Westover Hills Oral & Maxillofacial Surgery

Complaint: [redacted] I am rejecting this response because: As I stated in my original complaint, billing/copay information was not discussed when I set up my appointment I was asked for, and provided, my medical and dental insurance information Additionally, when I encountered the form that I signed explaining the complicated nature of insurance billing, that was when I inquired to the office staff about if the practice was in-network with BlueCross/BlueShield The office staff, after consulting with additional staff, informed me that they were in-network with BlueCross/BlueShied I relied on that information, to my detriment, in signing that form Finally, I would simply suggest that any potential consumer read the accusatory response provided by this business in response to my complaint I think that speaks volumes Regards, [redacted] ***

Complaint: ***
I am rejecting this response because: As I stated in my original complaint, billing/copay information was not discussed when I set up my appointment I was asked for, and provided, my medical and dental insurance information Additionally, when I encountered the form that I signed explaining the complicated nature of insurance billing, that was when I inquired to the office staff about if the practice was in-network with BlueCross/BlueShield The office staff, after consulting with additional staff, informed me that they were in-network with BlueCross/BlueShied I relied on that information, to my detriment, in signing that formFinally, I would simply suggest that any potential consumer read the accusatory response provided by this business in response to my complaint I think that speaks volumes
Regards,
*** ***

Thank you for advising me that a complaint had been filed toward my Oral & Maxillofacial Surgery Clinic Practice.       This is the first time such an action has been directed toward my practice. I take very seriously the standard of care we provide our patients...

and our continued reputation of providing superb service to all. I do not take this situation lightly.         I find it especially troubling when an individual can make completely false and fabricated statements freely against my office and personnel and have that information posted as if it were true. The patient in question was referred from his Medical Provider for evaluation and treatment.         He was appointed in the standard fashion by phone and preliminary insurance information was obtained concerning his Dental and Medical policies. All patients including this one are advised when making their appointment that all co-payment fees and/or deductibles are due at the time of service. At the time of his presentation further insurance information was obtained. He was advised by both administrative office staff that we file both Dental and Medical Claims for any procedure. He was advised that we were networked with his Dental Insurance, however, were not networked with his Medical Insurance. I am an Oral & Maxillofacial Surgeon practicing under a TX Dental License. I am not networked with any Medical Insurance Companies.           As a voluntary service for our patients we do file both Dental and Medical claims on there behalf. Also an explanation of how Insurance Claims are processed and the reminder that all Insurance Policies are contracts between the patient and the Insurance Company is provided and signed by all patients before being evaluated or treated.         The patient in question signed acknowledgement of these facts before being evaluated. (Signed Forms Attached) The patient was evaluated and a treatment plan fabricated during his visit.  He was again advised that both a Dental Claim and Medical Claim would be filed on his behalf. Fees utilized for his visit were discounted utilizing network dental fees. According to the information provided by his Dental Insurance he was responsible for a co-payment and deductible. That amount($62.00)was collected. He was advised that if in fact additional  reimbursement was obtained from the Dental Insurance or payment  was received from the Medical Insurance a refund check for the  appropriate amount would be forwarded to him ASAP. The estimated treatment plan (again utilizing the Delta Dental Network Fee Schedule) for his required surgery was reviewed with him. He declined to schedule the surgery and left. As explained above this patient was advised and well aware of the fact that I was not Networked with his Medical Plan. We take time and effort to provide this information in advance.    (Information he could have easily been aware of on his own by reviewing his policy or obtaining a list of Network providers from his insurance.) I take issue with the fact that this patient filed this complaint within a week of his encounter, when he knows very well that it takes much longer for insurance claims to be finalized by the carriers. This patient may in fact receive a refund once the claims are finalized. I also take issue with the fact that this patient is employed in Health Care and as such should be well aware of how insurance claims are processed. No, my office nor my staff do not lack integrity. The only loss of integrity has been demonstrated by the blatantly false statement from this past patient.

Thank you for advising me that a complaint had been filed toward
Verdana; font-size: 11px;">my Oral & Maxillofacial Surgery Clinic Practice.       This is the first time such an action has been directed toward my practice. I take very seriously the standard of care we provide our patients and our continued reputation of providing superb service to all. I do not take this situation lightly.         I find it especially troubling when an individual can make completely false and fabricated statements freely against my office and personnel and have that information posted as if it were true. The patient in question was referred from his Medical Provider for evaluation and treatment.         He was appointed in the standard fashion by phone and preliminary insurance information was obtained concerning his Dental and Medical policies. All patients including this one are advised when making their appointment that all co-payment fees and/or deductibles are due at the time of service. At the time of his presentation further insurance information was obtained. He was advised by both administrative office staff that we file both Dental and Medical Claims for any procedure. He was advised that we were networked with his Dental Insurance, however, were not networked with his Medical Insurance. I am an Oral & Maxillofacial Surgeon practicing under a TX Dental License. I am not networked with any Medical Insurance Companies.           As a voluntary service for our patients we do file both Dental and Medical claims on there behalf. Also an explanation of how Insurance Claims are processed and the reminder that all Insurance Policies are contracts between the patient and the Insurance Company is provided and signed by all patients before being evaluated or treated.         The patient in question signed acknowledgement of these facts before being evaluated. (Signed Forms Attached) The patient was evaluated and a treatment plan fabricated during his visit.  He was again advised that both a Dental Claim and Medical Claim would be filed on his behalf. Fees utilized for his
visit were discounted utilizing network dental fees. According to the information provided by his Dental Insurance he was responsible for a co-payment and deductible. That amount($62.00)was collected. He was advised that if in fact additional  reimbursement was obtained from the Dental Insurance or payment  was received from the Medical Insurance a refund check for the  appropriate amount would be forwarded to him ASAP. The estimated treatment plan (again utilizing the Delta Dental Network Fee Schedule) for his required surgery was reviewed with him. He declined to schedule the surgery and left. As explained above this patient was advised and well aware of the fact that I was not Networked with his Medical Plan. We take time and effort to provide this information in advance.    (Information he could have easily been aware of on his own by reviewing his policy or obtaining a list of Network providers from his insurance.) I take issue with the fact that this patient filed this complaint within a week of his encounter, when he knows very well that it takes much longer for insurance claims to be finalized by the carriers. This patient may in fact receive a refund once the claims are finalized. I also take issue with the fact that this patient is employed in Health Care and as such should be well aware of how insurance claims are processed. No, my office nor my staff do not lack integrity. The only loss of integrity has been demonstrated by the blatantly false statement from this past patient.

Complaint: [redacted]
I am rejecting this response because:  
As I stated in my original complaint, billing/copay information was not discussed when I set up my appointment.  I was asked for, and provided, my medical and dental insurance information.  Additionally, when I encountered the form that I signed explaining the complicated nature of insurance billing, that was when I inquired to the office staff about if the practice was in-network with BlueCross/BlueShield.  The office staff, after consulting with additional staff, informed me that they were in-network with BlueCross/BlueShied.  I relied on that information, to my detriment, in signing that form.
Finally, I would simply suggest that any potential consumer read the accusatory response provided by this business in response to my complaint.  I think that speaks volumes.  
Regards,
[redacted]