Perio Central

Review: [redacted] office has misrepresented his billing by indicating an item was covered under insurance. His office and myself called the insurance prior to the work being done and received approval for the codes indicated. When billed later they indicated this was not case and did the work under the assumption/false prentence of "who cares what the insurance pays we can always get the money out of the patient" by having them sign something with small print on it. They down right lied knowing the item would not be covered. I have email correspondene to prove this.I dispute this billing and will be contacting the insurance commissioners office to file a complaint their as well.Desired Settlement: To be taken out of collection, reduce the bill on the item that was over charged, remove interest and any late fees and begin making payments directly to [redacted] at the rate of $50 per month, due by the 20th of each month.

Business

Response:

I am writing letter in response to Mr. [redacted]’s complaint. I was never told that this claim had not been addressed, and did not receive any e-mails as such from the Revdex.com. I believe your e-mails may have been sent, but went to spam on the [redacted] e-mail account. I am not sure of the details, but am addressing the issue today. For future correspondence, please e-mail me at [redacted],and you may also reach me on my cell ###-###-####. With regards to the specific complaint, I personally reviewed Jason’s account, and all the e-mail and phone correspondence that has occurred between all parties involved, my office manager at the time ([redacted]), myself,and Mr. [redacted]. My review is as follows: He stated that we had not told him about his charges, that our office had not billed appropriately for the charges that had occurred, and that we “lied”, stating that we would just take the money from him, rather than billing his insurance. I disagree with his claim, as reviewing the case and all thee-mails, as well as a personal phone call that I made to him reviewing his prospective treatment were very clear. In each case, we had told him that the billing of the bone graft material, sedation charges, and membrane charges were not a covered benefit with his insurance carrier (Delta Care). These particular charges to my knowledge have never been covered by this particular dental plan, or by any similar plans under the Delta Dental umbrella, in the 11+ years that I have been doing this type of surgical procedure. I personally told him at his initial consult that these would not be covered under his plan,and he signed all the paperwork (gone over with him by [redacted]), which stated what would be covered under his plan, and what would not, for which he would be responsible. Mr. [redacted] signed the financial agreement, which stated that his out of pocket expense would be paid as follows: $200.00 down that day, followed by $100.00/month until resolution of the balance has occurred. The fact is that on the day of surgery (12/29/11), he paid nothing. He waited until the 3rd of January 2012, and only paid $100, so he was in violation of his contract from the first day of his surgery. Since that time, he has not made a payment according to his ledger. His total bill was $3436.00, and his total out of pocket expense was only$808.00 In his particular case, I even offered to cut his sedation charges by almost 50%, because I wanted my patient to be happy with our care. $1130.00 was written off by us due to insurance by “contract adjustment”. His ledger also shows this, and that I gave him the discount from the sedation of $195,credited the day of his surgery.All charges were addressed, and nothing was billed that has not been completed; All out of pocket expense to be incurred by Mr. [redacted] was agreed upon before we followed through with treatment, in the paperwork that he signed. His consent for treatment was very clear,with all out of pocket expense accounted for on the paperwork that he signed,as well as consent for surgical care. This demonstrated that he knew from the beginning that some of the charges were not covered by his insurance plan, and that he was aware. It is my opinion that we went above and beyond with Mr.[redacted] to try and help him not only with his health by following through with necessary infection treatment, but also financially in every way that I could,which included reduction of his expense. For complete resolution to this complaint, I will agree to remove his account from the collection agency, to remove late charges and interest fees (there are none), and to accept payment in the amount of $50 dollars/month until his account is paid in full. To agree with his terms, he will need to make an immediate payment, and to withdraw his complaint from the Revdex.com, as well as the insurance commissioner, showing proof that he has done so. To be clear, his current charges in our office that were sent to collections did not include late charges or interest,and was a total of $708.00. He has never been charged for late fees or interest according to the ledger dated 2/13/13 when his account was sent to collections due to non-payment of the contractual agreement.