Orange Door Dental Group

Initial Business Response /* (1000, 6, 2016/08/05) */
RE: Case # [redacted]
We will address each part of the patient's complaint:
#1-overcharging for a service/credit balance:
The patient was responsible for half of a specific procedure done 12/10/15. She paid [redacted] with check...

[redacted] When the insurance paid on this claim, they considered that procedure as part of the original filling and said we had to write off procedure. This is a a normal process with insurances, some require write off, others do not based on the patient's policy and we do not know these details on the policies until the insurance returns payment with the explanation of benefits. Ms. [redacted]'s insurance coverage switched back and forth with employer insurance and HIP insurance. It took time to get the claims straightened out and paid since incorrect insurance information was given to us. The total credit on the account was [redacted] due to a [redacted] payment made by HIP that had to be adjusted to the insurance. When an insurance over pays, the overpayment goes back to the insurance not the patient. The only credit balance is the [redacted] mentioned above, which was a finalized number January 26 this year. Ms. [redacted] was scheduled to return in June of this year. As a rule, we refund if patients have a credit and do not want to use it toward their treatment copay. We do not have a record of her response to that information at her June 16 visit, but, most patients save that credit for their copay on treatment that is still needed, which she does have treatment to be done.
#2-Cavities (treatment) to be done:
According to Ms. [redacted]'s treatment she had 6 cavities to be done and 5 have been completed. She may be confused with the rule for her HIP insurance said that only 4 fillings can be done per plan year. We do not add and take away needed treatment. When Ms. [redacted] go another insurance, she was able to do more fillings.
#3-appointment cancellation:
Attached you will find a signed copy of our Financial/Cancellation Policy and a Patient Note report documenting the incident. Ms. [redacted] had an appointment on July 26, 2016. On July 25 our appointments coordinator called Ms. [redacted] to get a confirmation of her appointment which was made 6 months previously. Her voice mail was not set up. Ms. [redacted] then returned the call and said she needed to cancel because she did not have the copay due to car repairs. Per policy, we offered to divide the copay cost into 2 payments to help her avoid a [redacted] cancellation fee. Ms. [redacted] became very rude at this and the call ended. Her account was looked up and a credit balance found. We called her back and offered that she would have her credit to help, this is when she said she did not have a ride. Grace is always offered if patients are sick, have broken down vehicles, or need to stay at work and must reschedule their appointments. Unfortunately the lack of transportation information was not offered with the original conversation with Ms. [redacted] This unfortunate situation has been reviewed by Dr. [redacted] and the [redacted] charge has been reversed. A request to refund the [redacted] is being sent through the process for Ms. [redacted]. Our goal at Orange Door Dental Group is to provide the best dental care possible to our patients and honesty financial transactions with insurance companies and our patients. Feel free to contact us if more information is needeed.
Sincerely,
[redacted] A.[redacted] D.D.S.