ComplaintsforWoodridge Family Dental, P.C.

• Initial Complaint

  03/25/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I received a bill in Jan 2023 for services rendered in 2021. This was the first time receiving a bill for these services and I was unaware there was still billing issues from this date. I have received 1 bill so far regarding this issue and that was in Jan 2023. Woodridge family dental has sent this claim to a collection agency saying I have owed them since 2021. They have not contacted me since Jan 2023 and I have not received any communication prior or after that date. This is completely unacceptable as I they have not even given me proper notification regarding this matter. The collection needs to be removed immediately.

  

  Business response

  03/29/2023

   
  The Complaint is from a patient who has been at our practice since 2015 with her family members .They moved to a different dentist sometime in 2021.
  The Current balance of $788.22 Is due to claims from Date of Service in March and April of 2021 for multiple family members.
  Due to the ************** patient has, the claims kept getting processed under a wrong provider by the insurance company and we went back and forth getting that fixed .
  We wanted to make sure the claims were processed correctly before closing the claim and billing the patient.
   
   
  The way her insurance works ,Instead of us receiving the payment for the services rendered at our practice , ********************* sent the payment directly to the subscriber ( Patient ) and it was her obligation to return that payment to us or at least question why and how she received the payment from an insurance company..
  But the subscriber /Patient never called our office to inform or enquire about the check she received on our behalf, nor did she return the payment to us or to the insurance company back .
  Below is the timeline in short for your reference and attached is the detailed Account reports only from 2020-current where you can see detailed account notes , insurance company notes to support our timeline and reason we have sent the patient to the collections.
   
   
  Date of service- March and April 2021
  11/15/2021- Ins paid but under wrong provider .
  12/01/2021 Called and LM for the patient to call regarding the account.
  12/08/21- We refunded the amount back to the ins to reprocess the claim correctly .
  From Jan Nov we were working with the insurance company to process the claim correctly so we can close the claim and bill patient right amount.
  11/14/2022 We received a $0 payment for all the services from the insurance company.
  12/30/2022- we called patient about the payment she received from the insurance and she said she would check her bank account and call us back.
  01/05/2023 PT was called and LM,
  -01/12/2023 LM again for the patient in regards to the balance
  01/21/2023 Statement sent .
  02/09/23 Pts accounts was turned over to collections.
   
   
  As you see above and by the attached Account reports , Pt was aware of the balance since Dec 2022 and probably way before when she first received the check from the ***************** that she had to hand over to us and she did not.
  We would like to request that you withdraw this complaint and request Subscriber/Patient to render the payments due of $788.22 to our practice immediately .
   
  Attached is the Account report with notes, we can provide account reports dating prior years from 2020 if needed along with any more information .
   
  Thanking You ,
  Sincerely ,
  ******************* .
  WoodridgeFamilyDental.
  ***********************************

  Customer response

  04/03/2023

   I just spoke with the insurance company and the reason that they did not pay you directly was due to the fact that not all your providers are in network. This is supposed to be explained at the time of visit. Benefits are ran before the appointments so your office was aware that these providers were out of network. I was never informed of this. Why was 4 of our appointments out of network but 1 was in network? When I receive checks from the insurance company they do not tell me who they are for. There could be a multitude of reasons I receive an insurance check. As you stated I had dual insurances and was never informed of any provider being out of network. How could I ever expect to receive a bill 2 years later? I was also never informed there was a bill pending from your office. 

  The insurance company did state they had sent the checks to my house, as to which I received them this year in 2023. To assume I knew about this or kept the checks is completely ridiculous as you are business and should know better. If your office did what they were supposed to do from the beginning, which was to notify myself that your providers were out of network, none of this would have happened. 

  You did not do your job correctly from the very beginning. You did not notify me that there was pending transactions, you assumed I had received the checks and kept them, then you sent me to collections without even giving me 30 days to find out what was going on and pay the bill. 

  The insurance company is sending documents by mail to show that the checks were just received this year. The bill will be paid but I am not removing my complaint due to the negligence of your office. Next time do your due diligence and gather  the facts before assuming and sending someone to collections and potentially ruining  their credit, especially when this was through no fault of your own. 
  Complaint: 19852143
  
  I am rejecting this response because:
  
  Sincerely,
  
  ***************************

  

  Business response

  04/06/2023

  TO WHOM IT MAY CONCERN:

  In Regards to the complaint **********

   

  Our reply is below in red(*) to address concerns one by one :

   

  I just spoke with the insurance company and the reason that they did not pay you directly was due to the fact that not all your providers are in network. This is supposed to be explained at the time of visit. Benefits are ran before the appointments so your office was aware that these providers were out of network. I was never informed of this. Why was 4 of our appointments out of network but 1 was in network? When I receive checks from the insurance company they do not tell me who they are for. There could be a multitude of reasons I receive an insurance check. As you stated I had dual insurances and was never informed of any provider being out of network. How could I ever expect to receive a bill 2 years later? I was also never informed there was a bill pending from your office.

  *Please be advised that this isnt a bill from our office to you. This is the payment from the insurance company for our services provided to you that you received on our behalf for the claim our office processed . We were not aware you would be receiving payment; would we have known we could have rescheduled your appointment or collected payment upfront. The first time we contacted you to go over your account was 12/01/21 and we did not receive a response from you.

  We are only asking that you return the money the insurance company sent to you for our services. If you received a check from the insurance company and was not sure what it was for and why you got it , you could have called the insurance company then to ask them or called our office.*

  The insurance company did state they had sent the checks to my house, as to which I received them this year in 2023. To assume I knew about this or kept the checks is completely ridiculous as you are business and should know better. If your office did what they were supposed to do from the beginning, which was to notify myself that your providers were out of network, none of this would have happened.

  *We did not assume you had the check , hence we called you in December to ask if you received it and to go over the account and you said you would check your bank and let us know. If you would have contacted us or the insurance company upon receiving the check in ******** we could have explained to you, and this could have been avoided.  Payments for out of network claims are also mailed to providers directly, they are not always mailed to patients. When we verify the insurances, we are not informed that checks will go to the customers straight..*

  You did not do your job correctly from the very beginning. You did not notify me that there was pending transactions, you assumed I had received the checks and kept them, then you sent me to collections without even giving me 30 days to find out what was going on and pay the bill.

  *There were no pending transactions. If we did our job incorrectly, when received payment from the insurance company under the wrong provider we would have kept the initial payment and not returned it back to the insurance to get that fixed and wait longer to get paid. We tried contacting you as soon as we obtained information from the insurance on 12/01/21.  Once we knew the claims were processed correctly (Dec2022) and payment was sent to you, we contacted you without a successful response therefore we had no option but to send you to collections..*

  The insurance company is sending documents by mail to show that the checks were just received this year. The bill will be paid but I am not removing my complaint due to the negligence of your office. Next time do your due diligence and gather  the facts before assuming and sending someone to collections and potentially ruining  their credit, especially when this was through no fault of your own.

  *We are sorry that this had a negative outcome, but this is the reason we contacted you in Dec 2022 and you said you would check and let us know. In ******** our office tried reaching you 3 times regarding the payment and since there was no response from you, we had no other option but to send your accounts to collections.*

   

   

  Thank you ,

  ******************* .

  WoodridgeFamilyDental.

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩