Today's Dentistry, Today Mgmt PLLC

Good afternoon,   The response is extremely vague and does not provide me with information, answers or a clear direction of my claim.
I understand the [redacted] office can't evaluate the reimbursement amount on my account until everything is paid but did the [redacted] office submit the fluoride claim that was never sent it between 5 May 14 and 17 Mar 15?  According to [redacted], as of 17 Mar 15, everything was 100% processed and there was nothing pending but there was a fluoride charge on 5 May 14 that was never billed.   If the fluoride charge was submitted after 17 Mar 15, I would like a copy of it so I can provide to my personal claims processor, [redacted] at [redacted], who will expedite my claim.
I also understand that normal claims processing can take up to 1 year or more but my point of contact at [redacted] will process my unique multi-insurance claim within 3-5 days.  Please send any items that show as pending to me so I can send to [redacted]@[redacted].com. [redacted] has been unsuccessful in reaching someone at [redacted] who can complete the steps necessary to complete all claims (as stated above, the only item that is needed is the fluoride charge received on 5 May 14).  [redacted] is available and can provide step-by-step instructions to facilitate process.  According to my carrier/personal claims processor, [redacted] should call [redacted] at [redacted], ext [redacted] in order to obtain clarification on what is needed.  [redacted] will stay on the phone with [redacted] and process anything that is not complete.  Please provide a few times/dates that will work best and I can arrange a phone conference between [redacted] and [redacted] at [redacted] so we can complete any outstanding claims.    If it makes it any easier, [redacted] can provide me with a time and date to go by the office so we can all figure this out together.  It is one piece of paper that is holding everything up that should have been submitted eleven months ago. Let's just please get this done.   V/r, [redacted]
 
[redacted]@att.net

Complaint: [redacted]
I am rejecting this response because: Now that all claims have been properly submitted and processed, please provide instructions on how we
will receive reimbursement for overpayment of [redacted] expenses and an estimated
timeframe to expect reimbursement.
 
The attachments [redacted]
provided to Revdex.com (Revdex.com) are completed different from the
statements [redacted] provided me with (see attached).
 
In the end, I am willing to
disregard the statements [redacted] provided to Revdex.com since I spoke with [redacted]) and [redacted] today, 21 Jan 15.  Both insurances said as of
six business days ago (12 Jan 15), the claims have finally been properly
submitted and being that my husband paid $263 on 2 Jun 14 (see attached
receipt), we are still owed a reimbursement from [redacted].  [redacted] and [redacted] instructed me to ask [redacted] for reimbursement and if the [redacted] office
does not comply, both insurance carriers will contact [redacted] to facilitate.
 
[redacted] has come through and
done their part so far and I believe they will be able to provide the reimbursement
we are rightfully owed.
 
Regards,
[redacted]

Hello,    Please be informed that while we do acknowledge your frustration regarding the processing time, the delay is not out of the ordinary.  The progression of events has occurred in the exact sequence we originally stated .  We did inform you that your first insurance has 12 months to pay claims.  Here we are, almost at the 12 month mark, and we are in the process of getting the final claim paid on the family account from [redacted].  Claims are being evaluated in an even shorter time-frame than anticipated by [redacted], however they will only evaluate claims after [redacted] has made a final decision.    We ask that you continue to be patient as we can only file to [redacted] once your [redacted] plan has rendered a final decision on paper.  This "EOB" is then sent to [redacted] along with a claim for secondary claim processing.  Hopefully we will know more within the next 30-90 days.     Please remember that this stage is not in our hands.  We have submitted all necessary documents, and have confirmation reports attesting to that.  At this point, we have to wait on your insurances to respond.

Complaint: [redacted]I am rejecting this response because:The response does not state how the situation will be fixed.  Additionally, my claims were not and still have not been submitted to either of my insurances as of 2 December.  After being pushed aside for half a year, I had to resort to going to the office in person.  In October, [redacted] said my billing issue would be fixed before an appointment we scheduled for 24 November.  On 7 November, I sent an email requesting review of our previous charges.  On 14 November, 1330 hours, I called to get a status update and make sure nothing else was needed from me.  [redacted] told me she did not have time for me and her priority was the patients in her office at that moment and not me or my email.  I decided to drive to the office and be the last patient of the day since they closed at 1400 hours.  I did not say anything to any of the other 5 patients that were in and out of the office.  I sat patiently and waited until I was called on (I was not called upon until the entire office was clear of all patients). My goal was to try to speak with someone else (or higher) with the hopes that maybe they would be able assist me and get my paperwork going before my scheduled appointment on 24 November or even assure me my situation was being worked. After discovering [redacted]'s father owns the clinic, I have basically given up on all communication with [redacted] and have had to resort to utilizing [redacted] and [redacted] representatives by having them contact [redacted] on three-way phone calls since my family's billing issues have not been corrected. [redacted] has contacted [redacted] 3 times and [redacted] has contacted [redacted] 2 times so they could explain the documents that are needed in order to complete my claims.   In the end, claims need to be submitted correctly.  Services received on 5 May were never submitted from [redacted] to the primary or secondary insurance. Because the 5 May claims were never submitted by [redacted], the 6 Jun visit can't be completed.  Request [redacted] submit 5 May claim to [redacted]. Once that EOB is received, send it to [redacted]. Once 5 May claim is complete, ensure proper documents were submitted for 2 Jun visit to [redacted] and [redacted].  I'd be more than willing to complete myself; just give me what I need to give them.  Since there are transmission issues, [redacted] (###-###-####) and/or [redacted] (###-###-####) representative(s) may be contacted and can provide a direct fax line and confirm the transmission they receive is the correct one.I apologize for demanding assistance but this has been a very grueling and prolonged experience.  I am willing to do whatever it takes to get it processed and resolved. My situation sounded like it was a few pieces of paper away from being fixed.  It's not even about the money; if it makes it any easier, please donate the payment I am owed to charity. Regards,[redacted]

Complaint: [redacted]
I am rejecting this response because:
Good morning,
 
I spoke with you on 17 Feb 15 and you instructed me to email you with the final total for reimbursement.  At that time, my dental claims were in the final stages of processing.  I contacted [redacted] on 17 Mar 15 to verify all claims were 100% processed; unfortunately, it was discovered that [redacted] left off a fluoride treatment code received on the 5 May 14 visit.  
 
According to [redacted] as we currently stand, my family is owed a refund of $127.  Once [redacted] resubmits 5 May 14 claim with the $16 fluoride code, we will be owed a refund of $143. The [redacted] representative stated the dental office should bill items correctly and tried to reach someone several times this week at the dental office who could assist with resubmitting the claim properly but was unsuccessful. 
 
Therefore, I would like to reinstate complaint #[redacted].  Please let me know if anything else is needed. 
Thanks in advance.
 
V/r,
[redacted]
 
[redacted] [redacted]

As mentioned in a previous response, insurance has up to 1 year to keep claims open.  Keeping in mind that this client has 2 policies (the second policy will not even consider the claim until they have a primary response), the time-frame for final payments can be 1+ years.  As we continue to receive payments we will post them to the family account.  Once all claims have been received, if any refund is due at the time, we can certainly take the proper steps for reimbursement.  Please understand claims filing is a timely process.  At this point, everything is in the hands of the insurance companies.