Total Health Dentistry

See attached document2/1/2016To Whom It May Concern:I am responding to the reply complaint following our response to the initial complaint filed on 12/29/(Complairt ID 11017036)After our response, the patient was contacted and informed that if the x-rays were returned to us, that her money would be refunded to her.Within a couple of days, the patient sent her husband to the office with the paper copy of her radiographsThe patient's husband requested an onsite refund and he was informed that they would receive a refund within 7-business days following review through the accountantAdditionally, during the patient’s initial visit to the office, she listed herself as guarantor of her accountWe are unable to issue a refund directly to anyone other than the account guarantorHer husband was simply not listed on the accountClearly, we would position ourselves unfavorably, if we began issuing cash or check refunds to anyone other than the patient in question and more importantly, to someone who has never been to our office and who is not directly listed as a member of the family or a guarantor on the account in questionHad a cash refund been granted at that time, there would have been no way to ensure that she would have received itAgain, we did not know her husband, he had never been to our office prior to this specific circumstance, and he was not listed on the family or patient account.In this case, the radiographs were returned to our office on January 21, and the refund was sent on the 7" business day following, on February 1, 2016.Our policies exist for both the protection of the patient's privacy and account information as well as to ensure that we are not in a position to issue refunds that may or may not be returned to the patient in question.Again, similar to our last response, we would have been happy to explain our policies and address any concerns to this patient had she reached out to us at any point throughout this process and allowed us to handle this issue internallyAt no point did the patient give our office an opportunity to handle this concern internallyWe would understand filing a complaint against us had attempts to handle the concern with us directly been futile, however, we were and are willing to hear concerns and issues and work directly with our patients to resolve therm quickly and efficientlyIn this case, to question our ability to handle customer service or billing issues without addressing us with the questions directly seems to invalidate the complaint.Thank you for your consideration.Sincerely, Rachel E G***, DMD

See attached document1/11/2016To Whom It May Concern:I am writing in response to a customer concern submitted on 12/29/with ID # [redacted] .We take every possible measure to ensure all patients are receiving accurate data regarding their specific insurance plans and insurance agreementsTo that end, we are only able to be as accurate as the information that is provided to us.in this specific case, the patient called to make an appointment for an exam and a cleaning and at that time was asked what insurance we would be billingWe are in network with multiple insurance carriers, but within each carrier there are some plans that are excluded from our in network agreementMany larger insurance carriers may have or more individual plans within the parent provider that have individual identifiers and specific limitationsWithout accurate Insurance information provided by the patient, we are unable to confirm our in network status or a patients active or inactive benefit status ahead of any scheduled appointmentsWhen the patient stated that she had a [redacted] plan, the receptionist was sure to confirm that the insurance was a [redacted] PPO plan, as most other [redacted] plans are not plans in which we are in networkOur receptionist is very clear about this when discussing [redacted] insurance with prospective patientsThe patient confirmed to her at that time that the plan was a PPO plan and that she found information about our office onlineShe also provided the name of her employer and the appointment was madeAt the end of the call the patient was asked to complete her new patient registration information online through our websiteWe ask that patients fill out all information online ahead of their scheduled appointment in order to allow us to confirm insurance plan information, to confirm that the patient or any dependents are currently active within the plan and that we are a provider that is considered in network.The patient arrived for the appointment as scheduled and informed our receptionist that she was unable to complete the online paperworkHowever, the patient did not contact us at any point prior to her visit to inform us that she was having issues accessing the online portal and again we were not able to gather any of the necessary insurance data ahead of the scheduled appointmentHad we had accurate information, we would have called the patient and informed her that we were not an in network provider and the patient could have then made a choice at that time whether to keep or cancel the appointment.The process of verifying insurance online and via fax can often take 10-minutes of phone calls and transfersWe are an office that works on appointment times and in order to stay on time for all of our scheduled patients we are unable to have verified benefits prior to seating the patient and beginning our exam, unless we are provided with the information needed ahead of time through paperwork or through initial and follow up phone callsDue to the incomplete information we were given, the receptionist was walking back and forth between the treatment room and the phone in order to provide the customer service representative from [redacted] the correct information in an attempt to receive up to date information regarding the patients insurance and our status as an in network provider.As soon as the information was available, the patient was informed that our office was not in network and that the she could staying for her full exam, radiographs and cleaning at a discounted rate, or that she could pay for her radiographs and the service that had already been provided and she would be provided a copy of those radiographs to take with her to her next dentist should she choose not to be seen in our office.The patient decided to not stay and was distributed a copy of her radiographs and was charged for the service provided.Prior to receipt of this complaint, there was no attempt made by the patient to contact our office to voice her concerns and there was no indication at the time of service that the patient was unwilling or unhappy with the request for payment for services renderedHad any one in our office been aware of the patients concerns at the time of the appointment, or any time following, we would have been more than happy to inform the patient of our policies and explain to the point of clarity any questions she may have hadI'm concerned that this complaint, although being taken very seriously, was not related to an actual lack of responsive and reasonable customer service as our office was never given an opportunity to resolve the concern internally.At our office we strive to make every patient experience an excellent one and provide exceptional serviceAs insurance can be an area of great confusion for many people, we work to ensure that we are providing up to date accurate information to our patientsUltimately, our acceptance and billing of insurance as well as our confirmation of in network status is a service we provide as a COURTESYHowever, each patient is RESPONSIBLE for understanding their individual insurance as the insurance contract is between the patient and insurance carrier, not the insurance carrier and our officeEach new patient reads and agrees to these terms when completing new patient paperwork.We regret that this patient was unhappy with her time in our office and we wish we had been able to provide her treatment within the confines of her particular insurance plan.Thank you for your consideration,Sincerely,Rachel EG***, DMDOwner, Total Health DentistryWindsor DrSte 6Cold Spring, KY

See attached document2/1/2016To Whom It May Concern:I am responding to the reply complaint following our response to the initial complaint filed on 12/29/2015. (Complairt ID 11017036)After our response, the patient was contacted and informed that if the x-rays were returned to us, that her money would be refunded to her.Within a couple of days, the patient sent her husband to the office with the paper copy of her radiographs. The patient's husband requested an onsite refund and he was informed that they would receive a refund within 7-10 business days following review through the accountant. Additionally, during the patient’s initial visit to the office, she listed herself as guarantor of her account. We are unable to issue a refund directly to anyone other than the account guarantor. Her husband was simply not listed on the account. Clearly, we would position ourselves unfavorably, if we began issuing cash or check refunds to anyone other than the patient in question and more importantly, to someone who has never been to our office and who is not directly listed as a member of the family or a guarantor on the account in question. Had a cash refund been granted at that time, there would have been no way to ensure that she would have received it. Again, we did not know her husband, he had never been to our office prior to this specific circumstance, and he was not listed on the family or patient account.In this case, the radiographs were returned to our office on January 21, 2015 and the refund was sent on the 7" business day following, on February 1, 2016.Our policies exist for both the protection of the patient's privacy and account information as well as to ensure that we are not in a position to issue refunds that may or may not be returned to the patient in question.Again, similar to our last response, we would have been happy to explain our policies and address any concerns to this patient had she reached out to us at any point throughout this process and allowed us to handle this issue internally. At no point did the patient give our office an opportunity to handle this concern internally. We would understand filing a complaint against us had attempts to handle the concern with us directly been futile, however, we were and are willing to hear concerns and issues and work directly with our patients to resolve therm quickly and efficiently. In this case, to question our ability to handle customer service or billing issues without addressing us with the questions directly seems to invalidate the complaint.Thank you for your consideration.Sincerely, Rachel E G[redacted], DMD

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
Regards,
[redacted] Hello [redacted],Dr G[redacted]'s office has agreed to refund my money, and though I paid cash, they will only send me a check in 7-10 days, though they wanted their money that day. That's not right to me.[redacted]

See attached document1/11/2016To Whom It May Concern:I am writing in response to a customer concern submitted on 12/29/15 with ID # [redacted].We take every possible measure to ensure all patients are receiving accurate data regarding their specific insurance plans and insurance agreements. To that...

end, we are only able to be as accurate as the information that is provided to us.in this specific case, the patient called to make an appointment for an exam and a cleaning and at that time was asked what insurance we would be billing. We are in network with multiple insurance carriers, but within each carrier there are some plans that are excluded from our in network agreement. Many larger insurance carriers may have 50 or more individual plans within the parent provider that have individual identifiers and specific limitations. Without accurate Insurance information provided by the patient, we are unable to confirm our in network status or a patients active or inactive benefit status ahead of any scheduled appointments. When the patient stated that she had a [redacted] plan, the receptionist was sure to confirm that the insurance was a [redacted] PPO plan, as most other [redacted] plans are not plans in which we are in network. Our receptionist is very clear about this when discussing [redacted] insurance with prospective patients. The patient confirmed to her at that time that the plan was a PPO plan and that she found information about our office online. She also provided the name of her employer and the appointment was made. At the end of the call the patient was asked to complete her new patient registration information online through our website. We ask that patients fill out all information online ahead of their scheduled appointment in order to allow us to confirm insurance plan information, to confirm that the patient or any dependents are currently active within the plan and that we are a provider that is considered in network.The patient arrived for the appointment as scheduled and informed our receptionist that she was unable to complete the online paperwork. However, the patient did not contact us at any point prior to her visit to inform us that she was having issues accessing the online portal and again we were not able to gather any of the necessary insurance data ahead of the scheduled appointment. Had we had accurate information, we would have called the patient and informed her that we were not an in network provider and the patient could have then made a choice at that time whether to keep or cancel the appointment.The process of verifying insurance online and via fax can often take 10-20 minutes of phone calls and transfers. We are an office that works on appointment times and in order to stay on time for all of our scheduled patients we are unable to have verified benefits prior to seating the patient and beginning our exam, unless we are provided with the information needed ahead of time through paperwork or through initial and follow up phone calls. Due to the incomplete information we were given, the receptionist was walking back and forth between the treatment room and the phone in order to provide the customer service representative from [redacted] the correct information in an attempt to receive up to date information regarding the patients insurance and our status as an in network provider.As soon as the information was available, the patient was informed that our office was not in network and that the she could staying for her full exam, radiographs and cleaning at a discounted rate, or that she could pay for her radiographs and the service that had already been provided and she would be provided a copy of those radiographs to take with her to her next dentist should she choose not to be seen in our office.The patient decided to not stay and was distributed a copy of her radiographs and was charged for the service provided.Prior to receipt of this complaint, there was no attempt made by the patient to contact our office to voice her concerns and there was no indication at the time of service that the patient was unwilling or unhappy with the request for payment for services rendered. Had any one in our office been aware of the patients concerns at the time of the appointment, or any time following, we would have been more than happy to inform the patient of our policies and explain to the point of clarity any questions she may have had. I'm concerned that this complaint, although being taken very seriously, was not related to an actual lack of responsive and reasonable customer service as our office was never given an opportunity to resolve the concern internally.At our office we strive to make every patient experience an excellent one and provide exceptional service. As insurance can be an area of great confusion for many people, we work to ensure that we are providing up to date accurate information to our patients. Ultimately, our acceptance and billing of insurance as well as our confirmation of in network status is a service we provide as a COURTESY. However, each patient is RESPONSIBLE for understanding their individual insurance as the insurance contract is between the patient and insurance carrier, not the insurance carrier and our office. Each new patient reads and agrees to these terms when completing new patient paperwork.We regret that this patient was unhappy with her time in our office and we wish we had been able to provide her treatment within the confines of her particular insurance plan.Thank you for your consideration,Sincerely,Rachel E. G[redacted], DMDOwner, Total Health Dentistry1010 Windsor Dr. Ste 6Cold Spring, KY 41076