Dear Mrs [redacted] , I have been personally communicating with a Network Advocate from MetLife in order to clarify this situationIn this particular case there were some contract updates in which the secondary Insurance (MetLife) POP contractual schedule amount needed to be considered as the maximum allowable charge accepted for FEDVIP (his primary Insurance group)After many phone calls and communications, MetLife was able to communicate to us that the patient's responsibility was $Today we are mailing a check for the amount of $When we have a signed contract with an Insurance Company we go by their fees, not our office feesWhenever there is a secondary insurance involved, they usually cover the co-insurance portion of the primaryIn this case it was different due to their FEDVIP groupI have tried contacting Mr [redacted] several times, but I have not been able to communicate with himWe wanted to communicate the outcome of the investigationOnce again, our ultimate goal is to take care of our patientsIf you need additional information, please do not hesitate to contact us at ###-###-####Sincerely, [redacted]
Complaint: [redacted] I am rejecting this response because: The letter sent from Preferred Dental was dated May 18, 2015. The letter stated that a refund check was being mailed that same day. As of today, June 4th, 2015, I have yet to receive a refund check. Local mail should take no more than 3 days so it appears doubtful that a check was actually mailed on May 18th. Thank you for your assistance in resolving this matter. [redacted] Regards, [redacted] ***
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.
I received my refund last week, thanks for your help.
Regards,
[redacted]
see attached [Revdex.com converted the PDF attachment and copied it below; thus, formatting irregularities may occur.]Dear [redacted]:The patient had his wisdom teeth extracted on 11/10/2014. We submitted to his primary insurance(Blue Cross Blue Shield) and received payment on December 2014 for the...
amount of $1689.92 out of the$2,599.84(for services rendered). After receiving payment we were able to submit to patient'ssecondary insurance company on January 2015. The secondary (Metlife) only made a partial payment of$102.20. The patients' responsibility stated by his primary insurance was of $909.92. The patient paid$629.00. As of today the patient still has a balance of $178.72. We cannot reimburse for money that wehave NOT received. We submit to secondary insurance as a courtesy to our patients. Our Insurancecoordinator, [redacted] has exhausted all ways of appealing this claim. Today, she is contactingthem as a courtesy to our patient, Reference number (Metlife) is #[redacted], and she spoke to[redacted].We include this as part of financial agreement:Insurance Estimates ("Ins. Est.") and "Please Pay" amounts based on insurance estimates are providedas a courtesy. In the event that your insurance carrier pays less than the estimated amount, you areresponsible for the unpaid balance.Our ultimate goal is to provide the best care and service to our patients. It is unfortunate that hissecondary insurance company did not pay for his portion as expected. At this point I stronglyrecommend that our patient calls Metlife for more information.If you or Mr. [redacted] need any additional information regarding this matter, please do not hesitate tocontact our office at ###-###-####.Sincerely,[redacted]
Complaint: [redacted]
I am rejecting this response because: The letter sent from Preferred Dental was dated May 18, 2015. The letter stated that a refund check was being mailed that same day. As of today, June 4th, 2015, I have yet to receive a refund check. Local mail should take no more than 3 days so it appears doubtful that a check was actually mailed on May 18th. Thank you for your assistance in resolving this matter. [redacted]
Regards,
[redacted]
Complaint: [redacted]
I am rejecting this response because:The original treatment plan total that Preferred Dental gave me in writing was 1397.00. Also I was informed by [redacted] in their billing dept that my primary insurance provider, Blue Cross Blue Shield would most likely not cover any of the dental work. They made this clear on my invoice, showing zero dollars would be covered by BCBS. Not only did they bill me 629.10 out of my pocket they also collected 1689.92 from BCBS as well as 102.20 from Met Life Dental. These amounts add up to 2421.22, well in excess of the original 1397.00 that I was told in writing that the procedure would cost. Not only was I misled but also it appears that the amounts for the dental work increased after completion. This amounts to fraud and presently Met Life is investigating. I was also told by [redacted] at Preferred Dental that if BCBS did cover any of the dental work since one of the teeth was impacted I would receive my out of pocket charge back. That was over 6 months ago. I will be happy to provide paperwork from the dental office showing the charge of 1397.00 given to me on the day service was rendered. Thank you for your assistance in helping to resolve this matter.
Regards,
[redacted]
Dear Mrs. [redacted], I have been personally communicating with a Network Advocate from MetLife in order to clarify this situation. In this particular case there were some contract updates in which the secondary Insurance (MetLife) POP contractual schedule amount needed to be considered as the maximum allowable charge accepted for FEDVIP (his primary Insurance group). After many phone calls and communications, MetLife was able to communicate to us that the patient's responsibility was $19. Today we are mailing a check for the amount of $610.10. When we have a signed contract with an Insurance Company we go by their fees, not our office fees. Whenever there is a secondary insurance involved, they usually cover the co-insurance portion of the primary. In this case it was different due to their FEDVIP group. I have tried contacting Mr. [redacted] several times, but I have not been able to communicate with him. We wanted to communicate the outcome of the investigation. Once again, our ultimate goal is to take care of our patients. If you need additional information, please do not hesitate to contact us at ###-###-####. Sincerely, [redacted]
Dear Mrs [redacted] , I have been personally communicating with a Network Advocate from MetLife in order to clarify this situationIn this particular case there were some contract updates in which the secondary Insurance (MetLife) POP contractual schedule amount needed to be considered as the maximum allowable charge accepted for FEDVIP (his primary Insurance group)After many phone calls and communications, MetLife was able to communicate to us that the patient's responsibility was $Today we are mailing a check for the amount of $When we have a signed contract with an Insurance Company we go by their fees, not our office feesWhenever there is a secondary insurance involved, they usually cover the co-insurance portion of the primaryIn this case it was different due to their FEDVIP groupI have tried contacting Mr [redacted] several times, but I have not been able to communicate with himWe wanted to communicate the outcome of the investigationOnce again, our ultimate goal is to take care of our patientsIf you need additional information, please do not hesitate to contact us at ###-###-####Sincerely, [redacted]
Complaint: [redacted] I am rejecting this response because: The letter sent from Preferred Dental was dated May 18, 2015. The letter stated that a refund check was being mailed that same day. As of today, June 4th, 2015, I have yet to receive a refund check. Local mail should take no more than 3 days so it appears doubtful that a check was actually mailed on May 18th. Thank you for your assistance in resolving this matter. [redacted] Regards, [redacted] ***
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.
I received my refund last week, thanks for your help.
Regards,
[redacted]
see attached [Revdex.com converted the PDF attachment and copied it below; thus, formatting irregularities may occur.]Dear [redacted]:The patient had his wisdom teeth extracted on 11/10/2014. We submitted to his primary insurance(Blue Cross Blue Shield) and received payment on December 2014 for the...
amount of $1689.92 out of the$2,599.84(for services rendered). After receiving payment we were able to submit to patient'ssecondary insurance company on January 2015. The secondary (Metlife) only made a partial payment of$102.20. The patients' responsibility stated by his primary insurance was of $909.92. The patient paid$629.00. As of today the patient still has a balance of $178.72. We cannot reimburse for money that wehave NOT received. We submit to secondary insurance as a courtesy to our patients. Our Insurancecoordinator, [redacted] has exhausted all ways of appealing this claim. Today, she is contactingthem as a courtesy to our patient, Reference number (Metlife) is #[redacted], and she spoke to[redacted].We include this as part of financial agreement:Insurance Estimates ("Ins. Est.") and "Please Pay" amounts based on insurance estimates are providedas a courtesy. In the event that your insurance carrier pays less than the estimated amount, you areresponsible for the unpaid balance.Our ultimate goal is to provide the best care and service to our patients. It is unfortunate that hissecondary insurance company did not pay for his portion as expected. At this point I stronglyrecommend that our patient calls Metlife for more information.If you or Mr. [redacted] need any additional information regarding this matter, please do not hesitate tocontact our office at ###-###-####.Sincerely,[redacted]
Complaint: [redacted]
I am rejecting this response because: The letter sent from Preferred Dental was dated May 18, 2015. The letter stated that a refund check was being mailed that same day. As of today, June 4th, 2015, I have yet to receive a refund check. Local mail should take no more than 3 days so it appears doubtful that a check was actually mailed on May 18th. Thank you for your assistance in resolving this matter. [redacted]
Regards,
[redacted]
Complaint: [redacted]
I am rejecting this response because:The original treatment plan total that Preferred Dental gave me in writing was 1397.00. Also I was informed by [redacted] in their billing dept that my primary insurance provider, Blue Cross Blue Shield would most likely not cover any of the dental work. They made this clear on my invoice, showing zero dollars would be covered by BCBS. Not only did they bill me 629.10 out of my pocket they also collected 1689.92 from BCBS as well as 102.20 from Met Life Dental. These amounts add up to 2421.22, well in excess of the original 1397.00 that I was told in writing that the procedure would cost. Not only was I misled but also it appears that the amounts for the dental work increased after completion. This amounts to fraud and presently Met Life is investigating. I was also told by [redacted] at Preferred Dental that if BCBS did cover any of the dental work since one of the teeth was impacted I would receive my out of pocket charge back. That was over 6 months ago. I will be happy to provide paperwork from the dental office showing the charge of 1397.00 given to me on the day service was rendered. Thank you for your assistance in helping to resolve this matter.
Regards,
[redacted]
Dear Mrs. [redacted], I have been personally communicating with a Network Advocate from MetLife in order to clarify this situation. In this particular case there were some contract updates in which the secondary Insurance (MetLife) POP contractual schedule amount needed to be considered as the maximum allowable charge accepted for FEDVIP (his primary Insurance group). After many phone calls and communications, MetLife was able to communicate to us that the patient's responsibility was $19. Today we are mailing a check for the amount of $610.10. When we have a signed contract with an Insurance Company we go by their fees, not our office fees. Whenever there is a secondary insurance involved, they usually cover the co-insurance portion of the primary. In this case it was different due to their FEDVIP group. I have tried contacting Mr. [redacted] several times, but I have not been able to communicate with him. We wanted to communicate the outcome of the investigation. Once again, our ultimate goal is to take care of our patients. If you need additional information, please do not hesitate to contact us at ###-###-####. Sincerely, [redacted]