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Northwood Dental Reviews (1)

Initial Business Response /* (1000, 7, 2015/10/05) */
[redacted]response has been scanned in and converted to text below (original document is available using the online complaint system).
To Whom It May Concern,
I will first provide you with some background on this case specifically and also on...

how dental insurance works.
Mr. [redacted]'s daughter [redacted] was the first in the family to come into our office on 8/24/15 for a lost filling. At that time, [redacted]'s mother [redacted] presented us with a Delta Dental insurance card showing that [redacted] was the policy holder and that his birthdate was [redacted]. The claim for those services was submitted to Delta on 8/25/15 the next business day. Typically when dealing with dental insurance it can take at least 30 days for our office to either receive a payment or denial of a claim. Until we receive either a payment or denial we have no way of knowing the status of a particular claim. We assume the patient has provided us with current and correct information.
[redacted] then came into our office on 8/31/15 (less than one week since the daughter's appointment). She confirmed with us again that the Delta policy she presented to us on 8/25/15 also covered her. The claim for her services were also submitted the next business day 9/1/15.
On 9/16/15 we received an electronic notice from Delta that the two claims we submitted were not processing due to: incorrect subscriber information. Their daughter [redacted] also had an appointment that same day and this notice from Delta was brought to [redacted]s attention at that time. She told us to go ahead and see [redacted] again stating to us that the Delta Dental card she had provided to us on 8/25/15 was the only plan she was aware of having. She did however tell us at that time that she could not remember if [redacted]'s birthday was[redacted] or 1979. Normally patients are aware of their spouse's birthdate but in this case. This alone would cause a delay or problem in processing a claim.
As it turns out the correct birth year was 1979 not 1978 as she had originally told us. On 9/21/15 [redacted] then came into our office with a completely different Delta Dental plan card which had never been presented to us before. As it turns out this new plan was a PPO plan. A PPO plan requires the plan participants to seek services from a finite list of providers. We are not PPO providers for this plan. Had [redacted] presented us this correct card from the beginning we would have informed her of that and she could have then chosen to seek services from a participating provider or stay here and just pay out of pocket. She then promptly cancelled all remaining appointments she or her family had in our office.
Additionally, prior to anyone receiving treatment, [redacted] signed off on treatment plans for [redacted] and herself.
All of these treatment plans clearly state: Patient and/or guarantor is responsible for payment of fees in full not covered by your insurance carrier.
Following all of this, [redacted] phone our office on numerous occasions on 9/21/15 and 9/22/15 insisting that we resubmit the charges to Delta with different dates or that we submit them under the name of our contracted periodontist who is on their PPO plan. The problem with those suggestions is that they are both insurance fraud. The dates we provide the service are the dates we provided the service. Secondly Dr. Rajek did not provide the services and does not provide those services as he is not a general dentist. He also then insisted that we then just write off all of the charges. This is also not going to happen.
Addressing Mr. [redacted]'s complaint item by item:
o The billing office did not timely process our dental claims.
o Our office as stated above submitted all claims by the next business day. His wife showed us her insurance card.
o The card [redacted] presented to our office was the incorrect card. She maintained that it
was the correct card until 9/21/15 when she presented us with the correct Delta PPO card.
o The assistant confirmed that they can work with "this plan".
o The card that [redacted] initially presented to us, we do in fact work with. It is the patients responsibility to present us with current and accurate information, which she did not do.
o After the third appointment the administrator told my wife that your insurance is not going through and you have to pay all the cost.
o As I explained previously, as soon as we were notified of a problem, which was 23 days
from the first submission date, we informed the patient. At that time we had not yet received information on any other coverage, so as is stated in their signed treatment plans, they are responsible for any fees not covered by their insurance.
o I just wanted to report what was going on to the dentist or business owner, but the administrator did not allow me to reach anyone else.
o While it is true that Robyn, our treatment coordinator is not the dentist or business
owner, she does oversee our accounts receivable department. Neither of the dentists, who are the business owners get involved in the day to day dealings of accounts receivable. Robyn is the correct and only person he should have been dealing with.
I hope this letter explains the situation. Mr. [redacted]'s family balance owing to our office is $1086.12. We are awaiting it's prompt payment. You may inform Mr. [redacted] that if the balance is not paid or payment arrangements are not made with our office, we will be turning his account over to our collection agency.
Initial Consumer Rebuttal /* (3000, 9, 2015/10/06) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I am really disappointed with this very defensive response. It starts in a sarcastic tone and ends with threatening statements! It is very unfortunate that the response has several pieces of misinformation that makes me question whether this is deliberate or just by act of negligence.
In summary, the two major points are the confusion about my date of birth and the change of insurance cards. First, my date of birth is 1978, the one originally provided by my wife and recorded in their system from the first place. I do not know how they mention that "As it turns out the correct birth year was 1979 not 1978". It is really surprises me when someone claims that they know your birth date better than yourself.
The other major point is the change of the insurance cards. Both cards are for the same plan Delta Dental PPO, with the same group number. The only difference is the ID. I do not know why Delta has changed my ID and sent me a new card. However, when we contacted Delta, they informed us that the two cards are for the same PPO plan with the same coverage criteria, so this should not make any difference.
For detailed point-by-point response, please find the attached file.
Final Business Response /* (4000, 11, 2015/10/15) */
[redacted]response has been scanned in and converted to text below (original document is available using the online complaint system).
To Whom It May Concern,
1. On 9/16/15 we were informed by Delta that their claims were being denied. Our office then
went to the Delta website to do a subscriber search to check for a coverage summary and claims inquiry. In order to do this search you need to provide the subscriber ([redacted]) birthdate and a Delta subscriber ID number. When we did this with the information that they had originally provided to us, the search came back with No subscriber/member was found for the search criteria used. We are not told by Delta if it is the birthdate or ID number which are causing us to not be able to locate them in the system. Immediately we asked [redacted], Mr. [redacted]'s wife, about this and she told us that this was the only card she had so the ID number must be correct but that she was not sure if her husband's birthday was in 1978 or 1979 and that she would check and get back to us. So up until this point we had no way of knowing what if any coverage the [redacted]'s had with our office.
2. As it turns out, Delta Dental had in fact subsequently provided Mr. [redacted] with another card with a corrected ID number on it. [redacted] then brought us in the correct number on 9/21/15 and told us her husband's birth year was 1979. We again ran the search with the new subscriber ID and the 1979 birthdate and again it came back No subscriber/member was found for the search criteria used. We then ran it one more time with the new ID number and the 1978 birth year. This time we got the information that the PPO plan for which the [redacted]'s were enrolled had zero benefits for our office. That plan in fact requires them to seek treatment from a defined list of providers, which the subscriber should have prior access to. We are not on that list.
3. We aid patients in filing their claims and do everything we can to help them maximize their
benefits, but ultimately it is the patients responsibility to understand the dental benefit plan they have and provide us with timely and accurate information. Getting inaccurate and conflicting information makes our ability to help our patients understand and file claims impossible.
I hope this answers any and all questions on this matter. Lastly, as I said in my last response, Mr. [redacted]'s family account balance with our office is $1086.12. We are still awaiting its prompt payment.
Payment arrangements may be made by calling our office at [redacted]. If this is not done within the next 30 days we will have no choice but to turn his account over to our collection agency.

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Address: 10748 E Traverse Hwy, Traverse City, Michigan, United States, 49684-5550

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