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Winter Roofing Inc

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Winter Roofing Inc Reviews (1)

This patient came to our office initially 2/13/2003 for a consult for wisdom teeth. The patient was given a treatment plan which included general anesthesia and the removal of four wisdom teeth. The patient at the initial presentation was given a treatment estimate and had a predetermination of...

benefits sent to his dental and medical insurance. The patient never had the surgery completed. The patient presented back to my office two years later on 3/13/2015 in pain with his wisdom teeth and now wanted the teeth removed as soon as possible. The patient was given a prescription for pain medication and antibiotics to help calm down the infection and pain. At the second consultation the patient was given a revised treatment plan and the general anesthesia was removed and replaced with nitrous oxide analgesia to lower his costs. The patient presented to our office with a new insurance card which listed his medical and dental benefits on the same card. The patient was given an estimate of payment required to schedule the surgery. The patient was interested in proceeding with the surgery as soon as possible and did not want to wait the two weeks for the treatment estimate. The patient was told that a predetermination would take two weeks for insurance to respond. The patient proceeded with surgery four days later. The treatment estimate clearly states “your signature below means that you and your doctor have reviewed this plan of treatment and you agree that you approve and understand it and agree to the fees and terms. All efforts are made to determine your surgical costs, however; this treatment plan is an estimate and may be subject to changes based on insurance coverages and findings at the time of your surgery.” Furthermore the financial policy of the practice which Mr. [redacted] signed states the office will help assist the patient with receiving the maximum allowable benefits under their insurance policy. The patient is ultimately responsible for their account.
In the case of Mr. [redacted] it turned out the patient had no dental benefits and his medical insurance did not cover any of the procedure. [redacted] medical insurance has not covered wisdom teeth removal for two years and my staff would never tell a patient that his medical insurance would cover this procedure since [redacted] has changed their benefits and most of the time does not cover the surgery. Of course there are always exception to these rules which our office cannot have knowledge of for all patient encounters. The patient was quoted a copay based on an anticipated insurance reimbursement from [redacted] dental which when billed came back as showing the patient had no coverage.
No one attempted to mislead Mr. [redacted] but rather help facilitate his care since he was in pain and wanted definitive relief of the problem after putting off the procedure for two years. Furthermore, attempts were made to reduce the healthcare costs to the patient by developing an alternative treatment plan which was less costly.
It is unfortunate that Mr. [redacted] is upset that he received no coverage from his insurance plan. In today’s rapidly changing insurance environment the patient has to assume some responsibility in checking their benefits. Mr. [redacted] had his benefits preauthorized the first time he came in to our practice. At the second consult visit it would not be feasible to get a preauthorization back in time for his surgery scheduled in 4 days from his consult visit. The patient had the option of waiting for a estimate of benefits to be returned back before proceeding with the surgery. At this juncture I would be more than willing to have the patient set up a payment plan with our office to settle his account, but the balance will not be written off since the services have been rendered.

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