Mark S. Obernesser D.D.S. M.M.Sc Akron Periodontics & Dental Implantology

Initial Business Response / [redacted] (1000, 5, 2016/06/13) */ This patient was new to our practice in September, We did an initial consultation and presented the patient with all of the fees that would be incurred (including the initial visit)As courtesy to our patients who have insurance, we submit their initial exam to their insurance, given that most insurance companies usually allow two consultations per contractual yearEvery patient that comes to our practice has a different plan, different limitations, maximums, deductibles, etc., it would be near impossible to know exactly what is covered; if you have ever dealt with insurance companies, you will know nothing is ever a certaintyThis patient exceeded their annual allowance for consultations and therefore was billed for what was not coveredThey were aware of this fee and unfortunately their plan did not allow itWe did not surprise the patient with this fee or bill for a service that was not provided As far as timing, the erratic world of insurance can take up to a yearOur practice ran a periodic report, we then realized this initial visit was still outstanding and that the insurance company never responded (which can be a tactic for prolonging claims)Our office then resubmitted the claim for which the insurance company responded approximately a month later with the denial and the patient was billedThe patient is ultimately responsible for fees that are not covered under their plan We strive to make our patients satisfied, deceiving or "trapping" is something we surly want to avoidInsurance is a contract between the insurance company and the subscriber; we are the "middleman" and try to help the patient to the best of our abilityIf an exam is something you want to be sure that will be covered, it would be best to check with your insurance plan before visiting an office Initial Consumer Rebuttal / [redacted] (3000, 7, 2016/06/14) */ (The consumer indicated he/she DID NOT accept the response from the business.) As the business explains in their response, they work with insurance companies and patients all the timeThey have much more experience than a patient doesThey know very well what can be paid and what cannot be paid by the insurance claimI went to this business with all the details of my medical history and any previous visits I made in that yearThey should very well know if an initial exam will be covered or notIf they weren't sure, why did not they ask me to pay for it? I guess it is nothing except to make the bill look smaller If they would like to be more accurate on charges and payments, they should inform the patient about unlikely refunds that may not be paid by the insurance, not send them bills after monthsIf a business is running its periodic reports every six months, they should better improve If the business thinks they are not good with dealing insurance companies, they should charge the patient immediatelyHow they handled my case was misinformation and a charge that I received months after my initial examFunny enough, the part was not covered is the "initial" exam

Initial Business Response /* (1000, 5, 2016/06/13) */
This patient was new to our practice in September, 2015. We did an initial consultation and presented the patient with all of the fees that would be incurred (including the initial visit). As courtesy to our patients who have insurance, we...

submit their initial exam to their insurance, given that most insurance companies usually allow two consultations per contractual year. Every patient that comes to our practice has a different plan, different limitations, maximums, deductibles, etc., it would be near impossible to know exactly what is covered; if you have ever dealt with insurance companies, you will know nothing is ever a certainty. This patient exceeded their annual allowance for consultations and therefore was billed for what was not covered. They were aware of this fee and unfortunately their plan did not allow it. We did not surprise the patient with this fee or bill for a service that was not provided.

As far as timing, the erratic world of insurance can take up to a year. Our practice ran a periodic report, we then realized this initial visit was still outstanding and that the insurance company never responded (which can be a tactic for prolonging claims). Our office then resubmitted the claim for which the insurance company responded approximately a month later with the denial and the patient was billed. The patient is ultimately responsible for fees that are not covered under their plan.

We strive to make our patients satisfied, deceiving or "trapping" is something we surly want to avoid. Insurance is a contract between the insurance company and the subscriber; we are the "middleman" and try to help the patient to the best of our ability. If an exam is something you want to be sure that will be covered, it would be best to check with your insurance plan before visiting an office.
Initial Consumer Rebuttal /* (3000, 7, 2016/06/14) */
(The consumer indicated he/she DID NOT accept the response from the business.)
As the business explains in their response, they work with insurance companies and patients all the time. They have much more experience than a patient does. They know very well what can be paid and what cannot be paid by the insurance claim. I went to this business with all the details of my medical history and any previous visits I made in that year. They should very well know if an initial exam will be covered or not. If they weren't sure, why did not they ask me to pay for it? I guess it is nothing except to make the bill look smaller.
If they would like to be more accurate on charges and payments, they should inform the patient about unlikely refunds that may not be paid by the insurance, not send them bills after 8 months. If a business is running its periodic reports every six months, they should better improve.
If the business thinks they are not good with dealing insurance companies, they should charge the patient immediately. How they handled my case was misinformation and a charge that I received 8 months after my initial exam. Funny enough, the part was not covered is the "initial" exam.