TMJ & Sleep Therapy Centre

At TMJ & Sleep Therapy Centre, Dr. David Shirazi is one the best TMJ Specialist in the Thousand Oaks.

Initial Business Response / [redacted] (1000, 9, 2017/03/24) */ Revdex.com CASE#: XXXXXXXX Revdex.com Designated Category: Billing or Collection Issues Patient [redacted] (05/15/2001) Supporting documentation is attached Date of service 06/26/ Charged amount [redacted] 06/26/charges total [redacted] Payments by blue cross blue shield were on 8/17/in the amount [redacted] and 12/21/in the amount of $ [redacted] totaling [redacted] Patient's mother made a payment of [redacted] making all payments made to the office [redacted] in totalResulting in a$ [redacted] balance and no over payment on the account Patient was seen by our office for a comprehensive exam and imaging to determine a treatment plan We are a non-participating provider with all insurance companiesWe are out of network for all medical and dental insurance carriersWhen services are rendered by an out of network provider the patient or guarantor is responsible for all charges incurredThis includes anything applied to the members' deductible, out of pocket and anything not considered, or exceeds the allowed amount set by the insurance carrierWhen rendering services with an out of network provider any insurance correspondence or payment is not guaranteed to be communicated to the office as the contract is between the member and the insurance plan This has been explained to the claimant and documentation has been signed to state understanding and agreement with regard to financial responsibility pertaining to services when rendered by our officeThe signed documentation serves as a private contract between the claimant and the practice for the services resulting in the charges / fees being brought into question The total charges associated with the claimant were [redacted] and were posted to the ledger 06/26/ A claim was sent to the insurance carriers in the amount of [redacted] resulting in payment in the amount of [redacted] on 08/17/made to our office by Blue Cross Blue ShieldThe claim was then refiled with the secondary insurance (Tricare) explanation of benefits reflecting a [redacted] payment, resulting in an additional payment of [redacted] made to the office on 12/21/by Blue Cross Blue Shield The explanation of benefits resulting in payment totaling [redacted] was forwarded to the secondary insurance plan (Tricare)The claim was processed and a payment of [redacted] was made the insured and was never cashed per my conversation with the Tricare customer services representative [redacted] A on 03/17/at 9:00am After several attempts to collect the debt the account was placed with a third party collection agencyPayment to resolve the account was submitted by the claimant on 01/21/in the amount of [redacted] There remains a [redacted] balance on the account with no over-paymentThe account has been settled for over a year

Initial Business Response /* (1000, 9, 2017/03/24) */
Revdex.com CASE#: XXXXXXXX
Revdex.com Designated Category: Billing or Collection Issues
Patient [redacted] (05/15/2001)
Supporting documentation is attached
Date of service 06/26/2015
Charged amount [redacted]
06/26/2016 charges total...

[redacted]
Payments by blue cross blue shield were on 8/17/15 in the amount [redacted] and 12/21/2016 in the amount of $ [redacted] totaling [redacted]
Patient's mother made a payment of [redacted] making all payments made to the office [redacted] in total. Resulting in a$ [redacted] balance and no over payment on the account
Patient was seen by our office for a comprehensive exam and imaging to determine a treatment plan.
We are a non-participating provider with all insurance companies. We are out of network for all medical and dental insurance carriers. When services are rendered by an out of network provider the patient or guarantor is responsible for all charges incurred. This includes anything applied to the members' deductible, out of pocket and anything not considered, or exceeds the allowed amount set by the insurance carrier. When rendering services with an out of network provider any insurance correspondence or payment is not guaranteed to be communicated to the office as the contract is between the member and the insurance plan.
This has been explained to the claimant and documentation has been signed to state understanding and agreement with regard to financial responsibility pertaining to services when rendered by our office. The signed documentation serves as a private contract between the claimant and the practice for the services resulting in the charges / fees being brought into question.
The total charges associated with the claimant were [redacted] and were posted to the ledger 06/26/2015
A claim was sent to the insurance carriers in the amount of [redacted] resulting in payment in the amount of [redacted] on 08/17/2015 made to our office by Blue Cross Blue Shield. The claim was then refiled with the secondary insurance (Tricare) explanation of benefits reflecting a ** payment, resulting in an additional payment of [redacted] made to the office on 12/21/2015 by Blue Cross Blue Shield.
The explanation of benefits resulting in payment totaling [redacted] was forwarded to the secondary insurance plan (Tricare). The claim was processed and a payment of [redacted] was made the insured and was never cashed per my conversation with the Tricare customer services representative [redacted] A on 03/17/2017 at 9:00am
After several attempts to collect the debt the account was placed with a third party collection agency. Payment to resolve the account was submitted by the claimant on 01/21/2016 in the amount of [redacted]
There remains a ** balance on the account with no over-payment. The account has been settled for over a year.