Russell J Caputo Dental

RE: *** ** *** *** *** *** came into our office on 7/15/for a cleaning and exam appointmentHe presented his *** Dental Advantage card, which we do participate withI specifically ask Mr.*** if the dental coverage was also under ***, he stated yes (I never
at any point told *** his appointment was approved, how would I know that?)He went on to elaborate he was given a list by the broker he purchased the insurance from of participating providers and we were on itWe treated Mr***, and submitted claim on his behalf, with the information he had provided us withShortly thereafter, we received a denial from his insurance "member not found"I called Mr.*** to make him aware of thisHe said he would call his insuranceI never heard back from himApproximately month later when going through "aged accounts receivable", I phoned Mr.*** again to make his aware, account was still not paidHe told me he had contacted the insurance company, and "went round and round with them", he said he had called them numerous times and it had been resolved, I again submitted the claim back to the Insurance Company; again they denied the claim "no coverage"I called ***We had a long conversation that really went nowhereI advised Mr.*** I would personally call his insurance company myself (as a courtesy)I called and found out *** was not under *** for his dental, He had a rider for dental through *** (which let me know *** had never called them himself, or he would have know that)This particular plan was an HMO program we do not participate withI phoned *** and made him aware of thisHe was extremely upset and rudeHe blamed his insurance broker for lying to him, and in turn started blaming us for not knowing thisI told Mr.***, this was an issue between him and his insurance brokerThat he needed to contact themI didn't hear from *** again, until he received a collection letter from our officeHe was very hostile, and said this was our issue and our problem; he wasn't paying it, and threatened if we turned this over there would be consequencesI told *** he has had plenty of time to resolve this, it had been almost monthsUnfortunately, Insurance is ultimately the patient's responsibility periodHe again said he was going to call his insurance company*** came into the office 2/25/2015, he was very upset and loudHe started showing me paper work from his broker and list he was given which showed providersI told Mr.*** unfortunatly there was nothing I could personally do tor himAgain this was an issue which information he was misinformed ofI was not the broker, nor the insurance companyThe conversation continued to go around in a circle*** even started video recording me at one point with his phone, asking me to repeat to him "there was nothing more I could do for him"He was very disruptive to the officeI told *** the only way to avoid collections at this point was to pay it, and then continue to argue with his insurance for reimbursement*** finally left the officeThere has been no contact from him since, until this complaintPlease let me know if you require any additional information or facts.Sincerely,
*** ***
Office Manager

Review: [redacted] my dental provider , provided me with a listing of approved dentist under their plan in which they sold me. (I have the original email from [redacted] showing the listings of providers) Caputo Dental was on the list of approved providers under my plan. I scheduled and had a routine checkup and cleaning at Caputo Dental. Caputo Dental took my insurance card and said I was approved for services. Two months following the dental visit I received an invoice and letter stating that Caputo was sending my claim to collections. I immediately contacted Caputo and asked for their reasoning for the invoice and collections letter. They stated that my insurance was not in their network. This is totally opposite of what I was told and I have proof of my insurance and the [redacted] list of approved provider of which Caputo is one. I contacted [redacted] to discuss and they simply said that the issue took too long and therefore they cannot resubmit my claim and I would have to pay in full. I have saved emails and other communications regarding this and can prove that these two companies have lied to me.Desired Settlement: All I want is for these two companies to do what they are suppose to do. I have paid for the insurance. I expect to pay for my deductible whatever that amount is? And for [redacted] to pay their required part and for Caputo Dental to understand that they also have made a mistake by indicating to me that my insurance was in their network on the day of services. They told me I was covered.Caputo needs to withdraw their collections efforts and clear my record.I WILL AND ALWAYS WOULD HAVE PAID FOR MYPART

Business

Response:

RE: [redacted] came into our office on 7/15/2014 for a cleaning and exam appointment. He presented his [redacted] Dental Advantage card, which we do participate with. I specifically ask Mr.[redacted] if the dental coverage was also under [redacted], he stated yes (I never at any point told [redacted] his appointment was approved, how would I know that?). He went on to elaborate he was given a list by the broker he purchased the insurance from of participating providers and we were on it. We treated Mr. [redacted], and submitted claim on his behalf, with the information he had provided us with. Shortly thereafter, we received a denial from his insurance "member not found". I called Mr.[redacted] to make him aware of this. He said he would call his insurance. I never heard back from him. Approximately 1 month later when going through "aged accounts receivable", I phoned Mr.[redacted] again to make his aware, account was still not paid. He told me he had contacted the insurance company, and "went round and round with them", he said he had called them numerous times and it had been resolved, I again submitted the claim back to the Insurance Company; again they denied the claim "no coverage". I called [redacted]. We had a long conversation that really went nowhere. I advised Mr.[redacted] I would personally call his insurance company myself (as a courtesy). I called and found out [redacted] was not under [redacted] for his dental, He had a rider for dental through [redacted] (which let me know [redacted] had never called them himself, or he would have know that). This particular plan was an HMO program we do not participate with. I phoned [redacted] and made him aware of this. He was extremely upset and rude. He blamed his insurance broker for lying to him, and in turn started blaming us for not knowing this. I told Mr.[redacted], this was an issue between him and his insurance broker. That he needed to contact them. I didn't hear from [redacted] again, until he received a collection letter from our office. He was very hostile, and said this was our issue and our problem; he wasn't paying it, and threatened if we turned this over there would be consequences. I told [redacted] he has had plenty of time to resolve this, it had been almost 6 months. Unfortunately, Insurance is ultimately the patient's responsibility period. He again said he was going to call his insurance company. [redacted] came into the office 2/25/2015, he was very upset and loud. He started showing me paper work from his broker and list he was given which showed providers. I told Mr.[redacted] unfortunatly there was nothing I could personally do tor him. Again this was an issue which information he was misinformed of. I was not the broker, nor the insurance company. The conversation continued to go around in a circle. [redacted] even started video recording me at one point with his phone, asking me to repeat to him "there was nothing more I could do for him". He was very disruptive to the office. I told [redacted] the only way to avoid collections at this point was to pay it, and then continue to argue with his insurance for reimbursement. [redacted] finally left the office. There has been no contact from him since, until this complaint. Please let me know if you require any additional information or facts.Sincerely, [redacted]Office Manager