Madison Oral & Maxillofacial Surgeons, SC

I am sorry to hear that you are unhappy with your experience in our clinic Our surgeons' primary concern is for our patient's safety and well being Given your medical history it was necessary to thoroughly review and discuss your situation before moving forward with oral surgery under
sedation There are risks that can arise and each case must be evaluated appropriately The amount of time that Dr*** spent with you discussing the surgery along with the follow up necessary with your other doctors warrants the Comprehensive Oral Evaluation fee If you would like to discuss this further please contact me directly Thank you

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
Regards,
I been to other oral surgeons and many dentists who have spent more time with me than this dr. and they didn't charge me anything. I just went to my regular dentist the ather day to discuss getting my teeth extracted, no charge. I spent more time with him than this guy. I can see that greed is a factor in his practice. No further business will ever be done with him or his group.Mark [redacted]

Review: On July 8, 2013 my son had four impacted wisdom teeth removed. We believed we had insurance covering the procedure (Blue Cross) which turned out not to be the case after it was processed. Madison Oral & Maxillofacial Surgeons billed us $3,259 for the procedure that lasted a little over an hour. Blue Cross, which had all of the codes and new every detail of the procedure informed us that had they had a contract with them the fee would have been about $1,000. No medical facility would negotiate a contract where they aren't making money. Even though they make a profit at $1,000 they then charged us $3,259 for the exact same procedure. They are essentially inventing a bill that is abusive and outrageous. They then have the audacity to offer you a payment plan (at very high interest rates). Without the paper work of insurance the fees should be less not over 3 times more. Many people do not have dental insurance. There billing practices are abusive and unconscionable.Desired Settlement: A reasonable price for the service. If they will take $1,000 all day long I would even be willing to pay $1,200 or $1,300.

Business

Response:

This letter is in response to the above referenced complaint against our practice. Unfortunately the patient’s father had inaccurate expectations coming into his son’s surgery due to the fact that he was comparing the cost of his surgery, which took place a year prior, to the cost of his sons. The surgeries were in fact very different and thus incurred very different fees. I have discussed this all with the patient’s mother and father.

Our fees are developed and compared to market data to ensure that they are reasonable. In fact it has been further verified by various contracts that we do have with several insurance companies. We are not providers for Blue Cross, the amount that they would pay us for our surgery is irrelevant. Most insurance companies offer a reduced rate or no payment at all for out of network providers. I have reviewed the explanation of benefits that we received from Blue Cross and because we are not providers they only pay a certain amount towards the fees, however given the type of insurance plan that the patient’s father has, it was applied to the deductible.

The payment plan that he is referring to is through Care Credit. We offer Care Credit to all of our patients that may need assistance with the financial portion of our services. Although the interest rate can be as high as 14.9%, it is much more manageable than many credit card interest rates and we find that our patients are thankful to have it as an option.

Many people have insurance plans with high deductibles and little coverage. They enroll in these insurances in order to keep their monthly premium expenses low. We do our best to communicate openly with our patients about their insurance coverage. Many patients come in asking a lot of questions about insurance coverage and fees. We give them as much information as possible to help them make an informed decision. Because of the number of insurances that we deal with, we always encourage our patients to be familiar with their own coverage and look for themselves to be sure they understand what will and will not be covered. No such questions were ever raised by the patient or his mother or father.

Our fees are not abusive or outrageous. We stand behind them 100%. As I have expressed in previous phone conversations with the patient’s parents, I would be willing to work out a payment plan with them, outside of Care Credit, to assist them with this unexpected balance.

Practice Administrator

Madison Oral & Maxillofacial Surgeons, S.C.

5801 Research Park Blvd., Ste. 110

Madison, WI 53719

Phone [redacted]

Fax [redacted]

Consumer

Response:

Review: This complaint is in regards to their business practices regarding insurance and billing. As a consumer, I am angered at their unconscionable neglect in providing upfront information regarding billing, costs and insurance coverage. If we had initially received the proper information, we would have gone to GHC’s preferred Madison provider and the operation and associated costs would have been covered 100% (per my recent phone call to GHC). Instead, we are left with a balance of $250 medical bills due to your office and $235 to the pathology lab.

We were referred by our dental offfice, just around the corner. We setup a consultation on June 6th, 2013. We provided health and dental insurance information at the front desk. We have Group Health Cooperative (GHC) as a health insurance. At no time were we told that this business was not a preferred provider for GHC. We were not told that their services may not be covered by our dental insurance companies (dental insurance denies biopsies since they are considered medical procedures). We did not receive any price lists for costs regarding the office visits, scans, or operation at this visit or the subsequent visit until later requested in October 2013. As a medical provider, we feel that there should be a duty of full disclosure and need to provide the appropriate insurance information to your clients.

At this appointment, they did a scan on my son’s teeth. I consented because I assumed that it was covered by insurance. Their staff did not tell me the price of your scan. My son had a panoramic x-rays done on 4/29/13 at his dentist's in which this office had copies in their possession. This bill for the scan was rejected by the dental insurances, since it is considered medical (on the gums, not teeth) and x-rays were already paid for earlier this year. Again, if this business were a preferred provider, GHC would have covered the bill its entirety. There is also a question if the x-rays were detailed enough to adequately provide you the information you needed for surgery ($250 billing).

The operation was scheduled for one month later on 7/16/13 in which their billing office would have had plenty of time to obtain preauthorization from insurance. They requested preauthorization from GHC on 7/9/13 and it was rejected by fax on 7/11/13, since they are not a preferred provider. Because of the late request from GHC, we were not notified from GHC by mail until after the date of surgery. Delta Dental preauthorized the majority of the operation, but not the full amount of the operation of $1,972. This office did not inform us of GHC’s denial and reason for denial. We were not notified of any shortfall of coverage. Nor were we notified of the price of the surgery itself.

I want to stress that we would have walked out of this business and not had the surgery performed if we knew the lack of preauthorization for the costs of the surgery. However, since we did not have full disclosure of the out-of-pocket costs, we consented to surgery. We are fortunate that our two dental carriers covered the cost.

I called their business office in September, on 10/3/13, and on 10/4/13 to follow-up on the outstanding bills and the submission to the insurance carriers. I did not receive hard copies of the full medical bills until after my request of 10/4/13.

We paid the outstanding bill of $250 to avoid any credit issues and we still have an outstanding pathology lab bill of $235 (still waiting to see if dental insurance will cover).Desired Settlement: I would like a written apology. Also, although we received value for their services, we felt that we could have avoided any expense (since GHC would have paid the full amount) if we would have had full disclosure upfront in the initial visit. Also, a refund of the $250 and reimbursement of any outstanding amount from the pathology bill is preferable.

Business

Response:

January 21, 2014