Oral-Facial Surgery Associates, P.S.C

Tuesday, October 20, 2015Revdex.com 1.E4", Suite Cincinnati, Ohio 45202Re: ID [redacted] To whom It May Concern;I am writing in response to correspondence from your office in regards to a patient’s complaintThe patient was seen in our office for an initial consultation on 3/12/At that time an exam and x-ray were done and insurance was checked on line as is protocol in our officeWe found on line that this patients plan with [redacted] covered this procedure at 80% with a $deductible and a $annual maximum; also that she had her full benefit at that timeShe was given an amount to pay on the day of surgery based on these findings and was told this was only an estimate and she would be billed for any balancesAs all patients in our office she signed a financial agreement stating the fees and that this is an estimateWe work very hard to help our patients understand that checking benefits is never a guarantee of payment.When the surgery claim was paid and the anesthesia was denied we spoke with the patient and filed an appeal for her with the insurance company, The appeal was denied, therefore the patient was billed the balanceAfter several statements were sent to the patient, she called and was advised we were happy to set up a payment plan in-house.Please let me know if I can provide any further information.enc: copy of signed financial agreement & screen shot of current on line benefitsRegards,Yvonne R [redacted] Practice ManagerOral Facial Surgery Associates [redacted] Phone: [redacted]

Revdex.comE4th Street, Suite Cincinnati, Ohio 45202RE: ID# [redacted] I am writing in response to complainants’ letter dated October 21, There are two issues with the patients’ responseFirst, there are a variety of inaccuracies stated regarding the payment of insurance claimsSecond, she is trying to avoid payment based on our contract entitled "Fees, Terms and Conditions of ServiceHowever, she signed the contract thus agreeing to the terms that states a pre-estimate is never guaranteedThe patient has made five payments on her outstanding balanceI have included a copy for your reference (Exhibit A)First, Ms [redacted] made a variety of inaccurate statements regarding insurance claims in hcr response letterAt Oral facial Surgery Associates, we do understand that insurance payments are a complex issue and difficult for a layperson to understand the exact procedures in which a physician's office files a claimWith that being said, Ms [redacted] is incorrect that "had the office called, they would have been advised of the - guidelines." It is common practice in dealing with [redacted] to be referred to the website by the [redacted] Representative over the telephoneThe insurance coverage sheet printed from [redacted] 's website is attached as Exhibit BAs you can see by this attachment Ms [redacted] benefits were printed up again on October 20, and it still states general anesthesia is paid at 80%As stated by any representative of any insurance company, they do not guarantee coverage when obtaining estimated benefitsThey cannot and will not guarantee that a claim will be paid or what will be paid until the claim is actually filed.In addition, Ms [redacted] states that "there arc guidelines across the board for [redacted] in determining whether or not anesthesia is covered for a procedure." However, this is inaccurateI have enclosed several explanations of benefits from [redacted] (Exhibit C)These provide proof that [redacted] is not across the board when paying for anesthesiaAs you can see we get payment for anesthesia many times with fewer extractions than this patient hadThe differences are the results of the way the individual plan is written.Second, Ms [redacted] signed the contract entitled, "Fees, Terms and Conditions of Service" and is attempting to avoid payment based on this contractual agreement (Exhibit A)However, the contract states that "pre-estimates are estimates only and could vary from the actual benefit paidThe estimate given to Ms [redacted] varied from the final bill due to incomplete information received from her insurance companyThe insurance company provided the information we used for the estimate and this information provided by the insurance company was incomplete informationSituations such as these do occasionally arise and as a result we have our patients sign the contract entitled, "Fees, Terms and Conditions of Service" to help our patients understand that we can only provide estimates, and that the insurance pre-estimate is never guaranteedWe contact patient’s insurance company for information on benefits as a courtesy to our patientsWe try to give patients an ideal of out of pocket expenses with the information we receiveThis is never exact.Ms [redacted] has made five payments on her accountShe currently owes $and has paid a total $We have been extremely flexible with Ms [redacted] regarding her delinquency and have offered to set up payment arrangements on her account; however a payment has not been made since OctoberWe do request that Ms [redacted] contact our office promptly to avoid any Collections effort from an outside company.Feel free to call my office at your convenience to discuss any remaining questions regarding this matter.Thank you,Yvonne R [redacted] Practice Manager Oral Facial Surgery Associates Thomas More Parkway, Suite Crestview Hills, KY 41017###-###-#### [redacted]