Business ProfileforNorthwest Arkansas Oral & Maxillofacial Surgery, PLLC

The surgeon (Dr. Aneet Sharma) who performed the surgery did a wonderful job. This is not a review of his skills, rather it is a review of the office overall. Doctors don't realize the front office staff can make or break a practice and this is the WORST front office I have ever dealt with. This office staff refused to call our insurance company to verify coverage, even though this office is a BC/BS Preferred Provider!!! Because of this, I called BC/BS and discovered that every one of the billing/service codes were active and would be paid. I then provided the office with a Reference number for them to follow up. Did they? NO. We arrived the day of surgery and they demanded full payment before they would do the surgery. I demanded they call BC/BS right then and verify coverage. After a 20 minute phone call, they said they were going to have to file a form to complete the coverage estimate... so I still had to pay the full amount. Feeling over a barrel, we paid. $3169.00. After filing the insurance, the EOB came to us and said the office was a Preferred Provider and BY LAW they have to accept what BC/BS pays. The EOB said we owe $0.00. Which means this office owes us $3169.00. Hmmmm The surgery was 07/01/2021. They were paid by BC/BS by the 28th of July. It is now October 7 , 2021 and the Northwest Arkansas Oral & Maxillofacial Surgery office is STILL holding our money. So, to date... they have received $1250-ish OVER the price of the procedure. Pretty good return. We are preparing letters to the Arkansas State Medical Board, Denise Gardner (our state representative) and the Northwest Arkansas Times. Hopefully, something will spur this office to return our money.

Thank you for your review. We apologize that you had a negative experience; however we would like to clear up some discrepancies that were provided.

As a courtesy to our patients we contact and file insurance. Our front office strives to go above and beyond to provide the most accurate and up to date information for each of our patients based on their individual policies and are often times recognized for their friendly personalities.

With your specific policy we were informed that BCBS was secondary to Medicare, which we cannot file since we are opt out providers for Medicare. With this being said, typically if a policy is secondary to Medicare, the secondary policy will not process a claim without the primary EOB in hand, which would be unattainable for us.

When we contacted your BCBS insurance the representative we spoke to was unable to provide us with the coverage for your necessary treatment, leaving us no possible way of estimating what we thought your insurance would pay. This is why you were required to pay what we knew your dental insurance would not cover; not the full payment for all of your treatment. The portion we collect for all patients' is deductible (if not already satisfied), co-insurance, and any codes that are not covered by your individual policy.

After treatment has been completed, claims are submitted to insurance. Insurance companies typically say the turnaround processing time is 30 business days; however it is out of our control as a provider for how long it might take your insurance to process and finalize your claim. When multiple insurances are involved this can typically take longer.

Your claim was submitted to your BCBS insurance on 7/1/21. BCBS did pay a portion of this claim, which was received on 8/3/21; however 3 of the incurred charges were not processed correctly. (Please note even though you might have received your EOB on 7/28/21, we had not received our EOB nor had the insurance payment cleared the bank until 8/3/21). Since 3 charges processed incorrectly, we reached out to your insurance on the backend to make sure the claim was processed and paid correctly for the services rendered. Your insurance was working to get this claim to reprocess on the codes that processed incorrectly, again informing us that this process can take up to 30 business days.

We received multiple phone calls from you where we made our best efforts to explain the status of your claim as well as informing you that insurance was still processing. At this point your claim has not even been submitted to your dental insurance since your BCBS was still correcting the claim.

After multiple calls to your BCBS insurance, it was determined that we needed to submit a corrected claim for the completed treatment. You were notified on 9/13/21 that this information was sent and to allow 30 business days for review and reprocessing. You were also informed that our provider representative was involved, assisting with the claim reprocessing.

On 10/8/21 an additional payment from BCBS was received and a refund check for over payment was generated to you. We apologize if your claim was not processed more efficiently for you, but unfortunately it does take time when dealing with insurance.

Thank you for your review. We apologize that you had a negative experience; however we would like to clear up some discrepancies that were provided.

As a courtesy to our patients we contact and file insurance. Our front office strives to go above and beyond to provide the most accurate and up to date information for each of our patients based on their individual policies and are often times recognized for their friendly personalities.

With your specific policy we were informed that BCBS was secondary to Medicare, which we cannot file since we are opt out providers for Medicare. With this being said, typically if a policy is secondary to Medicare, the secondary policy will not process a claim without the primary EOB in hand, which would be unattainable for us.

When we contacted your BCBS insurance the representative we spoke to was unable to provide us with the coverage for your necessary treatment, leaving us no possible way of estimating what we thought your insurance would pay. This is why you were required to pay what we knew your dental insurance would not cover; not the full payment for all of your treatment. The portion we collect for all patients' is deductible (if not already satisfied), co-insurance, and any codes that are not covered by your individual policy.

After treatment has been completed, claims are submitted to insurance. Insurance companies typically say the turnaround processing time is 30 business days; however it is out of our control as a provider for how long it might take your insurance to process and finalize your claim. When multiple insurances are involved this can typically take longer.

Your claim was submitted to your BCBS insurance on 7/1/21. BCBS did pay a portion of this claim, which was received on 8/3/21; however 3 of the incurred charges were not processed correctly. (Please note even though you might have received your EOB on 7/28/21, we had not received our EOB nor had the insurance payment cleared the bank until 8/3/21). Since 3 charges processed incorrectly, we reached out to your insurance on the backend to make sure the claim was processed and paid correctly for the services rendered. Your insurance was working to get this claim to reprocess on the codes that processed incorrectly, again informing us that this process can take up to 30 business days.

We received multiple phone calls from you where we made our best efforts to explain the status of your claim as well as informing you that insurance was still processing. At this point your claim has not even been submitted to your dental insurance since your BCBS was still correcting the claim.

After multiple calls to your BCBS insurance, it was determined that we needed to submit a corrected claim for the completed treatment. You were notified on 9/13/21 that this information was sent and to allow 30 business days for review and reprocessing. You were also informed that our provider representative was involved, assisting with the claim reprocessing.

On 10/8/21 an additional payment from BCBS was received and a refund check for over payment was generated to you. We apologize if your claim was not processed more efficiently for you, but unfortunately it does take time when dealing with insurance.

The comment from NWA-OMS concerning our insurance and Medicare would be correct if we had a gap policy for Medicare. We do not. We still carry a full-fledged insurance policy with Federal Blue Cross/Blue Shield. Therefore, they were quite free to file it independently of Medicare. We told the office that at the time. And, again... when they insisted on only filing with our Dental Insurance, which we told them up front it would not pay on this type of procedure and that our Medical insurance (Federal Blue Cross/Blue Shield) would pay... I called BC/BS myself and verified the procedure codes and provided NWA-OMS with a Reference Number to call BC/BS. We also told them 9 months before the surgery they would be required by BC/BS to file an Advanced Benefit Determination. Which is why on the day of surgery when we discovered they had not called BC/BS or filed an Advanced Benefit Determination, I demanded Shelley call right then. What did she discover when she called? The office had to file an Advanced Benefit Determination!!

The biggest problem with their entire comment is that NWA-OMS is a Preferred Provider for Blue Cross/Blue Shield. This is their statement in their paperwork:

"WE ARE PROVIDERS OF ARKANSAS BLUE CROSS/BLUE SHIELD AND DELTA DENTAL INSURANCE. YOUR INSURANCE IS A CONTRACT BETWEEN YOUR EMPLOYER AND THE INSURANCE COMPANY. BENEFITS ARE BASED ON THE TERMS OF THE CONTRACT THEY NEGOTIATED FOR YOU. PLEASE PRESENT YOUR INSURANCE CARD TO US AT YOUR FIRST VISIT, AND WE WILL VERIFY YOUR ELIGIBILITY AND BENEFITS. WE WILL PROVIDE YOU WITH AN ESTIMATE OF YOUR INSURANCE COVERAGE."

Did they do this? No. Did they do this when I provided them a reference number? No. We knew our benefits before we ever walked through their door.

As Preferred Providers, they have a contract with BC/BS and they are required to abide by the contract they have with the insurance company. This is part of their contract that was on our EOB from BC/BS:
"BECAUSE YOUR PROVIDER HAS A CONTRACTUAL AGREEMENT WITH YOUR PLAN, YOU ARE NOT RESPONSIBLE FOR THE DIFFERENCE BETWEEN THE SUBMITTED CHARGES AND OUR ALLOIWABLE CHARGES."
So, as soon as they received the EOB, they knew it didn't matter what our insurance paid. They knew they would have to accept it. They knew this by their own comment on 08/03/2021. They knew they owed us all or most of the $3169.00. Because at that point, the balance due was not between us and them. It was between Blue Cross/Blue Shield and them. At that point, they should have refunded our money, but the did not.

Their final statement that on 10/08/2021 an additional payment was received from BC/BS and then they sent the refund check? Guess what? The additional payment to them from BC/BS did not change the amount they owed us. What they owed us on 08/03/2021, they owed us on 10/08/2021.

Most of the comment from the NWS-OMS is exactly what we have been fed since the beginning. A whole bunch of runaround. I'm just afraid they have treated other people the same way.