The Raven

The Raven

Thursday, August 26, 2010

Your Medical Billing Complaint Here

Since the doctors have the privilege of submitting their so-called unpaid or late bills to a pack of collection hyneas before anything is actually adjudicated, why not let us have the public view the patients's side of the story since we are not hyneas, just sheep!

Just send your problem to whether you reside in Singapore or Phoenix, London or Montreal, Tel Aviv or Brooklyn, Coney Island or Fifth Avenue, etc...

Here is one for openers on guess who? Dr. Kootman

My husband went here to have an impacted wisdom tooth removed. Dr. Kootman was one of 2 oral surgeons on our plan. When I called for an appointment, the office manager informed me he was the only oral surgeon on our plan and quoted me a price of $546.00 on our dental plan. Well, an impacted tooth is covered under medical. Our copay was $25.00. She said, oh yes, well the price will be $137.00. I questioned her and she gave me a litany of resons why we had to pay all these extras even though they are contracted with out HMO. She said we had to pay for medication and anesthesia etc. Having worked in insurance, I know that these items are covered as part of the procedure and it also stated such in our plan book. The insurance company agreed with me and even called the provider more than once and the provider told them to read their contract and hung up. Finally, after the procedure, I sent in my receipts to the HMO and was reimbursed the extra I had paid by the HMO. The doctor continued to balance bill me until the insurance company called them and told them they would be flagged and the contract possibly revoked. The doctor himself hung up, but later called back and agreed I was correct. The insurance company told me I was not the first with this issue with this provider. Also, the dental board told me the same thing. This provider tried to strong arm us into paying money we didn't owe and had a history of doing such. It was clear they knew what they were doing. If you ever have to see this provider, make sure they are following your insurance contract and if they don't, call your insurance company right away.

PROS: they didn't commit malpractice

CONS: very dishonest billing practices

Here is another complaint:

★☆☆☆☆ Dental Rip Off!

Anonymous 1 Windsor Jean - Valley Oral Maxillofacial Sug

My foster daughter recently transferred to an art school in Arizona. Her mouth swelled up and she sought dental care. When the office was asked for a quote, they scribbled some information on a piece of paper and then told my daughter it would be $800 for her share of the bill. My insurance covers up to $1,000, so I was quite suspicious. The quote was for a root canal, but it they ended up doing an extraction.

I watched for the insurance claims to clear. In the end, there were a total of three claims totalling $1430. The insurance I have does have a contract with Dr. Kootman and discounted the claim for a little over $500. Here's the kicker though, my daughter's portion of the charges as per our insurance was to be $195.20. That's 20% of what was covered plus the $50 deductible.

I contacted Dr. Kootman's office and left a message with no response. When I finally got through, I was placed on hold for 10 minutes. I finally was so irritated I just asked for a fax nunber and faxed them a letter stating they had over charged my daughter and that they owed her a refund of $600 on her credit card that she used to pay for the services.

I asked for a response, but to date, no response has been given. I can only assume at this point that this is the dental office general practice in billing and that it will likely take a trip to court to recover the fees. It looks as if they have billed my daughter for the portion of the bill that the insurance did not pay due to the fact that it was over the amount charged for their contracted fee. That is not legal and they could lose their contract with the dental office.

I am hoping for a good resolution to this, but am doubtful that they will make this right. If you live in Arizona, stay away from this guy. My insurance carrier told me that they are always discounting his fees to the contracted amount and that those fees are typically high. See someone else if you need dental care in Phoenix.

I wrote an essay on these complaints and Kootman's response to them but it did not come through. I will save it for another time.
Jordan Richman

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