The balance due from Ms [redacted] is a direct result of the alternate benefit clause in her insurance plan Ms [redacted] signed her consent form for the composite fillings (see attached), which states that all co-pays are estimated and subject to change based on her particular insurance plan Also attached is her new patient paperwork, which she signed, stating that she understands that insurance plans may contain clauses, such as the alternate benefit clause, and that she is responsible for all charges not covered by her insurance
Complaint: [redacted] I am rejecting this response because: the dentist office did a procedure they knew was not covered by my insurance after I clearly expressed that I will not have anything done that was not covered 100% They knew of the different type of filling and failed to inform me of the details Instead they insisted my cost would be $and wrote that on the paperwork without explaining any differences Regards, [redacted] ***
Insurance breakdowns often just say "fillings" are covered at a certain percentage and there is no specification between types It is the clause that makes the specification and caused them to change the codes and pay them at the lower rate We file insurance as a courtesy and everything not paid by your insurance is ultimately your responsibility
Complaint: [redacted]
I am rejecting this response because: when I walked into that office with my insurance plan printed out on paper and told the dental assistant I am only getting procedures done that are covered 100% by my insurance. It then becomes their responsibility to say to the patient in some regard as "this dentist office does not do the type of fillings that are covered under your insurance, there will be an extra charge". Instead they went back to their computer and ASSURED me I was correct and I would owe $0 and even wrote that on the paperwork and never once mentioned the difference in fillings and which one was specifically covered. The fact is, the dental office KNEW my filling was not covered even after I told them I only approve procedures that are covered 100%. There was no explanation of different types of fillings being covered and others not being covered. They just told me "ok you will pay $0" and continued on without an explanation as to what was being signed for.
Regards,
[redacted]
The balance due from Ms. [redacted] is a direct result of the alternate benefit clause in her insurance plan. Ms. [redacted] signed her consent form for the composite fillings (see attached), which states that all co-pays are estimated and subject to change based on her particular insurance plan. ...
Also attached is her new patient paperwork, which she signed, stating that she understands that insurance plans may contain clauses, such as the alternate benefit clause, and that she is responsible for all charges not covered by her insurance.
Complaint: [redacted]
I am rejecting this response because: the dentist office did a procedure they knew was not covered by my insurance after I clearly expressed that I will not have anything done that was not covered 100%. They knew of the different type of filling and failed to inform me of the details. Instead they insisted my cost would be $0 and wrote that on the paperwork without explaining any differences.
Regards,
[redacted]
Insurance breakdowns often just say "fillings" are covered at a certain percentage and there is no specification between types. It is the clause that makes the specification and caused them to change the codes and pay them at the lower rate. We file insurance as a courtesy and everything not paid by your insurance is ultimately your responsibility.
The balance due from Ms [redacted] is a direct result of the alternate benefit clause in her insurance plan Ms [redacted] signed her consent form for the composite fillings (see attached), which states that all co-pays are estimated and subject to change based on her particular insurance plan Also attached is her new patient paperwork, which she signed, stating that she understands that insurance plans may contain clauses, such as the alternate benefit clause, and that she is responsible for all charges not covered by her insurance
Complaint: [redacted] I am rejecting this response because: the dentist office did a procedure they knew was not covered by my insurance after I clearly expressed that I will not have anything done that was not covered 100% They knew of the different type of filling and failed to inform me of the details Instead they insisted my cost would be $and wrote that on the paperwork without explaining any differences Regards, [redacted] ***
Insurance breakdowns often just say "fillings" are covered at a certain percentage and there is no specification between types It is the clause that makes the specification and caused them to change the codes and pay them at the lower rate We file insurance as a courtesy and everything not paid by your insurance is ultimately your responsibility
Complaint: [redacted]
I am rejecting this response because: when I walked into that office with my insurance plan printed out on paper and told the dental assistant I am only getting procedures done that are covered 100% by my insurance. It then becomes their responsibility to say to the patient in some regard as "this dentist office does not do the type of fillings that are covered under your insurance, there will be an extra charge". Instead they went back to their computer and ASSURED me I was correct and I would owe $0 and even wrote that on the paperwork and never once mentioned the difference in fillings and which one was specifically covered. The fact is, the dental office KNEW my filling was not covered even after I told them I only approve procedures that are covered 100%. There was no explanation of different types of fillings being covered and others not being covered. They just told me "ok you will pay $0" and continued on without an explanation as to what was being signed for.
Regards,
[redacted]
The balance due from Ms. [redacted] is a direct result of the alternate benefit clause in her insurance plan. Ms. [redacted] signed her consent form for the composite fillings (see attached), which states that all co-pays are estimated and subject to change based on her particular insurance plan. ...
Also attached is her new patient paperwork, which she signed, stating that she understands that insurance plans may contain clauses, such as the alternate benefit clause, and that she is responsible for all charges not covered by her insurance.
Complaint: [redacted]
I am rejecting this response because: the dentist office did a procedure they knew was not covered by my insurance after I clearly expressed that I will not have anything done that was not covered 100%. They knew of the different type of filling and failed to inform me of the details. Instead they insisted my cost would be $0 and wrote that on the paperwork without explaining any differences.
Regards,
[redacted]
Insurance breakdowns often just say "fillings" are covered at a certain percentage and there is no specification between types. It is the clause that makes the specification and caused them to change the codes and pay them at the lower rate. We file insurance as a courtesy and everything not paid by your insurance is ultimately your responsibility.