she paid the
bill and was told she had a $balance on both statementsIn addition, there
was no need to “inform the office” of any changes, because there were noneAt
the time of service we were not aware of any changes in coverage to report
In the last
paragraph on page 3, DrSanchez has identified that, ‘This matter has been referred to a collection agency that is handling
the matter following applicable federal regulations” and on pages and
she has attached signed copies of the ‘Financial
Policy’ and the ‘Cancellation Policy’.
DrSanchez has incorporated many legal terms and documents to identify
my mother and I as negligent consumers of her dental practiceHowever, it is
very easy to make my mother and I look as if we are at fault in this situation,
but despite her legal and dental references this is not a matter of non-payment
or disrespectThis is a matter of dental ethics, office procedures, best
practices and customer serviceAs simply as I can put it, we were given
misinformation that DrSanchez has yet to reference or comment aboutThat
misinformation, whether human error or not, denied me the right to make a fair
and informed decision and now, as unfair and unethical as it has become, Dr
Sanchez wants to hide behind legality and dental jargon, rather than admitting
the error that was generated from her office, resulting in this unfortunate circumstance
Regards,
*** ***