Michiana Oral & Maxillofacial Surgery

Initial Business Response /* (1000, 6, 2016/05/18) */
May 18,
Revdex.com
*** *** *** *** *** ***
Fort Wayne, IN XXXXX
Dear ***:
Here are the facts regarding the billing for general anesthesia and the patients balance due on account after insurance paid, This information was sent
to *** *** on 5/6/I am also including a complaint letter answered by the IDA
Please review Exhibit Don 3/10/you phoned the office and stated you had received an EOB form Cigna showing they processed your claim and you thought you might be entitled to a refundExhibit A is an email I received from you sending in a copy of the EOB you received from CignaExhibit B is the email printed for viewingI did review this EOB and noticed Cigna made an error processed the claim with the 'amount eligible for coverage" being incorrect
On 3/11/as documented on Exhibit p, I.phoned Cigna and spoke with Bill>f explained at this point we had not received payment for surgery and I received a copy of the EOB from the patient and noticed they processed the Anesthesia incorrectlyHe did look and claim and agreedBill asked that I fax him a paper copy of the claim we originally filed so he could see the units of anesthesia, apparently with Cigna's system they it was not recognizing units of time on the electronic claimsThe unit of anesthesia filed was The original claim only took in to consideration unit(General Anesthesia is billed each minutes)As Exhibit E shows: start time was 10:and to recovery is 11:07, that allows for units of anesthesia to be billed
During the conversation with Bill from Cigna on 3/11/16, he advised me he would be putting a "stop payment" on the check originally sent and reprocessing claim correctly
I phoned Cigna on 4/11/to check thestatus of the claimThe representative I spoke with stated they did reprocess and sent out a payment of only *** They did not put a hold on the stopped payment amount, instead processed additional claims that came in and used much of your remaining benefit
We did finally receive the payment from Cigna for your 2/23/surgery on 4/18/(Exhibit C)If you take a moment to review both EOB's you will see that the amount of
anesthesia billed was exactly the same on both EOB's, The full dollar amount of the claim was also the sameThe only difference is the allowable amount on Exhibit C was correctedAgain the payment was less because your benefits had been used by other claims payments
I did attempt to phone you to discuss the payment on 4/and when you answered you instructed me that you were driving and would call me back on Wednesday, I never received that call
I spoke with your fianc*** on 4/19/and explained the amount due after insurance paid and was told you would send in balanceAs of today you still have an outstanding balance due in our office
These are the factsin black and whiteWe do feel terribly for you that Cigna did not hold back enough benefit to reprocess your claim as they did originallyWe have no control over your insurance and not receiving the original check
We pride ourselves in offering exceptional care here at Michiana OM and hope you review the facts and decide we have done nothing wrong in the situation
If you need to make a short term payment arrangement on your unpaid balance I will be glad to extend that courtesyJust let me know
If you have any questions, please feel free to contact me at (XXX) XXX-XXXX ext Sincerely,
In
N, airvecr
***
Business Manager *** ***., D.D.S
Initial Consumer Rebuttal /* (3000, 8, 2016/05/24) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Looking at the businesses own items you can look at exhibit E and see that the surgery start time was 10:35, anesthesia was 10:amWhen they began the surgery I was only under a local and because they couldn't numb me enough the pain and stress of the extraction caused my blood pressure to spike significantly due to the extreme pain and stressWith my medical training with the South Bend Fire Department I knew the spike in my blood pressure could cause a stroke if continued at that rate so I requested they put me under a general after one extractionDr*** asked me if I had high blood pressure, to which I responded NoIf you look at their documents, exhibit E you can see the time at which the spike in pressure happened and was impossible for me to be under a general at that time which is what they are claimingSO by their own records it confirms what I have stated all along, that I was not under a general for minutesI was only under a general for minutes