Pioneer Dental P.A.

We have already waived the fee on a one time courtesyWe have spoke with her this morning and she apologized to usIf a patient fails an appointment we have an office policy of $charge if not notified in advanced to cancelWe typically waive a patients fee if they call back and explain the
situation and it is a one time occurrence Please let us know if you need any additional information from us Thank You,

Initial Business Response /* (1000, 6, 2016/02/18) */
I am surprised to see this complaint made by [redacted]. He was recently here to discuss his claims and he agreed to make a payment of $211.08, instead of the full amount $514.00 which he owed according to Cigna DHMO.
[redacted]'s earlier 'Patient...

Responsibility' amount was accidentally written off in 2014 and we are not charging him for the same. He is a yearly patient at our practice. On his next visits, his claims were summited and processed in a timely matter showing his patient responsibility. I called Cigna DHMO to verify this and I also decided to speak with a supervisor who also confirmed his patient responsibility. The supervisor also explained that [redacted] has received all Explanation of Benefits from Cigna DHMO in a timely manner. He also explained that I am not required to re-submit any old claims for [redacted] retrospectively.
After several calls to [redacted] he agreed to come in and go over his account. When [redacted] came in on Saturday February 6th, 2016 he again requested to get a supervisor on the phone to verify his patient portion on his account and wanted to know if we were required to re-submit retrospectively any claims. Michael, Cigna DHMO Supervisor, stated correctly his patient responsibility of $514.00 and stated that I am not required to resubmit any claims. Michael also stated that it is [redacted]'s responsibility to list us as his primary dental office with Cigna DHMO, and that I am not allowed to do this. [redacted] agreed to pay $211.08 and explained it was fair to all involved. He also told me that he was very happy with the dental care that my staff and I provided. He went to pay with his card but it was declined. He said he will call on Monday will his new card information. I have not charged [redacted] for any error made by my staff.
I have honestly and sincerely provided the dental care for [redacted]. I have submitted all his claims in a timely manner and followed up several times with Cigna DHMO.
On our last and final call to Cigna DHMO supervisor (Jane) we learned that [redacted] was supposed to call and list us as his primary care clinic and that we aren't able to do that ourselves. [redacted] is only paying for his patient responsibility of his recent visits, not the one that was written off by staff. I hope he will understand and call us to make his final payment.
If you need anything please do not hesitate to contact us at any time. Our office contact is [redacted]. Our email address is [email protected].
Initial Consumer Rebuttal /* (3000, 8, 2016/02/23) */
(The consumer indicated he/she DID NOT accept the response from the business.)
The response above states that they are not required to resubmit claims; while this is true, they are allowed to resubmit and refuse to. I find this alarming as I was never provided an opportunity to correct my insurance and Explanation of Benefits from CIGNA said "Approved" and did not list an amount oustanding.
In the business supplied response, they claim to have agreed to allow me to pay $211.08. I honestly would like to move forward and settle with Pioneer in the agreed upon amount of $211.08; however, I had been previously called by Pioneer stating they were no longer offering this as an option. They actually called me on the phone to say this was off the table in retaliation of me approaching the Revdex.com regarding my case.
Would you be able to contact Pioneer to confirm that they will accept the $211.08 as they claim above? If this is the case, I will eat the additional charge vs. the $47 I would have to pay if they agree to resubmit claims.
Final Business Response /* (4000, 10, 2016/02/25) */
As stated in the previous response we are only charging our patient less than half of his 'Patient Responsibility' in which both parties agreed upon when we met up on Saturday February 6th, 2016, which is $211.08. I would appreciate that he gives us a call to settle his balance on his account.
If you have any questions or concerns please give us a call at [redacted] or by email [email protected].

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.