River Oaks Endodontics

Initial Business Response /* (1000, 5, 2015/04/30) */
Contact Name and Title: Dr [redacted]
Contact Phone: XXX-XXX-XXXX
Contact Email: [redacted]@riveroaksendodontics.com
Prior to service the patient was quoted an estimate of what her insurance would pay. My staff member verified the...

patients insurance coverage, of which I am an in network provider. Verification quoted to us was based on in network prices and in network percentages. However when we received payment the insurance paid us on in network prices but out of network percentages because of a clause that is individualized to this patients coverage. Insurance is a tricky thing to navigate and never straight forward. Although our office strives in quoting all patients the absolute closest out of pocket as possible, insurance never guarantees payment. The patient was quoted an estimate of charge and signed a paper that says "If dental insurance applies: Although this office files insurance claims as a service to the patient, the insurance contract is between the patient and the insurance company. As we have no control over the insurance company's method of payment or amount of payment, any difference of payment is entirely the responsibility of the patient." As I said the patient was presented this information prior to treatment and signed it in agreement. Also she was given a printed statement of all charges, with estimated insurance and estimated patient portion. This form says "estimated" on both of those fees. It also says "Any insurance estimates provided with this plan are estimates. You are still responsible for any amounts which are not covered by your insurance." Finally she was informed verbally that day prior to treatment of all quotes being estimates. As you can see there were no "hidden charges" as the patient alludes. No fees were changed on our part. Her insurance company paid different than the estimated amount that they provided to us. We understand that this can be very frustrating for both parties. Unfortunately this is not uncommon in our industry and because of that we take every measure prior to treatment to help the patient understand possible outcomes. My office is very understanding with unexpected patient portions. We honor reasonable payment options to assist our patients if a balance is owed after claims are processed.
Initial Consumer Rebuttal /* (3000, 8, 2015/05/04) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I appriciate the response from buisness and appriciate that they are very understanding about the fact that how it can be very frustrating for the patient , but I am requesting the adjustment in payments .
Final Business Response /* (4000, 10, 2015/05/15) */
Prior to initiating treatment the patient signed and acknowledged our policy with billing her insurance. The remaining balance on this account is owed by the patient.