Richardson, Bevan - DDS

Review: Rec'd bill from dentist for services that were supposed to be covered 100% by insurance. Not notified by dentist of fees over insurance beforehand.

Below is the edited text of a fax sent to A/R mgr at dentist office. I have since been sent to collections without courtesy of any reply from them to message before collections proceedings began. Their own patient bill of rights will testify to their legal requirement for informed consent from the patient before proceeding with procedures not covered by insurance.

_____

October 24, 2013

To A/R manager:

Before my original (and only) appointment there in April 2013, I faxed over a copy of all my insurance paperwork, along with a copy of my insurance card and the standard new patient paperwork from your office.

The day of my appointment, I walked in the office - a place I had never set foot in before - and not one person acknowledged my existence when I walked in. There were three to four ladies at the front desk, each engrossed in her own conversation with the others. No one told me to sign in, sit down, or drop dead. Nothing.

Surprisingly, after a few minutes in the waiting room, the hygienist came out, called my name, and ushered me to the back. I have no idea how she knew I was there since I hadn't been acknowledged by anyone. The hygienist and the dentist were very helpful and pleasant. Repeatedly, as the hygienist was working on my teeth, we both mentioned "If the insurance is paying for it, do it" because we both assumed that my insurance was covering the entire bill.

As health care providers, it is the responsibility of the provider to inform the patient of any procedure that is not covered in full or in part by the patient's insurance coverage.

No one ever said anything to me about my insurance coverage, or the possibility that any procedure done that day would be over and above the "preventative care" aspect of my routine exam and cleaning.

This is not acceptable. I should have been informed of the office rates for procedures versus my coverage and any variance thereof. The front desk ladies had my paperwork weeks before my first visit and could have looked it over to let me know long before that day ever arrived.

While you in A/R have been very helpful and patient regarding this outstanding bill, I am firm in my decree that I do not owe this bill at all. I was never informed by ANYONE at the office beforehand that any procedure was going to go over my coverage or of any "fee schedule" that might apply. Signing of any paperwork stating responsibility of payment for procedures not covered was done with the presumption that I would be informed of such before the procedure took place, and with the (apparently inaccurate) information that my preventative care coverage was footing the entire bill for that procedure.

I ask that you and the doctor review the procedures that lead to this bill being issued at all. It is well within his (and potentially your) power to write-off this bill as a billing error and move on from here. I work in A/R myself, so I know it can be done.

Either way, there is no payment forthcoming because there is no money to be had. I wish this whole event had never happened. It was never my intent to end up owing something that I never expected to owe in the first place.

As I mentioned, you have been more than helpful in allowing me lenience to provide payment, but if you review the issue at hand, hopefully you will see my point of view as if you were the patient and not the employee of the office.Desired Settlement: Write-off the $175 bill and any late fees that office claims I owe because of insurance billing and fee schedules that I was never informed of.

Immediately stop collections proceedings.

Remove any negative credit reports that may be associated with this collections attempt.

Contact has been made between myself and the office A/R manager since this incident started in April. She has been very helpful and understanding. The latest collections effort has been surprising in that my latest contact with the office (in text above) received no reply but was sent straight to collections instead. No consideration was given to the request at the end of the message.

Remove this bill, admit that patient fee notification procedures in-house failed miserably, and stop collections proceedings.

Thank you.

Business

Response:

Initial Business Response

[redacted] M. [redacted], D.D.S.

A Professional Corporation

12-10-13

RE: Case #65035505: [redacted]

Ms. [redacted] was seen in our office 4-2-13 as a new patient, for an exam, x-rays, & routine cleaning. Her bill totaled $293.00. It was our understanding that her PPO insurance coverage would pay 100%. Unfortunately, they did not, which left Ms. [redacted] owing a balance of $175.00. As the provider, we do our best to ESTIMATE our patients' insurance coverage, but we ALWAYS stipulate that this is an ESTIMATE. It is not a guarantee until the insurance company ACTUALLY pays the bill. It is ultimately every patient's responsibility to know what their insurance policy covers or does not cover.

Our office gave Ms. [redacted] 3 months, interest free to pay on her outstanding balance, as we do for all of our patients. On 7-18-13, we received a note from Ms. [redacted] expressing financial hardships, so on our next billing cycle of 8-21-13, we, in turn, expressed our condolences & told her we would extend her payment plan a few more months. We requested that she attempt to make a $10.00 "good faith" payment. Over the course of 7 months, Ms. [redacted] did not make a single payment to our office. After much deliberation, we were forced to send Ms. [redacted]'s account to an outside collection agency on 11-12-13.

Dr. [redacted] has been providing dental services to the Rio Linda community for over 40 years, & prides himself on being EXTREMELY compassionate towards, not only his patient's dental needs, but also, their financial needs.

It is most unfortunate when a patient does not agree with the amount their insurance company pays to their provider, but ultimately has to know that it is THEIR financial obligation to pay on a balance owed.

Sincerely,

[redacted] Practice Administrator

851 Oak Lane (XXX)XXX-XXXX

Rio Linda, CA XXXXX (XXX)XXX-XXXX FAX

Final Consumer Response

(The consumer indicated he/she DID NOT accept the response from the business.)

I'm sorry this has been such a painful and prolonged debate. Yes, Dr [redacted] is very competent and personable. I liked him very much and am sad that I will not be able to visit that office again because of this insurance issue.

While I do agree and accept that the A/R dept manager was indeed very, very helpful in giving me time to make payments since my dental appt, I take issue with the phrase:

> As the provider, we do our best to ESTIMATE our patients' insurance coverage, but we ALWAYS stipulate that this is an ESTIMATE. It is not a guarantee until the insurance company ACTUALLY pays the bill. It is ultimately every patient's responsibility to know what their insurance policy covers or does not cover.<

If there was any "stipulation that this is an estimate", no one ever told me about the office fees being "an estimate". Even if it is/was in the fine print of the reams of paperwork, it is apparently still something of great enough importance to be reiterated verbally to every patient.

I know for a fact that I am not the only one who has this particular insurance who visits this office, so the math would be fairly simple to "estimate" and relate to me beforehand, as in "we have other patients with your insurance, and they usually end up owing $x to $xx after their '100% covered' procedures. Would you like to continue?"

Every other medical office that I've been to has always has access to the insurance coverage info online through the "provider" portal on the insurance website. What need is there to "estimate" when the "fee schedule" is available online or by phone to the insurance company? A simple preventative cleaning appt has basic components that can be calculated and known beforehand. Yes, every patient is different, but xrays and cleaning are basic fees. If an xray is "$x" and my insurance covers "$1/2 of x", that can be recorded. Having had my insurance information for weeks beforehand, plenty of time was given for them to get the "fee schedule" from the insurance company and compare it with their procedure fees, and notify me of the "estimate" difference.

My knowing what my own insurance covers does exactly zero for me (especially in "insurance-speak" that the average layman doesn't understand) when I do not know what the dentist office charges for a procedure to compare to my coverage. If they accept my insurance, they have the responsibility to inform the patient of the difference between coverage and office fees for basic preventative (and predictable) procedures.

Routine acceptance of my insurance from other patients would give them enough precedence as to what is commonly 100% covered and what is not. I have trouble believing that it was a surprise to them that the insurance did not cover as much as they thought it would.

I cannot seem to express enough how sorry I am that I am having such financial hardships right now. I don't like it any more than they do and it's much more involved than what anyone is assuming. I never intended for this one simple "preventative visit" to get out of hand like this. If it were not for the assistance of my church and family, I would be on the street. I could not make "good faith" payments in "good faith" because I honestly did not -- and still don't -- know how those remaining payments would have been made after a $10 pymt early on. Even the hospital recently wrote off a bill much larger than this one for the same financial hardship reason. At least they understood.

I understand that $175 (or $236?) is a large amount to a tiny office, but it is still very much within their ability to write this off and remove the collections / credit report filings against my name. It only takes "willingness" from the dentist/partners and A/R manager. Being a bookkeeper myself, I know it is more than possible if the owner is willing, especially at the end of the year before the accounting goes to the tax preparer. In the long run, there is no tax consquence to a "bad debt" write-off of this amount. If the doctor is so compassionate to wait 7 months for a "good faith" payment, is there not compassion when the realization is that there will be no payment made because there is NO MONEY to be had? It is not that I don't "want" to pay, it's that I "CANNOT".

I'm sorry again.

Merry Christmas

[redacted] T