Oral & Maxillofacial Surgery Associates

I received your correspondence and thank you for the opportunity to reply in writingI was sorry to see that a patient of ours was dissatisfied with the way the billing was handled with his insurance companyThis complaint revolves around the coding of an office evaluation vs/ consultation for a patient seen in our officeThis is a problem that occurs usually after an office evaluation is billed to an insurance company and is not coveredThe insurance company then suggests to the patient to bill under an office consultation code and that would be a covered service.We follow the guidelines set forth by our [redacted] - The [redacted] of [redacted] and [redacted] I have enclosed a copy of their documentation on just this issue for your reviewIt clearly states that a consultation code [redacted] should be used only when the referring Doctor is unsure of the surgical path that is needed on the patientCode [redacted] should be used when the patient is referred to us already diagnosed and the need for surgical intervention has been established.We coded the claim [redacted] as an exam for new patient because the referring Doctor had already established the need for the extraction of wisdom teethI have also enclosed the referral form which clearly states extraction of wisdom teethThe examination prior to surgery is to review the patients' health history, the procedure, difficulty of extractions, IV sedation and possible complicationsClaims cannot be coded simply by what is covered or not coveredChanging our code to a consultation, simply to have a service covered would be fraudulentI hope this better explains our policy on coding.I would like to address the apology from "***" for being rudeNo employee should ever be rude to a patient in our officeI cannot directly address this as I have no "***" employed hereOn behalf of this corporation, I apologize for any employee that was rude at any time during the course of treatment.Sincerely, [redacted] ***Administrator

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below
When my son went in for his surgery to get his wisdom teeth out I asked the doctor if the first visit would be considered a consultation and he said yes it wasSince he told me that it is was a consultation and they were charging me as a regular visit I don't really follow what they are telling me in their responseIf the doctor is telling me it's a consultation and the insurance company needs a different code to pay it as a consultation, I really don't understand the mess with it not being considered a consultation visitI know my sons dentist recommended this office as one of the places to go to to get the procedureSo, we went there to get a consultation on the matterWhat would've happened if we didn't get a good feeling about this place after the "Consultation" and didn't have the procedure done here? Bottom line is I am still not happy with the outcome of this matterI don't believe this would be fraudulent since this should be considered a consultation like the doctor said it was and it being our first ever visit to the placeI still think that they should resubmit the claim as a consultation and refund the money I paid them.Also, my wife corrected me and the "Rude" office girls name was ***.
Regards,
*** ***

I received your correspondence and thank you for the opportunity to reply in writing. I was sorry to see that a patient of ours was dissatisfied with the way the billing was handled with his insurance company. This complaint revolves around the coding of an office evaluation vs/ consultation for a...

patient seen in our office. This is a problem that occurs usually after an office evaluation is billed to an insurance company and is not covered. The insurance company then suggests to the patient to bill under an office consultation code and that would be a covered service.We follow the guidelines set forth by our [redacted]- The [redacted] of [redacted] and [redacted]. I have enclosed a copy of their documentation on just this issue for your review. It clearly states that a consultation code [redacted] should be used only when the referring Doctor is unsure of the surgical path that is needed on the patient. Code [redacted] should be used when the patient is referred to us already diagnosed and the need for surgical intervention has been established.We coded the claim [redacted] as an exam for new patient because the referring Doctor had already established the need for the extraction of wisdom teeth. I have also enclosed the referral form which clearly states extraction of wisdom teeth. The examination prior to surgery is to review the patients' health history, the procedure, difficulty of extractions, IV sedation and possible complications. Claims cannot be coded simply by what is covered or not covered. Changing our code to a consultation, simply to have a service covered would be fraudulent. I hope this better explains our policy on coding.I would like to address the apology from "[redacted]" for being rude. No employee should ever be rude to a patient in our office. I cannot directly address this as I have no "[redacted]" employed here. On behalf of this corporation, I apologize for any employee that was rude at any time during the course of treatment.Sincerely,[redacted]Administrator