We are in receipt of your letter requesting resolution of *** ***'s complaint*** ***'s account balance of $287.80, was turned over to our collection attorney, July 17, 2015.On *** ***'s initial consultation, October 29, 2014, he was given an estimate for the proposed surgical servicesThe
procedures outlined in the estimate were performed on November 28, 2014, and charges were applied to his accountA claim itemizing his consultation and each procedure was sent to his insurance company*** ***'s insurance company denied some of the proceduresAppeals had been filed regarding the denials on his behalf, but the insurance company upheld their denialUnfortunately, we cannot dictate what procedures an insurance company will cover*** *** would need to contact them for resolution.*** *** is responsible for the entire balance of his account as well as any attorney fees that have been applied since July,
[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 as Answered]
Complaint: ***
I am rejecting this response because:
This business is NON-RESPONSIVE, is NOT responding to the complaint,
- they did not send in a proper pre-determination to the insurance as to the cost and coverage of the actual procedures, they knew exactly what the procedure codes were but all they did was to send in the generic implant services, with NO specifics, which the insurance responded with the generic 50% coverage
- Upon receipt of their first pay demand, I tried to contact numerous times (more than 10) the dentist in person, by hand delivered note, by email, by phone but they did not respond, after a long while, so they can say it is time to send for collection, when I got a response they just said I am responsible what the insurance did not pay and pay up or else they will send for collectionThis is intimidation and extortion
- Tried again to contact them, many times, but with similar no response, when a letter is received it said pay up or else they send the account to the collection agency
- When I got a letter from the collection agency, *** *** * ***, P.C*** *** *** *** Richmond, VA ***, I asked the agency to wait till I find out what the insurance issues were
- I had to contact the insurance myself, *** Dental, found out one of the claims (***) the insurance wanted more information but the dentist did not supply any or not the proper information, I without any dental nor any insurance knowledge did some research and gave what information I could and it satisfied the insurance and the claim was paidI had to do the dentist work
- On another claim, ***, I found out that was not the proper code to be used hereThe *** is used by a primary dentist for examination, but this was a referral examination requested by my primary dentist, the proper code is ***, Consultation - diagnostic service provided by dentist or physician other than requesting dentist or physicianWhen I requested that the claim code be changed, it was refused on the ground that they always use code ***, even it is NOT the correct codeIf they want to get paid for this claim all they need to do is to correct the claim code
- On two other claims, *** and ***, according to *** insurance these claims are NOT denied, but are already covered by claims that are already paid and are duplicatesAccording to *** this is the contractual agreement the insurance have with the dentistThis is similar to one can buy a band-aid from the medical-shop, but if you go there to treat a cut, the band-aid is included in the procedure feeThis business is OVER CHARGING
Regards,
*** ***
Please refer to our letter of June 20, in answer to *** ***'s complaint.A pre-treatment estimate was sent to *** ***'s insurance company for predetermination of servicesWe used the appropriate procedure codes for all proposed treatment and all procedures performed on *** ***We had been in Contact with *** *** on many occasions and appeals to the insurance Company had been sent on his behalf.We cannot change procedure codes to accommodate patient's requests so that their insurance company will pay.*** *** is responsible for his account with our practice
We are in receipt of your letter requesting resolution of *** ***'s complaint*** ***'s account balance of $287.80, was turned over to our collection attorney, July 17, 2015.On *** ***'s initial consultation, October 29, 2014, he was given an estimate for the proposed surgical servicesThe
procedures outlined in the estimate were performed on November 28, 2014, and charges were applied to his accountA claim itemizing his consultation and each procedure was sent to his insurance company*** ***'s insurance company denied some of the proceduresAppeals had been filed regarding the denials on his behalf, but the insurance company upheld their denialUnfortunately, we cannot dictate what procedures an insurance company will cover*** *** would need to contact them for resolution.*** *** is responsible for the entire balance of his account as well as any attorney fees that have been applied since July,
[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 as Answered]
Complaint: ***
I am rejecting this response because:
This business is NON-RESPONSIVE, is NOT responding to the complaint,
- they did not send in a proper pre-determination to the insurance as to the cost and coverage of the actual procedures, they knew exactly what the procedure codes were but all they did was to send in the generic implant services, with NO specifics, which the insurance responded with the generic 50% coverage
- Upon receipt of their first pay demand, I tried to contact numerous times (more than 10) the dentist in person, by hand delivered note, by email, by phone but they did not respond, after a long while, so they can say it is time to send for collection, when I got a response they just said I am responsible what the insurance did not pay and pay up or else they will send for collectionThis is intimidation and extortion
- Tried again to contact them, many times, but with similar no response, when a letter is received it said pay up or else they send the account to the collection agency
- When I got a letter from the collection agency, *** *** * ***, P.C*** *** *** *** Richmond, VA ***, I asked the agency to wait till I find out what the insurance issues were
- I had to contact the insurance myself, *** Dental, found out one of the claims (***) the insurance wanted more information but the dentist did not supply any or not the proper information, I without any dental nor any insurance knowledge did some research and gave what information I could and it satisfied the insurance and the claim was paidI had to do the dentist work
- On another claim, ***, I found out that was not the proper code to be used hereThe *** is used by a primary dentist for examination, but this was a referral examination requested by my primary dentist, the proper code is ***, Consultation - diagnostic service provided by dentist or physician other than requesting dentist or physicianWhen I requested that the claim code be changed, it was refused on the ground that they always use code ***, even it is NOT the correct codeIf they want to get paid for this claim all they need to do is to correct the claim code
- On two other claims, *** and ***, according to *** insurance these claims are NOT denied, but are already covered by claims that are already paid and are duplicatesAccording to *** this is the contractual agreement the insurance have with the dentistThis is similar to one can buy a band-aid from the medical-shop, but if you go there to treat a cut, the band-aid is included in the procedure feeThis business is OVER CHARGING
Regards,
*** ***
Please refer to our letter of June 20, in answer to *** ***'s complaint.A pre-treatment estimate was sent to *** ***'s insurance company for predetermination of servicesWe used the appropriate procedure codes for all proposed treatment and all procedures performed on *** ***We had been in Contact with *** *** on many occasions and appeals to the insurance Company had been sent on his behalf.We cannot change procedure codes to accommodate patient's requests so that their insurance company will pay.*** *** is responsible for his account with our practice