New Age Dental Care

Initial Business Response /* (1000, 5, 2016/01/28) */
Contact Name and Title: ***
Contact Phone: ***
Contact Email: ***@yahoo.com
We have been in contact with the patient the past months ,providing him with updates from his insurance company We also spoke this afternoon
,informing him that based on current information we do not owe him any refund I understand insurance claims and explanation of benefits can be confusing ,however we strive to help our patients thru this whole processIt is unfortunate that sometimes it takes so long for claims to be processedThank you and we apologize for any inconvenience to either party.Sincerely, Dr***

At New Age Dental [redacted], our patients and their dental [redacted] health/needs are of utmost importance.  When a new patient calls, we get their insurance information so we can call and verify their benefits and eligibility, as a courtesy at no additional cost.  We input the information with...

coverage percentages into a nationally used Dental Software.  At the first appointment we go over the patient’s benefits with him/her and have the patient sign the “Insurance Verification and Estimate of Dental Benefits”   acknowledging that we have verified the insurance but it is not a guarantee of payment, and that the percentage given in no way tells exactly how much of our fee will be paid and that we can only estimate. Claim payments vary by company.  As services are rendered the claims are electronically submitted to the primary insurance company. Insurance payments can take 30 days and sometimes longer if additional information is requested. Once the primary insurance has processed the claim, they send us an Explanation of Benefits (EOB) with payment. The payment is posted to the patient’s account upon receipt and the claim with the Primary Insurance Company is automatically closed and the claim is then submitted to the Secondary Insurance Company which again can take up to 30 days or longer for processing and payment.  Each time a payment is posted, the dental software automatically recalculates balance due and estimated insurance payment expected.  Once all insurance claims have been closed, the amount owed is the patient’s responsibility. With new patients, our procedure is to listen to the patients, identify the reason for the visit to our office and identify the treatment for the specific issue.  We ask if they are in pain, and also ask when their last cleaning was. The doctor will do an exam as well as any necessary x-rays.  She will then discuss her findings and the dental needs, propose a Treatment Plan that she has her staff input into the dental software.  The Treatment Plan is then printed and discussed with the patient.  The Treatment Plan has our fee, the estimated insurance coverage, as well as the patient’s responsibility.  We show this to the patient to ensure the patient understands his/her dental health needs and the cost. We ask the patient to sign this treatment plan acknowledging that he/she understands what is needed for his/her dental health and that he/she wants to pursue treatment.  In situations where patients may not have insurance or unsure how they will pay for the services, we offer deferred interest plans through [redacted] (CC) or [redacted] (LC). The patients apply on their own or in our office for approximately the patient’s portion of the Treatment Plan expense.  When the patients have their first service after the [redacted] approval, for example, the amount is charged to the account and the patient is required by [redacted] to sign the charge receipt and our office must keep the receipt.  Appointments are scheduled to begin and pursue the treatment plan services. As this complaint states, this is a young patient anxious to manage life on her own which leads to new experiences and learning opportunities. Dr. [redacted] and her staff did everything as explained above in our normal process. As a new patient, her primary and secondary insurances were verified, reviewed with her and the summary pages signed at her first visit, 4/1/17. The coverage percentages for both companies were put into her account. This patient was examined. A treatment plan was created and the services and costs were discussed with the patient.  The patient stated she wanted to have the services and signed the Treatment Plan, but unsure of how she was going to pay for the services.  The patient was offered [redacted] (LC) /[redacted] (CC) as a payment option for the proposed dental services. When approved, this allows payment for the patient’s dental needs interest free if paid off before the agreed to terms according to the LC/CC policies. The patient applied for CC at her home (not from our office) on 4/5/2017 and was approved for $1500. When she came in the office for her next appointment on 4/5/2017, the approved amount was charged and applied to her account for the services she said she wanted to have done per the signed Treatment Plan. The patient was given the [redacted] transaction receipt showing the amount charged and she signed it. Each additional appointment that the patient has come to, the services have been posted to her account, and the dental software works as normal estimating insurance, estimating the patient portion to be paid, and electronically submitting the claim first to Primary Insurance until payment is received and posted, and then automatically sending the claim to Secondary Insurance to process.  Patient’s statement that “charges after charges were made” is untrue. Services are charged to the account the day the services are rendered. The patient said the secondary insurance was never charged. [redacted] contacted the patient’s primary insurance company and they told us they did not show a secondary insurance and that the patient had to call the primary insurance company and let them know that she had a secondary insurance. This was not the fault of New Age Dental [redacted]; we had both insurances in our system.  On 5/1/17, we informed the patient that she or her family member who carries her insurance needed to contact their secondary insurance so that they can make payments.  Dr. [redacted] and [redacted] had asked the patient, after her mother had called the office multiple times, to sign a release authorizing us to discuss any treatment plan or financials with her mother, due to HIPPA laws. An email request for a signature to release medical information was sent to the patient on 5/9/1. On 5/8/17, the patient called and gave permission to discuss her account with her mom. The patient brought the signed authorization to release medical information to her mom to our office on 5/19/17, the date of this response. [redacted] has contacted both primary and secondary insurance companies and is working diligently to get the claims closed out to reconcile the patient’s account. [redacted] and the patient spoke to [redacted] from our office on 5/1 about the CC charge and the monthly payments. The CC Rep explained the statement process to the patient and told her what her payment would be each month.  The patient told rep that amount was fine. The Rep said if the patient wanted to change the amount approved for to a lesser amount she could and that our office would need to contact provider services. [redacted] discussed the patient’s concerns with the doctor. Our company has no problem reimbursing the patient any refunds after we know the exact dollar amounts paid by both insurance companies. It’s unfortunate that the patient feels that she was taken advantage of at our office.  Dr. [redacted] and our staff are an extremely friendly and caring team who go out of our way to help our patients get the dental [redacted] they need. We are working as quickly as possible to settle this unfortunate complaint.