Complaints

• Initial Complaint

  11/20/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I went to blue lake oral surgery for a procedure with 3 forms of insurance to cover costs. I was quoted $70 after all forms of insurance were verified and 6 months later the company is seeking $600 stating the insurance companies have paid and the balance remains. After showing statements, one insurance did not pay anything! They give false quotes and do not run legitimate insurance inquiries to give patients false quotes and mislead prices, then attempt to reclaim finances later after I had paid and finalized paper work.

  Business response

  12/01/2023

  The patient was first seen on 1/5/22 for a consult for a possible dental extraction and for a possible biopsy of tissue inside his mouth.  Patient requested IV sedation for his procedure to address anxiety.  His original surgery estimate was calculated using only one dental insurance (I will refer to this as Insurance A).  He was sent an emailed estimate for treatment on 5/17/2022 which indicated that his financial responsibility for treatment would be $1235 and his estimated down payment on the day of surgery would be $653 (note this is only a down payment and only an estimate).  A reworked estimate including his secondary insurance (I will refer to this as Insurance B) was put together.  On 5/18/22, the patient was then emailed this updated estimate indicating his estimated down payment would be $79.40.  His original consult fees were covered by his co-pay and payment from Insurance B.  On the day of surgery (6/9/22), he paid the estimated down payment of $79.40. The total cost of his surgery and sedation was $1015 ($220 lower than the original estimate). On 11/30/22, insurance A issued us a payment of $436, leaving a balance of $499.60.  On 8/18/22, Insurance B had sent an explanation of benefits (***) to us denying payment for any portion of the procedure.  The *** states The information previously requested for this claim from the member was not received.  This claim has been denied.  In other words, Insurance B contacted the patient and requested information from him in order to process the claim and the patient did not cooperate with insurance company B. After it became clear that there was not going to be further payment from either insurance company, the patient was sent statements starting on 4/3/23. When the patient received statements regarding the balance on his account, he came to the office upset about the balance on his account. The office manager spoke with him and showed him his treatment estimates, his signed financial agreement and tried to let him know that we sent his claim to insurance company A and insurance company B and they do not always guarantee payment. It was clear that this patient was not accepting any information regarding this matter, and he got up and left.
  Office manager called the insurance company that did not make payment on claim and tried to find out why they did not make payment and the office manager was told that they needed additional information from the patient, which they had requested from the patient, but he did not respond.  Several attempts were made to reach the patient to inform him of this request from his insurance company but the patient never returned our calls/statements/letters.It wasnt until he was sent to collections did he send our office an email.Once a file has been sent to collections we are no longer allowed to collect on that payment and all questions are directed to the collection agency.
  Below is a list of dates we attempted to reach the patient to discuss the above issues to which he did not respond until after he was sent to collections:
  4/3/23- Sent statement of account
  4/7/23 Left voice mail and sent 1st AR letter
  4/26/23- Left Voice mail regarding account
  5/1/23- Sent statement of account
  5/2/23 Left voice mail regarding account
  5/9/23 Left voice mail regarding account
  5/15/23 Left voice mail sent 2nd AR letter
  5/30/23- Left voice mail regarding account
  6/1/23- Sent statement of account
  6/13/23- Left voice mail regarding account
  6/21/23- Left voice mail regarding account
  7/3/23- Sent statement of account
  7/26/23- Left voice mail regarding acct sent a 3rd and final AR letter registered certified mail
  7/31/23- Sent Statement of account
  8/10/23- Sent email regarding account
  8/17/23- Left voice mail
  8/31/23 Sent account to QCI collections
  11/20/23- received email correspondence from patient. Referred him back to the collections company for any questions regarding his account.
  The patients account began to accrue interest charges on 2/2/23.  As of the date he was sent to collections, his total bill including interest charges was $560.78.
  All verbiage included in the treatment estimate and the financial agreement states patient is financially responsible for all charges whether or not paid by insurance and THIS IS NOT A GUARANTEE OF PAYMENT BY YOUR INSURANCE, BUT RATHER AN ESTIMATE OF WHAT YOUR INSURANCE MAY PAY.
  
  Our office made every attempt to work with the patient to clear the balance on the account prior to sending to collections.
  I have attempted to attach the 2 emailed estimates.

  Thank you.
  
  

  
  

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