Your Way Lawn & Landscape, Inc.

Any feedback we receive is very important to us, since it helps us maintain high quality care As a result, upon receiving this complaint, our Billing Department, Office Manager, and Clinical Director have reviewed the patient's account and treatment performed to ensure the best care has been
provided Of course, if there is anything that needs to be corrected on our end, we will gladly do so I will proceed to ad**ess the patient's concerns in the order they are mentioned.First, patient states a contract was signed where a monthly payment was agreed upon She mentions the monthly payments are related to the number and frequency of the anticipated adjustments I apologize for any confusion, but would like to clarify that the monthly payments are not related to the number and/or frequency of adjustments The monthly payments are determined based on the total cost of the the Orthodontic service Since we understand the total cost is not a small amount, we offer our patients the option to defer the amount in monthly payments The number of months is determined by the estimated amount of time the treatment will take to complete Of course this is an estimate, and is subject to change as issues may arise during the treatment Second, we are available Monday through Friday if the patient is experiencing discomfort due to wires that need to be clipped and are causing discomfort Although we do not overbook our schedules, the days we have the Orthodontist in the office, are our busiest days Nonetheless, our patients are provided with the best care and seen withing the recommended time suggested by the orthodontist As mentioned before, the planned treatment and/or time to complete the treatment may change In this case, the orthodontist did inform the patient that he needs approximately more months of treatment in order to complete the treatment Since we understand that the patient will be moving, the option was given to debond and deliver a retainer in order to halt the treatment and maintain the progress made If the patient decides to then return to us to continue the treatment, we have no problem doing so and a new contract would be created based on the remaining treatment needed Finally, regarding the insurance, we are in the process of reversing certain charges that were processed for any treatment that was paid for but not done However, any payments for services that were rendered will not be reversed Our Billing Department, specifically the agent mentioned, has been in constant communication with the patient's insurance to ensure the required steps to reverse these charges have and are being done Although we have been provided contradicting information from the insurance, we continue to move forward with the process by maintaining constant communication with the insurance The patient can always follow up with the insurance as well to obtain details of the process

Once again, I would liketo clarify that the monthly payments are not related to the number and/orfrequency of adjustments The monthly payments are determined based onthe total cost of the the Orthodontic service Since we understand thetotal cost is not a small amount, we offer our patients the option to defer theamount in monthly payments The number of months is determined by theestimated amount of time the treatment will take to complete Of coursethis is an estimate, and is subject to change as issues may arise during thetreatment. Once again, thecontract is not related to number of adjustments or frequency of them. Not all patients will need to come to theoffice every month, as each patient is different and may need to be seen 4,6,or weeks apart and some may need to have braces for the same or differentamount of time. As a result, to answerthe patient’s question, yes, a patient may sign a contract for months tomake monthly payments, but might need to be seen every weeks.We apologize for anyinconvenience related to the appointment availability, but we thank you for thefeedback since this will help us make improvements at the office. Our office is very busy, and we are bookedmonths in advance. However, precisely toavoid overbooking, we only place patients on the schedule when an opening isavailable. Nonetheless, patients areseen within a period of time that is effective for treatment and progress, anddoes not negatively affect the treatment. Note that the American Assoiciation of Orthodontists states that, “advancesin today’s orthodontic materials mean patients see the orthodontist only ABOUTonce every six weeks” Patient was inthe office for adjustments. Overalleach adjustment was done every or weeks apart. Only once, did we have an issue with ourschedule and the patient was seen in 4/after the visit in 1/10. We apologize for the inconvenience.The frequency in whichinsurances make payments, depends on the policy for each insurance. When the treatment was begun, in 2013, bothinsurances were on auto pay because this is the way they process the paymentsfor this treatment. On 4/7/we haverecorded that the patient called upset stating the insurance should not pay forvisits in which the patient was not seen and she should not have to pay monthlyif the patient is not seen every month. It was explained then the way the contract is set up and the way thepayments from her insurance are made.We have been in constantcommunication with the insurance since the treatment begun and have been on topof any changes with the insurance. On3/30/we have notated that Delta had paid $907.38, but patient was inactiveat that point. We were expecting fromCigna, and up to that point we had received $2047.60. [$4150-$2075=$2075-$(Delta)=$1167.62-$(pt has paid)=$as patient’s responsibility]. On 4/28, *** spoke with rep ***,informing him that patient won’t be coming back. *** was informed that pt only had 13adjustments done. Once the informationwas given to the insurance, it is up to the insurance to process the requestand issue the refund. Reference number:***. On 5/27, per Cigna, there will notbe a refund request issued. ***reinstated that patient only had adjustments, but insurance informed us thatit did not matter since insurance is set to pay for length of treatmentregardless of visits made. Once again,it was out of our hands. Then, on6/30/2015, mother stated a corrected claim was needed in order for arefund request to be issued. Consequently, *** called Cignaseveral times and never did any of them mention a refund request was going tobe issued or needed to be issued Nonetheless, she faxed a "corrected claim" statingthe number of months (21) patients wasin office and the number of visits (13) patient has had (we then leave it up toCigna to process refund request) *** then called again, also on6/30/to follow up on "corrected claim"Cigna informed us nothingwas received (confirmation faxed is available). After much time wasted (**oppedcalls and reps who had no idea what was going on with account) *** spoke withto reps: 1st rep: (call reference #***) Original claim was sent backto reprocessing on 6/and it can take up to 10-business days for"refund request"2nd rep: (Aaron) Did not see why a corrected claim wasneeded. This representative was explained the issue from the very beginning, discrepancy in info provided to us and to mom,and mom to us. Rep reviewed entire caseand stated that mom had appealed payments and that appeal got denied becausethere had been an arrangement with mom and office Finally, on 7/23/2015, *** called Cigna to inquired aboutrefund request, and was told a letterwas sent to *** on July 9th. We were not able to get an amount, nor a phone number to the refund deptunit! Reference #***, rep ***Employee ID ***. Later that same day,*** once again called Cigna SEVERAL TIMES, this time a new answer wasgiven! Rep ***, reference No*** informedher that NO REFUND REQUEST HAS BEEN ISSUED BECAUSE CIGNA HAS NOT DEFINE ARESOLUTION FOR THIS ACCOOUNT ON JULY 20thAN UPDATE WAS SENT BUT NO ANSWER STILL. Itusually take 30-business days for an update, but since this issue has beengoing on for a while, it will get escalated We were told we would receive a call one weeklater from Rosie, but we have no further updates

Complaint: [redacted]
I am rejecting this response because:Regardless of what you state you did not see [redacted] the full 22 or 24 months.  I will list the appointments where [redacted] was seen in your office for you and then you can explain the gaps in appointments and why the addtional 12 months of treatment is needed if you did not overbook patients.  If you had treated [redacted] 4-8 weeks as you previously stated there would be no addtional 12 months of treatment needed.  Your 4-8 weeks apart do not match the appointments made available to us.  6/18/2013 - Bonding; 8/2/2013 - Adjustment #1; 9/27/2013 - Adjustment #2 (per [redacted] on same date of appt -no appointments available in October as they are all booked.  I need to call in October to see if appointment is available for November); 11/8/2013- Adjustment #3 (per [redacted] on same date of appt - no appts available as they are all booked for Dec 2013.  I need to call in a couple of weeks to see when next appt is available as they do not have schedule yet); 1/10/14 - Adjustment #4 (per [redacted] on same date of appt - no appts available as they are all booked for the next two months and I need to call to see if anyone has cancelled.  Or if there is a problem I can call and they can see if they can work [redacted] in to be seen.; 4/7/2014 - called and complained - no appts available for 3 months and [redacted] has broken brackets, again!)  4/22/14 - Adjustment #5, 6/17/2014 - Adjustment #6; 8/29/14 - Adjustment #7 (same date of appt per [redacted] no appts available as they have all been booked for next two months); 10/7/14 - Adjustment #8; 11/71/14 - Adjustment #9; 12/9/14 - Adjustment #9; 1/27/15 - Adjustment #10 (per [redacted] on same date of appt -no appointments available for next several months, need to call to see about scheduling appts - see a pattern here?); 3/27/15 - Adjustment #11; 4/23/15 - Adjustment #12.  Treatment failed for [redacted] and he needs addtional 12 months of treatment because you failed to see patient as you had NO APPOINTMENTS available becasue you overbook patients.  This complaint is not only a financial issue but there are also quality of care issues at hand and you know this!Cigna/Accent submitted a credit request for 537.21 after which you denied and then submitted a suppressed list and requested that you not be contacted by Cigna/Accent to collect the amount they have requested.  But you insist on claiming that you have not received a credit request from the insurance company, not very honest are you?  Fact is you have no intention of refunding this amount requested by insurance company or you would not have gone to these lenghts to stop these requests.  I will be filing a second  complaint with Cigna and this will be for quality of care complaint with regards to Familia Dental and it is very possible that you may be hearing from Provider Relations with regards to these complaints.  I pray that your contract is revoked with Cigna where you can no longer treat patients in such a manner.  I can promise you, additonal complaints from other agency's will follow.    If you had you would state that he needs an additional 12 months of treatment, per **. [redacted].  I spoke with [redacted] at Cigna and they have requested a refund of 537.21 through Accent.  Familia Dental
Regards,
[redacted]