After finding an insurance company that the dentist would take, I signed up for it and became a member. Once that was done, I registered with the dental office and they verified that they took my insu rance company (Humana DHMO); the receptionist found my name on a list of names sent to them from the insurance company; she showed it to me, so that I could see that I was, indeed, a current member of the insurance plan. I was seen for my dental work February 25th, 2015, and I had 2 fillings done. According to the insurance data, this would involve copays of $70 per filling. This was verified by the dental office; they took the payment on the same day of service for $140.
Then I get a letter dated March 29th, 2015; it says they haven't been able to resolve my claim from the Feb. 25th date of service. They ask that I call the insurance company to find out why the insurance company isn't paying them. They also state in the letter that if they can't get money from the insurance company within 30 days, then the bill will go directly to me.
I went to the manager of the location on April 9th, 2015 and spoke with her; I inquired as to why I was receiving the letter, when it is the job of their billing dept to handle the issues like this. I informed the manager that the billing dept needs to call and find out how to properly file the claim so they can get paid.
The manager told me in no uncertain terms that "Oh, we don't have a billing dept. Our staff makes calls like this throughout the week when they have time; but they do make these calls". Upon being asked just how often those calls get made, the manager refused to give a direct answer, stating only that "I don't have an answer to your question. But you will get a bill if the insurance company does not pay".
I informed her that I would not be paying for anything outside of the copay, because it was her office staff that assured me that my two fillings were a covered service and that all that I would be responsible for would be the $140 copay ($70 for each filling). I left after that, seeing that she was not going to be of any help whatsoever. At no time did she state anything that could possibly even remotely construed as helpful. She said that if I "would only call the insurance, then I would probably find out that the check was in the mail". ((Really? Isn't that what their job is???)) I would have been satisfied if she'd stated "I'll make sure that a call is made today", or "Let me have your full contact info so I can reach out to you when this is resolved, which should be within # days"... but I did not get anything at all from her.
I do not feel it is my job to tell a business how to properly file claims for reimbursement; they should KNOW how to do their job. The ONLY possibility that comes to mind is that they are trying to double dip; meaning, that they want me to pay them and they want the insurance company to pay them also.
Even though I did not feel that I should have to, I called the insurance company on April 13th, 2015, at 12:16 pm, and spoke with Roxanne B. She listened to my story and quite firmly stated that the dental office should not be billing me for the remainder of my visit; she also confirmed that I should only be responsible for my copays. Roxanne then went one step further and called the dental office while I was on the line; unsurprisingly, they did not answer... Roxanne stated she would call them until she got through, & then call me back to let me know what was going on. I did get a call back from Roxanne later that same day at 12:47; she stated that she did speak to the dental office & that they had been instructed on not sending any bills outside of my copay to me directly, that they should be resolving it with the insurance. With this, I thought, it was all resolved...
Which brings me to today; I hold a letter dated April 19th, 2015; it is the second request for the billing resolution, and that they now have no option but to bill me directly.
I have already filed one complaint against their office. I am considering charges next.
They didn't seem too happy to be helping me. I had a complex partial spell in the office an I was never able to schedule another visit. They offered that a fax had to be sent to my neurologist and I tried three times to have it sent and every time on the claims it was sent and when I called they forgot my name and never sent the fax sometimes transferring me to a full mailbox when I called. I have two chipped teeth and at least two cavities and they won't even schedule my next appt. until the fax issue was resolved and there wasn't the hint of urgency to do that. Within 3 days I had an cleared appt. at a competitors place.
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