Nivine Y. El.Refai, BDS, DDS, MSD, Inc.

Initial Business Response /* (1000, 5, 2015/07/29) */
(Revdex.com - converted from original. See file.)
July 28, 2015
Re: Case: #[redacted]
To whom it may concern:
Mrs. [redacted] contacted our office on Mon 4/6/15 requesting an appointment for an exam and possible root...

canal. We got her information and contacted her insurance company Anthem. The representative who answered our call on 4/6/15 stated that Mr. [redacted]'s plan provided coverage for his spouse [redacted] for procedure code 3330 molar root canal at 100%, but this was not a guarantee of payment or coverage and that she had $50 deductible. We contacted Mrs. [redacted] and informed her that according to her insurance company the estimate is $169 for exam and if they do not cover the root canal procedure 100% she could owe an additional $1075. We informed her that this is an estimate and not a guarantee of payment per her insurance, any balance not covered by insurance will be her responsibility and she agreed. She requested a next day appointment and we accommodated her in our emergency slot for Tues 4/7/15 because she stated she was in pain.
When she arrived at our office on Tues 4/7/15, she filled and signed the Responsible Party Information that clearly states that any amount not covered by the insurance is her responsibility and she signed and initialed that. Also on that sheet she signed under that statement that explains that if the account is placed with a collection agency or an attorney, she will be responsible for all costs involved.
After her procedure was completed on 4/7/15, she was given a statement with all charges billed to her insurance and was informed that she is responsible for the balance if not covered by the insurance as they stated.
Then our office waited till we received the insurance explanation of benefits that the subscriber usually receives before us and we applied the insurance payment of $183 and the contracted write off of $274 to her account and sent her statement with her $614 balance. The statement clearly stated that the account will accrue billing fees if not paid.
She did not even try to contact the office to make payment arrangements. We gave her a chance till June, and then we started phoning her as can be seen by our phone log. She hung up on our staff several times. Then she claimed she sent a check, which we never received. We even contacted her several times to let her know check was never received and requested payment by credit card to avoid account going into collections.
Our office has been very courteous with this patient and tried to make payment arrangement with her, but she was the one who kept avoiding paying her balance, that was clearly stated in her insurance explanation of benefits and the statements we sent her. Therefore we had no other option but to send her to collections so we can focus on providing quality care to other patients in pain.
Is it our fault that we trusted the patient and allowed her to only pay for her exam until her insurance sent the explanation of benefits? Should we have collected our full fee upfront to avoid such problems?
Thankfully the majority of our patients immediately pay their balance after they receive their first statement.

After all the time Mrs. [redacted] has wasted for our staff, she is responsible to settle her balance with the collection agency. The matter now is totally out of our control. If she really wanted to settle her balance she had from 4/27/15 till 7/15/15 to contact our office!!!
Thank you for investigating the matter.
Best,
Nivine *. E[redacted], BDS, DDS, MSD,Inc