Complaints

• Initial Complaint

  08/22/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I am having trouble with the accounting at ************************************************** office. I believe I am due a refund or credit in the amount of $146.74 for service on the date of 9/17. According to the benefit statements I've received from my primary and secondary dental insurance companies, the contracted or eligible amount for those services is $1,248.06, my primary insurance paid $674.80 on claims related to those services, and my secondary insurance paid $349 on claims related to those services. When you add in the $371 I paid out of pocket, that means they were paid a total of $674.80 + $349 + $371 = $1,394.80. That's an overpayment of $146.74 beyond the contracted amount of $1,248.06.They may say that I still owe them for services on 9/15, but if so, I believe the balance owed for service on that date is only $13.09. According to the benefit statements I've received from my primary and secondary dental insurance companies, the contracted or eligible amount for services on that date is $87.89, my primary insurance paid $24.80 on claims related to those services, and my secondary insurance paid $50 on claims related to those services. That means the balance due for those services is $87.89 - $24.80 - $50 = $13.09.So the overpayment for 9/17 more than makes up for any balance owed for services on 9/15, and I am due at least $146.74 - $13.09 = $133.65.I would like some help obtaining the refund I am owed from *****************************

  Business response

  09/02/2022

  To Whom it may concern,
  ***************** was seen in our office for a root canal evaluation and treatment in 2021. After her insurances processed the dental claims her patient portion was $420.60.
  **** paid a total of $402 ($31 on 9/15/2021 and $371 on 11/3/21) which left a balance of $18.20.
  **** has two insurances. Her primary insurance is ************* and her secondary is Ameritas. Based on the information that we received from her secondary insurance on multiple occasions for clarification (Representative Melody September 2021, ******* June2022 and ************** September 2022) ***** plan is a non-coordinating plan (not a standard plan), which means we need to follow her primary insurance allowed fees and not the secondary Insurance fee schedule. **** wants us to follow her secondary Insurance fee schedule,however, because her secondary insurance plan is a non-coordinating plan, we must follow the fees schedule of her primary Insurance. This is where the discrepancy lies and **** does not understand. I have tried to explain this to **** on multiple occasions over the past year, via phone calls and emails. Whatever the secondary insurance paid was apply to her patient responsibility from the primary insurance. Our office processed ***** account based on this information that was provided from her secondary insurance. We dont have control over or say in how the insurance is processed. We have to and have abided to the rules and regulations set forth by the two insurances. As a reference you may contact claim representative ************** of Ameritas at ************************ reference #****.
  Attached her Insurance EOBs with her patient ledger that shows the amount that **** paid and what her insurances paid.
  Please let us know if you need any additional information.
  Roula.E
  Billing specialist at
  Endodontics Limited
  338 ************
  ********, ** 97230
  PH#************
  .

  Customer response

  09/13/2022

  But there is no insurance is primary or secondary. both are their own that was i told. but they needed one of them, so i told any of them u can put primary or secondary. so whichever eligible lowest, that calculates. that wat physicians Mutual has lowest eligible **** that s/b use to calculate
  

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