The Center for Oral & Reconstructive Surgery & Implantology

To whom it may concern, I am glad Mr [redacted] surgery went well as this is our main goalAs far as the copay and schedule, here is an event time line: · 10/21/2015: Mr [redacted] came to our office for a consultation appointmentAt that time, his insurance was MetLife and his benefits were quoted as insurance pay 50% and Patient pay 50% with an annual limit of $As with all insurance companies, they give an estimate over the phone for benefits but they always can change their estimate when the actual claim is received by their claim departmentHis calculated co-pay was $after we called the insurance and told them exactly what codes we will be using when the patient comes back for surgery· Before leaving that day, Mr [redacted] was scheduled to come for surgery on 10/28/He was also instructed that the co-pay need to be paid three days prior to his surgery date · We called the patient five days prior to his surgery date to collect his copay but was never successful even though he signed our “Pre-operative Instruction” form which states that if copay is not paid three days prior to your appointment, then your appointment will be cancelled· 10/26/2015: The patient never responded and his surgery was cancelled due to failure to pay the copay or confirm his appointment · 11/4/2015: patient called and paid his copay of $His appointment was scheduled for 11/13/· 11/13/2015: Patient came in for his surgery and it was completedWe submitted his claim to MetLife for payment · 11/20/2015: Patient came in for his post-operative appointment where he was doing well and no complaints · 12/4/2015: Metlife sent us EOB (Explanation of Benefits) with a $check and a write-off for $and Patient pay of $because he used his annual limit of $· 12/4/2015: Automated statement was sent from our office for a balance of $620.00– no payment received · 1/3/2016: Automated statement was sent from our office for a balance of $620.00– no payment received · Patient called and said that he will pay by 2/3/after being told that his account will go to collection if not paid in full · 2/3/2016: No payment received · 3/3/2016: Patient called our office to payOur office told him that his account might have gone to collection and that they will check with the office manager· 3/4/2016: I told our staff that the patient can pay since I did not send his account to collection yet · 3/4/2016: Patient paid balance of $on his credit cardTo directly answer Mr [redacted] concerns that he brought up in his complaint, here is our response: Mr [redacted] was not happy with being rescheduled several timesThat was due to not paying the copay on time per instructions signed by the patientMr [redacted] had concerns regarding his copay being higher than quoted in our officeAgain, insurance always give an estimate when asked about copayThey never give an exact dollar amount until they receive a claim with actual servicesIt seems like Mr [redacted] used his $limit with his insurance and never informed us that he have none leftRegarding his worries about his credit score and collection, Mr [redacted] was never sent to collection and there is absolutely no reporting to any agency from our officeAs for patient paying over the phone, not sure what happen but we have patients calling in all the time to pay their bill over the phoneThe only time would be if he called after hours and the answering service respondedThey are not part of our office and they can’t take any credit card numbersI hope that resolves that issue as there is no issue with surgery or credit scoreI apologize that Mr [redacted] had to miss some days at work but that is our office policy Sincerely, Yasser Sedhom Office Manager

To whom it may concern,   I am glad Mr. [redacted] surgery went well as this is our main goal. As far as the copay and schedule, here is an event time line: ·         10/21/2015: Mr. [redacted] came to our office for a consultation appointment. At that time, his...

insurance was MetLife and his benefits were quoted as insurance pay 50% and Patient pay 50% with an annual limit of $1000. As with all insurance companies, they give an estimate over the phone for benefits but they always can change their estimate when the actual claim is received by their claim department. His calculated co-pay was $655 after we called the insurance and told them exactly what codes we will be using when the patient comes back for surgery. ·         Before leaving that day, Mr. [redacted] was scheduled to come for surgery on 10/28/2015. He was also instructed that the co-pay need to be paid three days prior to his surgery date ·         We called the patient five days prior to his surgery date to collect his copay but was never successful even though he signed our “Pre-operative Instruction” form which states that if copay is not paid three days prior to your appointment, then your appointment will be cancelled. ·         10/26/2015: The patient never responded and his surgery was cancelled due to failure to pay the copay or confirm his appointment ·         11/4/2015: patient called and paid his copay of $655. His appointment was scheduled for 11/13/2015. ·         11/13/2015: Patient came in for his surgery and it was completed. We submitted his claim to MetLife for payment ·         11/20/2015: Patient came in for his post-operative appointment where he was doing well and no complaints ·         12/4/2015: Metlife sent us EOB (Explanation of Benefits) with a $0 check and a write-off for $836.00 and Patient pay of $1164.00 because he used his annual limit of $1000.00 ·         12/4/2015: Automated statement was sent from our office for a balance of $620.00– no payment received ·         1/3/2016: Automated statement was sent from our office for a balance of $620.00– no payment received ·         Patient called and said that he will pay by 2/3/2016 after being told that his account will go to collection if not paid in full ·         2/3/2016: No payment received ·         3/3/2016: Patient called our office to pay. Our office told him that his account might have gone to collection and that they will check with the office manager. ·         3/4/2016: I told our staff that the patient can pay since I did not send his account to collection yet ·         3/4/2016: Patient paid balance of $620.00 on his credit card. To directly answer Mr. [redacted] concerns that he brought up in his complaint, here is our response: Mr. [redacted] was not happy with being rescheduled several times. That was due to not paying the copay on time per instructions signed by the patient. Mr. [redacted] had concerns regarding his copay being higher than quoted in our office. Again, insurance always give an estimate when asked about copay. They never give an exact dollar amount until they receive a claim with actual services. It seems like Mr. [redacted] used his $1000.00 limit with his insurance and never informed us that he have none left. Regarding his worries about his credit score and collection, Mr. [redacted] was never sent to collection and there is absolutely no reporting to any agency from our office. As for patient paying over the phone, not sure what happen but we have patients calling in all the time to pay their bill over the phone. The only time would be if he called after hours and the answering service responded. They are not part of our office and they can’t take any credit card numbers. I hope that resolves that issue as there is no issue with surgery or credit score. I apologize that Mr. [redacted] had to miss some days at work but that is our office policy.   Sincerely, Yasser Sedhom Office Manager

Complaint: [redacted]
I am rejecting this response because the response is false. The initial appointment on 10/28 was never canceled due to me not paying my copay on time it was moved by me because I called them back and had them reschedule because I could not afford to miss that much work, I then reschedule for 10/30. A little later they called me back and said they couldn't fit me due to the fact it might snow that day even though they made the appointment.  We finally rescheduled to Friday 11/6, which is when I payed the Copay, two days before surgery, as agreed upon (not 3). The night before surgery they called my well after office hours and told me the oral surgeon wasn't going to make it due to personal issues, and then rescheduled again for 11/13 which is when I finally had my surgery.I have attached email conversation of this change in plans from emails between my bosses, to prove it wasn't because I didn't pay my copay.They neglect to mention the various times I had called trying to get a hold of them only to get a call center representative that told me to call back shortly because they should be open but their lines to their office had not been, and during multiple call attempts never got through. This is all after when I went into their office on 2/3 and went to pay after receiving the first notification, just to be turned away and told I had to pay over the phone. I received a message that day while I was at work asking to call them back, I had continuously tried but to no avail. No time during this was I ever informed it might go to collections. It wasn't until I contact their collections lawyer that said he had never received the information, that the office finally called me back saying they made a mistake and had never actually sent it. They need to take responsibility for this and the fact that they made it nearly impossible to pay them. When all I ever did was try to be proactive about a surprise debt due to my insurance cap.  
Sincerely,
[redacted]