Tsaknis Dental & Associates

Please note, this is the first email receivedPlease see documents providedPlease send us a response within days that this matter has been resolved from the Revdex.com standpointWe do not have an official release of records from the patient to allow us to send you anything, but are using this documentation as authorization in releasing of her records, since she has filed the complaintThank youDrTsaknis To: Revdex.com Re: ID of [redacted] Date: 1-8-2017This is the first notification received from the Revdex.comWe NEVER assure anything, it is documented on every formEverything is just an estimateWe did not submit any additional chargesWe ask the patient to contact their own insurance for specifics, we call for general coverage informationWe have NO fine print, it is just the statement at the bottomMsCabrera had come in for an exam on 11-5-She was emailed the treatment plan the same day ( [redacted] @***.com)She then called and made an appointment to begin the work a month laterShe came in and had that doneWe submitted the procedures done on 12-4-Her insurance sent us less money than was originally thought, she was notified 3-20-by phone about her situation and costsOn 12-7-she was once again contacted by phone and she stated she is not paying her bill and, was then sent to collections.12-27-chart notePt called regarding accountShe was calling because she was sent to the collection agencyShe said that it wasn`t like she was not trying to pay her billI told her that we have a note from a front desk receptionist stating that she had refused to pay her balanceShe stated that when she came in for her first visit Dr.H [redacted] told her she needed restorative work done and that she stayed in the office for over an hour with the front desk while they called her insurance company to make sure her services were covered and to find out how much she would have to payShe accused our office of lying and being unethicalI explained to her that she actually had her fillings done a month after her initial visitThen she said she doesn`t remember when she got the work doneShe said that she told the front desk that she did not want to be billed after her visitI assured her that our office does not do anything unethical and that I review all accounts for accuracy before claims are sent outI told her that the reason she had a balance was that she maxed out of benefitsShe said she did not max out and that she still had approximately $remainingI said maybe she had been seen at another provider`s officeShe said that we were the only office she had been to in I added up all insurance payments to see if the maximum of $of her benefits had been paidTotal paid to our office was $520.80, I then reviewed her [redacted] for the breakdown of benefits we had prior to the pt coming to the officeThe breakdown said pt had used $prior to our office with $remaining, which equals $1000, therefore, pt had met the maximum for the yearPt asked what I am going to do about this situationI said there is nothing that I can do and that she owes the balanceShe said it was our faultI explained to the pt that we are here to provide a service and those services were provided and that we send a claim to the insurance company as a courtesy and if they do not pay a portion then she is responsibleShe said she was never told that, I explained that her treatment plan states, "Insurance coverage is only an estimationGuarantor is responsible for all treatment not covered by insurance." She then stated that, "oh, so you are telling me that I should read the fine print?" I told her that we are not trying to hide anything and that the insurance company is the one she needed to speak with for an exact payment amountI told the pt that unfortunately she ran out of benefits and this is her balanceShe asked for my last name and hung up on meI was speaking to the patient for mins, Malina S [redacted]

This is very simpleWe verify that the patient has active insuranceWe perform the standard exam, x-rays and cleaning per the American Dental Association guidelinesHer insurance company refused to pay for an x-ray because it was already performed somewhere elseThe patient did not forward any of those records either during her initial visit or at the time she had her fillings doneWhen her insurance didn't pay, then she is responsibleIf she had gotten the records from the other dentist or stated that she already had those x-rays taken, then we may have been able to work look into it furtherI legally (as a legal assistant, she should know) that I cannot perform routine care without a full exam and the proper x-raysIf she had said at any point " I just had these done", then we could have possibly taken another pathI am still not sure what x-rays the other dentist took (if they were even taken), but many times they take a "full mouth series" and not what the ADA says, which is to take a PANThat is what was not covered and she most likely would have needed to pay for thatThat is my assumption at this timeI'm not sure why she has gone to the Revdex.comIn the end this is a problem with the insurance industryThe contract is between her and her insurance company to pay for servicesI have a contract with the same insurance company to provide services within certain guidelinesThe patient has a contract with me, that she will pay for services renderedI understand the patient is upset, but that needs to be directed towards her insurance company and their policiesWe did nothing wrong, tricky or misleadingIf you have any further questions please call our office at ###-###-####Thank youDrTsaknis owner (all work was performed by DrH***, whom is no longer practicing in the area)

Please note, this is the first email received. Please see 3 documents provided. Please send us a response within 10 days that this matter has been resolved from the Revdex.com standpoint. We do not have an official release of records from the patient to allow us to send you anything, but are using this...

documentation as authorization in releasing of her records, since she has filed the complaint. Thank you. Dr. Tsaknis To: Revdex.com Re: ID of [redacted] Date: 1-8-2017This is the first notification received from the Revdex.com. We NEVER assure anything, it is documented on every form. Everything is just an estimate. We did not submit any additional charges. We ask the patient to contact their own insurance for specifics, we call for general coverage information. We have NO fine print, it is just the statement at the bottom. Ms. Cabrera had come in for an exam on 11-5-2014. She was emailed the treatment plan the same day ([redacted]@[redacted].com). She then called and made an appointment to begin the work a month later. She came in and had that done. We submitted the procedures done on 12-4-2014. Her insurance sent us less money than was originally thought, she was notified 3-20-2015 by phone about her situation and costs. On 12-7-2015 she was once again contacted by phone and she stated she is not paying her bill and, was then sent to collections.12-27-2016 chart note. Pt called regarding account. She was calling because she was sent to the collection agency. She said that it wasn`t like she was not trying to pay her bill. I told her that we have a note from a front desk receptionist stating that she had refused to pay her balance. She stated that when she came in for her first visit Dr.H[redacted] told her she needed restorative work done and that she stayed in the office for over an hour with the front desk while they called her insurance company to make sure her services were covered and to find out how much she would have to pay. She accused our office of lying and being unethical. I explained to her that she actually had her fillings done a month after her initial visit. Then she said she doesn`t remember when she got the work done. She said that she told the front desk that she did not want to be billed after her visit. I assured her that our office does not do anything unethical and that I review all accounts for accuracy before claims are sent out. I told her that the reason she had a balance was that she maxed out of benefits. She said she did not max out and that she still had approximately $300 remaining. I said maybe she had been seen at another provider`s office. She said that we were the only office she had been to in 2014. I added up all insurance payments to see if the maximum of $1000 of her benefits had been paid. Total paid to our office was $520.80, I then reviewed her [redacted] for the breakdown of benefits we had prior to the pt coming to the office. The breakdown said pt had used $479.20 prior to our office with $520.80 remaining, which equals $1000, therefore, pt had met the maximum for the year. Pt asked what I am going to do about this situation. I said there is nothing that I can do and that she owes the balance. She said it was our fault. I explained to the pt that we are here to provide a service and those services were provided and that we send a claim to the insurance company as a courtesy and if they do not pay a portion then she is responsible. She said she was never told that, I explained that her treatment plan states, "Insurance coverage is only an estimation. Guarantor is responsible for all treatment not covered by insurance." She then stated that, "oh, so you are telling me that I should read the fine print?" I told her that we are not trying to hide anything and that the insurance company is the one she needed to speak with for an exact payment amount. I told the pt that unfortunately she ran out of benefits and this is her balance. She asked for my last name and hung up on me. I was speaking to the patient for 30 mins, Malina S[redacted]

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
 Complaint: [redacted]
I am rejecting this response because:Their response is partial untrue. I have outlined in the letter attached further detail the accurate information needed to substantiate my complaint. 
Regards,
[redacted]
[redacted]
[redacted]
[redacted]
[redacted]As I explained in my prior complaint and countless times to Ms. S[redacted] over the phone, they assure me at the front desk on November 5, 2014, that all I would have to pay is what they quoted me in person. I spent over two hours at their office on that day, so they could call the insurance and verify for me my insurance coverage. If they would provide honest and transparent service, they should have gone the proper route and requested my insurance balance and coverage from the Insurance company. This would have been important before confirming with me that I would not end up with hidden or surprise balances. I completely trusted them and their professionalism and decided to move forward on that treatment. Later I found out that I needed to pay additional money that I was not expecting to pay. I was not happy that day leaving the office and I reminded them that they had already confirmed I was good to go with my insurance before I agreed to move forward with that treatment. I paid it anyway with my credit card the amount of $195.00. Then later, I found out that there was still more money owed for the treatment. I called several times to speak to Ms. S[redacted] in protest of these unsubstantiated charges and asked for her to call me back. She never returned my call. In the meantime, I explained my situation to the billing person who answered the phone and asked her to help me fix this discrepancy. I never said to her, “I refuse to pay my balance”. Ms. S[redacted] only read a message on a sticky note from the billing person that took my messages. The billing person said she would give the message to Ms. S[redacted] and try to work it out. They never called again or ever tried to reach me to let me know that my balance was remaining outstanding. They never sent me another bill, email or text message, until I found out through my credit report they had sent me to collections. I consider this very negligent for the Dental Bug billing department and view it as an action against me to damage my credit.The worst part is I took the time to call and try to work things out. However, the billing department avoided a conflict resolution with me and sent me to collection, for what I see as their wrongdoing. Ms. Sitowiz did not try to offer any kind of agreement. This clearly shows how closed minded she is in her response, all she kept repeating there was “there is nothing I can do and this is what you owe”. This is not the first time they have conducted business like that. I even referred a new patient to their practice and they did the same thing to him. He went in for a cleaning that was covered under his insurance. Later he received an invoice in the mail for additional charges, apparently not covered by insurance, that he never agreed to up front. (Affidavit attached.)Ms. S[redacted] stated in her prior response that they advised me to speak with my insurance company, which is completely untrue. They called the insurance company in my presence and assured me I was good to go with treatment and it was fully covered.The treatment plan she says they sent me via email is a treatment that was never completed. I even wrote on the quote, “Will schedule treatment later” and initialed it. (This was one of the letters she uploaded to your site). This time I did personally check with my insurance company for how much of the treatment they would cover, especially since I started to suspect Dental Bug was not being completely transparent with the way the quote their client’s treatments. The insurance gave me a different amount than what Dental Bug provided. Thank God I did not have the treatment done immediately and told them I would think about it. They were very pushy and wanted me to come back right away. If I had gone through with it, I would have ended up owing a lot more money than what they told me. This is another example were Dental Bug personally tried to use trickery with quotes vs. actual costs for services performed.I am completely disappointed that businesses like that don’t care about providing good costumer service to their clients. They only look to profit based on trickery and in a non-transparent way to get more business.Last but not least, I did not hang up the phone on her. I asked her to provide her name multiple times and she refused, and before we hung up, I asked one last time for her name and she finally gave it to me. I said “Thank you” and disconnected the call.Thank you,/s/ [redacted]