The San Diego Oral & Maxillofacial Surgery

May 1, 2014
Revdex.com
4747 Vtewrldse Ave. # 200
San Diego, CA 92123-1688
Fax # ###-###-####
Attn: [redacted]
In response to the letter you received re: patient, [redacted], D.O.B.
[redacted]: During [redacted]'s consultation on 3/12/2014, Dr. [redacted] made a dedslon
based...

on the patient's history, that extractions in our office should be done with an
anesthesiologist. This decision is made when Dr. [redacted] feels that an anesthesiologist
should be monitoring the patient during surgery for the patient's safety and wall being.
When the patient came to the financial desk. It was explained that when we use an
anesthesiologist, we use an outside doctor whom we are contracted with on a cash basis
only and do not bill Insurance for his services. That doctor is paid at the time of service per
our agreement.
We are in no way violating our contracted agreement with [redacted] because our agreement
is for reimbursement with "the doctor performing surgery (Dr. [redacted])administering the
anesthesia. As stated, in Mr. [redacted] case an anesthesiologist was required and It
was clearly explained to the patient that this physician is not contracted with any
Insurances and the fee for his services was $500.00, payable at the time of service. The
balance collected was based on the amount the Insurance estimated as payment expected.
When [redacted] pays on this claim, If our estimate was higher than expected, the patient will
Immediately be Issued a credit. However, If [redacted] the patient Is responsible for a
higher charger, then the patient will be charged accordingly.
We take offense In the statement made that "'the office staff" takes vacations on theunaccounted money". There is no "'unaccounted" for money and our staff is professional
and does not deserve this insult.
Sincerely,
[redacted]
Office Manager & Administrator

Review: I received surgery from Dr. [redacted] on January 4th 2013 for two gum grafts. Before the surgery was started on that day it was my understanding that the total and complete cost for the surgery for both grafts was $890.00.I had a credit on my account with the doctor's office for $668.00 so they asked me for an additional $222.00 to pay 100% before the surgery started on that day 1/4/2013. I paid the $222.00 with my AmEx card.I later received a bill for an additional $760.00. When I called to find out why I am being asked to pay more than $890.00 they told me that [redacted] Dental does not cover gum grafts without a tooth being present when the graft is performed. Upon further questioning I found that since [redacted] Dental does not cover this type of surgery there is in effect no contract between [redacted] Dental and Dr. [redacted]s office. This freed Dr. [redacted]s office to charge their standard charge of $825.00 per graft instead of the $445.00 per graft I agreed to pay on 1-4-2013. [Note: 2X(825.00 445.00))= $760.00]. Dr. [redacted]s office added that this has also happened to a number of their patients and they are all being asked to pay more.Granted the $445.00 per tooth was the rate Dr. [redacted]s office agreed to charge because it was the contract rate between United Health Care and his office during 2012 when teeth were removed to place impacts. My company switched to [redacted] Dental before I had the surgery on 1-4-2013.Through my efforts alone I found out [redacted] Dental asked them to change the code and they would pay it. By then I had used all my benefits.My claim is Dr. [redacted]s office told me the total cost was $890.00 and I paid it. I should not nor my insurance company need to pay more than my understanding of what the charges were at the time of service.Desired Settlement: Dr. [redacted]'s office should reverse the $760.00 they are now charging and show my account fully paid for. That is the $890.00 I paid for the two grafts full covers all charges and my account should now show no moneys due for these services.

Business

Response:

September 16, 2013

Revdex.com

Attn: [redacted]

RE: [redacted]

ID # [redacted]

On January 4'2013, Mr. [redacted] did in fact have two gingival grafts, each in a different

quadrant of his mouth. These grafts are priced at $825.00 for each graft.

When Mr. [redacted] was seen, his insurance was [redacted]. When benefits were

checked, we were told by [redacted] that the procedures were not covered but that

the patient should receive the contracted rate of $445.00 per graft which would be a total of

$890.00. This "estimate" was sent to Mr. [redacted] in 2012. He did not schedule surgery until

January of 2013.

In the interim, his insurance changed to [redacted] Dental of California. Patient never gave us this

information. We only found this change out when we billed [redacted] for the

procedures and were denied due to his termination of this insurance.

We then proceeded to bill [redacted] Dental of CA and they denied the services stating that this

was not a covered benefit and the patient was responsible for the contracted rate which is

$825.00 per graft with [redacted].

When benefits are quoted to a patient, it is made very clear that it is only an "estimate". If

you call any insurance, the first thing they will read you is a disclaimer stating that the final

determination will be decided upon submission of the claim.

We always strive to give the most up to date information to the patient. If Mr. [redacted] had

advised up of his insurance change, we would have been able to give him more accurate

information prior to surgery.

If you have any questions, do not hesitate to call.

Sincerely,

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

Review: My son had 4 wisdom teeth removed on April 4th. This was precursor to a surgery that he needs, also was to be completed by Dr. [redacted]. At the time of the appt for the removal of teeth I was told there was a $800 coinsurance payment due. I questioned and was told this is usual as the anesthesia is not covered. I asked for an itemized statement and was told that they would send me one. I never received the statement and contacted the insurance company who said according to amounts billed my coinsurance should have been $135.00, the anesthesia would have been covered at either 90% or 60% depending on the status of the anesthesiologist(in or out of network). I called the office back and asked them to either bill or give me an itemized statement. Was told that they would not give me this as it is a "special type of contract" they have with the anesthesiologist. So, total billed amount is for $1840, total amount allowed for this doctor as a participating provider was $900 and my coinsurance and deductible amount totals $135.00. What happened to the other $635? I was wondering if the office staff were taking vacations on the amount of money that is not being accounted for? I would like my money back! Or an itemized billing so I can bill the insurance.Thank you.Desired Settlement: I would like to receive a refund of overpaid amount with interest. From what I can see it is the practice of this office to charge patients for the amount of money not covered by the insurance company as a result of the contract between Dr. [redacted] and the [redacted] company so that he can continue to see patients and not be bound by the terms of his contract.

Business

Response:

May 1, 2014

Revdex.com

4747 Vtewrldse Ave. # 200

San Diego, CA 92123-1688

Fax # ###-###-####

Attn: [redacted]

In response to the letter you received re: patient, [redacted], D.O.B.

[redacted]: During [redacted]'s consultation on 3/12/2014, Dr. [redacted] made a dedslon

based on the patient's history, that extractions in our office should be done with an

anesthesiologist. This decision is made when Dr. [redacted] feels that an anesthesiologist

should be monitoring the patient during surgery for the patient's safety and wall being.

When the patient came to the financial desk. It was explained that when we use an

anesthesiologist, we use an outside doctor whom we are contracted with on a cash basis

only and do not bill Insurance for his services. That doctor is paid at the time of service per

our agreement.

We are in no way violating our contracted agreement with [redacted] because our agreement

is for reimbursement with "the doctor performing surgery (Dr. [redacted])administering the

anesthesia. As stated, in Mr. [redacted] case an anesthesiologist was required and It

was clearly explained to the patient that this physician is not contracted with any

Insurances and the fee for his services was $500.00, payable at the time of service. The

balance collected was based on the amount the Insurance estimated as payment expected.

When [redacted] pays on this claim, If our estimate was higher than expected, the patient will

Immediately be Issued a credit. However, If [redacted] the patient Is responsible for a

higher charger, then the patient will be charged accordingly.

We take offense In the statement made that "'the office staff" takes vacations on theunaccounted money". There is no "'unaccounted" for money and our staff is professional

and does not deserve this insult.

Sincerely,

Office Manager & Administrator