Payne-Sanghvi Oral & Maxillofacial Surgery

This is in response to the complaint filed on 06/14/The patient was seen in our Lodi office on 06/08/for a consultation with the Oral SurgeonThe patient inaccurately and incompletely filled out her new
patient registration paperworkOur forms have a clear section to indicate primary and secondary insurance informationThe forms filled out by the patient stated that she only had one dental insuranceAll of the other areas to put additional insurance information were left blankThe patient also only gave our staff one dental insurance cardThe patient signed our forms that states, “We make every effort to keep down the cost of your careYou can help by paying upon completion of each visitOther arrangements can be made by our office manager depending upon special circumstancesAn estimate of the charge for any procedure or surgery you may require will be given to you upon requestIf you have any dental and/or medical insurance we will be glad to fill out the proper forms, but please complete the identifying information on this formPlease remember that insurance is considered a method of reimbursing the patient for fees paid to the doctor and not a substitute for paymentSome companies pay fixed allowances for certain procedures and other pay a percentage of the chargeIt is your responsibility to pay any deductible amount, co-insurance or any other balance not paid for by your insurance companyYou will be responsible for all collection costs, attorney’s fees, and court costs.” It later turns out that the patient gave us only her secondary insurance information and nothing regarding her primary dental insuranceWith the information she provided us, our office called what we thought at the time was her primary dental insuranceThe first attempt of inquiring about her dental benefits were made on 6/9/with her insurance companyAfter waiting several minutes on hold we opted to leave a message in which we were assured we would not lose our place in line and we would receive a call backWe did not hear back from her insurance companySo days later on 06/13/16, we called again, after several minutes on hold we left another message with no responseOn 06/14/16, we called a couple of times again and each time our calls were hung up on while waitingDespite leaving messages with the insurance company on two occasions we were not ready to leave a message until we spoke with someone this timeSo on 6/14/we waited on hold for hour and minutes, all for the phone to ring as if a representative was going to answer and then the call was placed back in the waiting queDuring the time we were on hold, we called the patient’s general dentist’s office to find out if we were calling the correct insurance companyThis is when we learned that the information that the patient had given to us was incorrect and that she only provided us with her secondary dental insuranceHer dentist’s office was able to provide us with her correct primary dental insurance informationWe called her primary dental insurance and received her benefits informationWe did not have the benefits information for her secondary insuranceWe made every effort to contact both of her insurance companies so we could get the most up to date information on her insurance benefitsWe called the patient to let her know about her insurance benefits and explained to her that we were not able to verify her secondary insurance due to the lack of response, but we did find out that she had other insurance coverage by her primary dentistWe told her in this situation we would collect her co-pay for her primary insuranceThe patient stated “I shouldn’t have to pay because you can’t do your job!” We would like to respond to that statement because it is clear that we spent a great amount of time trying to review her dental benefits with the limited information she gave usWe explained to her that we have tried several times with no responseWe also explained that we would be happy to send in a written preauthorization to the secondary insuranceA written preauthorization allows the insurance company days to respond as to whether they approve the treatment and the patient’s co-pay informationThe patient was very upset, and stated we wasted her time and wanted her money backShe said we charged her for nothingWe explained that the $was for the consultation that she had with the DoctorIt is customary in our office for all patients to have a consultation appointment prior to treatmentThis enables the doctor and patient to meet, discuss the reason for the appointment, review the health history of the patient, discuss any symptoms, examine the patient, review the radiographs, discuss treatment and answer all the questions the patient may haveShe stated that she didn’t have a consultation, she brought everything, and “The Doctorrdidn’t do anything”We are sorry the patient feels this way about our practice, but we can assure her we tried our very best to get a hold of her secondary insurance so that we had the most updated information about her benefitsWe are here to help people and we want all our patients to have the utmost confidence in our doctors and staff, therefore we have sent a $refund back to the patientSincerely, Payne&Sanghvi Oral and Maxillofacial Surgery

Review: On 6/8/13 I had a doctors visit with the dental office located at 525 S. Fairmont Avenue Suite B, Lodi, CA. I was referred by my regular dental office, so that I could have my wisdom teeth removed. I indicated verbally what insurance coverage I had, and informed the receptionist that I had double coverage for my dental benefits, which is teamsters and Aetna. I had a brief meeting with one of the oral surgeons, and was charged 103$. I paid with my debit card. The receptionist ([redacted]) called me on 6/14 to say that she couldn't reach my dental insurance. And that she wasn't going to waster her time being on hold to try to get in touch with a rep at teamsters. I told her I also had coverage with Aetna, and that she could contact them. She said she wasn't aware. She was not willing to help with the situation at hand. Told me that I should pay for the procedure out of pocket. I told her I would not pay out of pocket, when my insurance should cover everything, had someone taken the time to reach out to them She said a few smart remarks, which I in turn said to cancel the appointment, and that I would like a refund for the waste of time I spent at an appointment that at this time was meaningless. She was rude and refused to issue the refund. Said I should wait to see if my dental insurance will refund. I told [redacted] that I wanted the refund from the dental office. Because my insurance was not even aware of the billing issue because no one had taken the time to contact them.Desired Settlement: I would like a refund of the 103$ that I was charged.

Business

Response:

This is in response to the complaint filed on 06/14/16. The patient was seen in our Lodi office on 06/08/15 for a consultation with the Oral Surgeon. The patient inaccurately and incompletely filled out her new patient registration paperwork. Our forms have a clear section to indicate primary and secondary insurance information. The forms filled out by the patient stated that she only had one dental insurance. All of the other areas to put additional insurance information were left blank. The patient also only gave our staff one dental insurance card. The patient signed our forms that states, “We make every effort to keep down the cost of your care. You can help by paying upon completion of each visit. Other arrangements can be made by our office manager depending upon special circumstances. An estimate of the charge for any procedure or surgery you may require will be given to you upon request. If you have any dental and/or medical insurance we will be glad to fill out the proper forms, but please complete the identifying information on this form. Please remember that insurance is considered a method of reimbursing the patient for fees paid to the doctor and not a substitute for payment. Some companies pay fixed allowances for certain procedures and other pay a percentage of the charge. It is your responsibility to pay any deductible amount, co-insurance or any other balance not paid for by your insurance company. You will be responsible for all collection costs, attorney’s fees, and court costs.” It later turns out that the patient gave us only her secondary insurance information and nothing regarding her primary dental insurance. With the information she provided us, our office called what we thought at the time was her primary dental insurance. The first attempt of inquiring about her dental benefits were made on 6/9/16 with her insurance company. After waiting several minutes on hold we opted to leave a message in which we were assured we would not lose our place in line and we would receive a call back. We did not hear back from her insurance company. So 4 days later on 06/13/16, we called again, after several minutes on hold we left another message with no response. On 06/14/16, we called a couple of times again and each time our calls were hung up on while waiting. Despite leaving messages with the insurance company on two occasions we were not ready to leave a message until we spoke with someone this time. So on 6/14/16 we waited on hold for 1 hour and 18 minutes, all for the phone to ring as if a representative was going to answer and then the call was placed back in the waiting que. During the time we were on hold, we called the patient’s general dentist’s office to find out if we were calling the correct insurance company. This is when we learned that the information that the patient had given to us was incorrect and that she only provided us with her secondary dental insurance. Her dentist’s office was able to provide us with her correct primary dental insurance information. We called her primary dental insurance and received her benefits information. We did not have the benefits information for her secondary insurance. We made every effort to contact both of her insurance companies so we could get the most up to date information on her insurance benefits. We called the patient to let her know about her insurance benefits and explained to her that we were not able to verify her secondary insurance due to the lack of response, but we did find out that she had other insurance coverage by her primary dentist. We told her in this situation we would collect her co-pay for her primary insurance. The patient stated “I shouldn’t have to pay because you can’t do your job!” We would like to respond to that statement because it is clear that we spent a great amount of time trying to review her dental benefits with the limited information she gave us. We explained to her that we have tried several times with no response. We also explained that we would be happy to send in a written preauthorization to the secondary insurance. A written preauthorization allows the insurance company 30 days to respond as to whether they approve the treatment and the patient’s co-pay information. The patient was very upset, and stated we wasted her time and wanted her money back. She said we charged her for nothing. We explained that the $103.00 was for the consultation that she had with the Doctor. It is customary in our office for all patients to have a consultation appointment prior to treatment. This enables the doctor and patient to meet, discuss the reason for the appointment, review the health history of the patient, discuss any symptoms, examine the patient, review the radiographs, discuss treatment and answer all the questions the patient may have. She stated that she didn’t have a consultation, she brought everything, and “The Doctorr. didn’t do anything”. We are sorry the patient feels this way about our practice, but we can assure her we tried our very best to get a hold of her secondary insurance so that we had the most updated information about her benefits. We are here to help people and we want all our patients to have the utmost confidence in our doctors and staff, therefore we have sent a $103.00 refund back to the patient. Sincerely, Payne&Sanghvi Oral and Maxillofacial Surgery