Initial Business Response /* (1000, 5, 2016/05/09) */
Re: Case # XXXXXXX
Thank you for your correspondenceI have personally spoken to the patient, his son and his daughter-in-law several times as there are aspects of this that he does not understand
He presented for a cheand cleaning
on February 5/I went through the areas of decay he had as well as areas that bothered him, according to him that were sensitive and other areas that were catching foodI explained to him that these areas could be filled/covered with a filling materialI showed him the areas and confirmed a treatment planI also asked him about a missing tooth, which could be replaced and he stated that he wished to leave that area, which we did
I also asked him if he prefers to have as much treatment as possible at one time as he drives quite a way to come to the office, to which he responded yesIn fact, prior to his first appointment, he phoned to get directions and mentioned it was a far driveHis appointment was booked for fillings with a note to do as much as possible
He returned March 10/for fillingsHe was in my office for three hours and had all of his fillings doneHe was very tired at the end of the appointment and stated I should not have kept him so longI explained that from the note that I understood that he wanted as much done as possible in that appointment and that was his preference
At no point prior to the treatment did he ask for a breakdown of his portion or insurance portionAt the end of the appointment he may have been told that we had submitted to insurance and the amount that he was told ($2600) may also have been mentioned
This is what I have repeatedly explained to himThere are seniors benefits, which until recently were provided by ***Recently, it was transitioned to *** (***)*** handles all dental services accounts in AlbertaAny patients on social services get billed a specified amount for their services based on a fee guide set specifically for themThe dental office is not allowed to bill these patients the balance or charge them a different feeWe have to accept the fees set out by the government for these patientsSo in essence, the dental office has two fee guidesThe first is the fee guide of the office for all of its patients who are not on social services and the second is the fee guide specified by *** for social services patients (and this in fact is different for different types of social services, namely, standard, supplementary, child health benefits, etc.)
Because *** recently took over the seniors benefit program from ***, the receptionist had accidentally put the charges through as though he was a social services patientThe fees submitted to insurance would have been much lowerHowever, once it was noted that he was in fact not on social services but seniors benefits, the correct fee guide was submittedThis was a larger amount (as it is based on non-social services fee guide) and the amount not covered by insurance was transferred to the patient, and a 10% courtesy was given to the patient on his portion
The patient had returned on March 11/to have his bite adjustedIt was not until March 12/that we realized the incorrect fees were submittedThis was corrected and submittedOn march 29/we received a response of what was going to be covered and what was notThe patient came back in for further adjustment on March 30/At the end of this appointment, the receptionist explained to the patient what his portion was and what was billed to his insurance, as this information was recievd the previous dayHe got very angry with the receptionist and demanded to speak with someone from the back end that was in the room when treatment was completedMy assistant then went to the front and spoke with himHe started yelling at her and told her to talk to me and call him back, which she didHe continued to yell at her on the phoneShe said she would get someone to get back to himThe receptionist spoke with him, explained it again and sent him the details of what was billed outThis was in fact the first statement he would have receivedHe did not receive a letter as a first step asking him to payIt was in fact explained to him at his appointment here in the office prior to anything being sent to himHe also states that we charged his insurance without his consent, which is untrueWe ask our patients to sign a financial policy allowing us to submit to their insurance company on their behalfThe only other option would be to bill the patient and have them get reimbursed from the insurance companyHe has signed a financial policy (attached) which allows us to claim on his behalf
He asked costs after treatment was completed (as he himself states and has stated to me)At this point, if we had the correct fee guide inputted, the amount would have been what we are asking forThe treatment would already have been done anywayIf there was a concern about costs or his insurance, perhaps asking the question prior to his appointment would have been more appropriate
Our apologies for the initial error of submitting the incorrect fees to insurance but this would not have changed anything as treatment was already completed and there were no charges for the appointments March or March 30, so no additional charges where incurred
In essence, an error was made that would in no way affect the outcomeThe treatment was completed and the charges were put throughWe are actually not allowed to charge different fees to different patients based on their insurance or lack of insuranceThe only exception is social services, which as mentioned previously, has a fee guide which is substantially lower and set up by the government, not the dental office
I have tried to explain this to the patient as well as his son and daughter-in-law*** *** *** *** *** *** *** *** I would encourage a call to *** (1-800-232-or XXX-XXX-XXXX in Edmonton) where they can confirm both the limitations imposed on the fee guide of social services as well as that *** takes care of seniors benefits which used to be under ***
In closing, I am uncertain what more to sayThey were charged out regular fees, biller for patient portion and given a professional courtesy of 10%The treatment was completed and there was no question of cost, patient portion or insurance portion prior to treatment being completedIf there was, we would have gladly gone through it with the patient
Thank you for your time and consideration with this trying matter
Sincerely
Dr*** S***, B.Sc, DDS
Initial Business Response /* (1000, 5, 2016/05/09) */
Re: Case # XXXXXXX
Thank you for your correspondenceI have personally spoken to the patient, his son and his daughter-in-law several times as there are aspects of this that he does not understand
He presented for a cheand cleaning
on February 5/I went through the areas of decay he had as well as areas that bothered him, according to him that were sensitive and other areas that were catching foodI explained to him that these areas could be filled/covered with a filling materialI showed him the areas and confirmed a treatment planI also asked him about a missing tooth, which could be replaced and he stated that he wished to leave that area, which we did
I also asked him if he prefers to have as much treatment as possible at one time as he drives quite a way to come to the office, to which he responded yesIn fact, prior to his first appointment, he phoned to get directions and mentioned it was a far driveHis appointment was booked for fillings with a note to do as much as possible
He returned March 10/for fillingsHe was in my office for three hours and had all of his fillings doneHe was very tired at the end of the appointment and stated I should not have kept him so longI explained that from the note that I understood that he wanted as much done as possible in that appointment and that was his preference
At no point prior to the treatment did he ask for a breakdown of his portion or insurance portionAt the end of the appointment he may have been told that we had submitted to insurance and the amount that he was told ($2600) may also have been mentioned
This is what I have repeatedly explained to himThere are seniors benefits, which until recently were provided by ***Recently, it was transitioned to *** (***)*** handles all dental services accounts in AlbertaAny patients on social services get billed a specified amount for their services based on a fee guide set specifically for themThe dental office is not allowed to bill these patients the balance or charge them a different feeWe have to accept the fees set out by the government for these patientsSo in essence, the dental office has two fee guidesThe first is the fee guide of the office for all of its patients who are not on social services and the second is the fee guide specified by *** for social services patients (and this in fact is different for different types of social services, namely, standard, supplementary, child health benefits, etc.)
Because *** recently took over the seniors benefit program from ***, the receptionist had accidentally put the charges through as though he was a social services patientThe fees submitted to insurance would have been much lowerHowever, once it was noted that he was in fact not on social services but seniors benefits, the correct fee guide was submittedThis was a larger amount (as it is based on non-social services fee guide) and the amount not covered by insurance was transferred to the patient, and a 10% courtesy was given to the patient on his portion
The patient had returned on March 11/to have his bite adjustedIt was not until March 12/that we realized the incorrect fees were submittedThis was corrected and submittedOn march 29/we received a response of what was going to be covered and what was notThe patient came back in for further adjustment on March 30/At the end of this appointment, the receptionist explained to the patient what his portion was and what was billed to his insurance, as this information was recievd the previous dayHe got very angry with the receptionist and demanded to speak with someone from the back end that was in the room when treatment was completedMy assistant then went to the front and spoke with himHe started yelling at her and told her to talk to me and call him back, which she didHe continued to yell at her on the phoneShe said she would get someone to get back to himThe receptionist spoke with him, explained it again and sent him the details of what was billed outThis was in fact the first statement he would have receivedHe did not receive a letter as a first step asking him to payIt was in fact explained to him at his appointment here in the office prior to anything being sent to himHe also states that we charged his insurance without his consent, which is untrueWe ask our patients to sign a financial policy allowing us to submit to their insurance company on their behalfThe only other option would be to bill the patient and have them get reimbursed from the insurance companyHe has signed a financial policy (attached) which allows us to claim on his behalf
He asked costs after treatment was completed (as he himself states and has stated to me)At this point, if we had the correct fee guide inputted, the amount would have been what we are asking forThe treatment would already have been done anywayIf there was a concern about costs or his insurance, perhaps asking the question prior to his appointment would have been more appropriate
Our apologies for the initial error of submitting the incorrect fees to insurance but this would not have changed anything as treatment was already completed and there were no charges for the appointments March or March 30, so no additional charges where incurred
In essence, an error was made that would in no way affect the outcomeThe treatment was completed and the charges were put throughWe are actually not allowed to charge different fees to different patients based on their insurance or lack of insuranceThe only exception is social services, which as mentioned previously, has a fee guide which is substantially lower and set up by the government, not the dental office
I have tried to explain this to the patient as well as his son and daughter-in-law*** *** *** *** *** *** *** *** I would encourage a call to *** (1-800-232-or XXX-XXX-XXXX in Edmonton) where they can confirm both the limitations imposed on the fee guide of social services as well as that *** takes care of seniors benefits which used to be under ***
In closing, I am uncertain what more to sayThey were charged out regular fees, biller for patient portion and given a professional courtesy of 10%The treatment was completed and there was no question of cost, patient portion or insurance portion prior to treatment being completedIf there was, we would have gladly gone through it with the patient
Thank you for your time and consideration with this trying matter
Sincerely
Dr*** S***, B.Sc, DDS