ComplaintsforPatricia Berube, DMD, MS

• Initial Complaint

  08/14/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  Dental procedure was performed on 6/28/2021.Incorrect claim code was sent by *** Berube's to **************************** Initially it was paid by insurance on 8/5/2021 and we paid the remaining balance. In January 2022, ****** did a pay reversal for a claim number error on the billing. *********************************** reached out to us for payment and after MANY calls, emails and conversations with both the dr.s office and insurance company, United explained on 4/7/2022 that *********************************** simply needed to re-file with the correct claim codes and the claims would be paid! They have since refused to re-file and now in Jan 2024 turned us into collections for the amount that was due from insurance because of their filing error. They are not willing to work with us and no longer answering my phone calls or emails to resolve.

  Customer response

  08/14/2024

  Email response from the doctor on 8/14/2024.

  Good Afternoon,
  
  Your account has been turned over to collections as of January this year. We tried many times (almost weekly) to reach out to you in 2022 but there was no resolution. We even received our certified letter back that was sent. We made a few more attempts via email and regular mail last year and when we had spoken on the phone, you had told us not to call you anymore. There is still a balance of $1263.48 on the account from her procedure that was done in June of 2021. I apologize for not returning your call but once you are sent to collections, it is out of our hands.
  
  Thank you,
  
  Patient Care Coordinator
  ******** *.
  
  Dr. Patricia Berube
  

  Business response

  09/17/2024

  Please see attached:
  1) Office policy signed 6/3/21 at the first visit stating that they are financially responsible for their account, regardless of what insurance pays. We cannot guarantee payment from insurance. We also ask that if they have financial issues, to communicate with us. See Office policy item 1 (one page).
  2) Consult signed on 6/3/21 with the costs of treatment. It clearly again states that the estimate is not a guarantee of payment by the insurance company and if the insurance company does not pay what is expected, the balance on the account is their financial responsibility. See item 2 and 2.1 (two pages).
  3) See claim, item 3 (one page) for date of service on 6/8/21. The items were submitted as they are required, ie the first tooth is at 4273 and each additional tooth in the quadrant is 4283. This is the case with every insurance plan.
  4) See item 4 for a summary of events that occurred. You can clearly see that we submitted the claim, resubmitted the claim (8/17/21) and they were denied. The insurance then requested payment back and our office because we felt this was a mistake (11/30/21). On 12/6/21 the insurance started taking money back by pulling from other claims, even though the claim is under review (we are not sure how an insurance company is allowed to do that, which is another issue). We continued to try to have this claim paid in 12/21. Keep in mind the date of service was six months prior and my office continued to work on his behalf. We spoke with **** and told him what was happening with HIS insurance company and sent another statement.  You can continue to read this summary, but I have added all the progress notes to show how many entries my staff has made regarding this claim, including reaching out to the patients husband. You can see on 5/25/22 that he threatened a lawyer if we reached out for payment (see page 15). See pages 5-23 for further documentation.
  
  The amount of time that my staff (and now myself) has spent on their behalf is ************ is very black and white. If someone has treatment, they are responsible for the cost, regardless of their insurance policy. We file these claims as a courtesy to our patients, however, it is never a guarantee of payment as every company has their own rules. Their grievance should be with their insurance company or with their human resources department on their behalf. This case shouldnt have gone on as long as it has . Final payment should have been made three months after service was rendered in 2021. His complaint is without merit. And Im appalled that three years later we are still discussing this. It is situations like this which causes very good dentists to no longer accept insurance and ask for payment in full prior to the procedure being performed.

  Customer response

  09/21/2024

  I am rejecting this response because:

  - The patient balance was paid in full in a timely manner, resolved in November of 2021. 

  - The business failed to follow through in a timely manner with the insurance company, or offer to conference in the responsible parties to resolve the issue solely between the office and the insurance provider. 

  - The business did not negotiate (at least not effectively) on the patients behalf to the insurance provider. 

  - ********** is asserting charges that do not relate directly to any services provided, and charging for payment values withheld for other clients, not sure if this is even legal. 

  Collections had to be involved. The money is not the concern, it is a matter of principle and a doctor's oath to act in good faith for the patient. 

  I will not be recommending this business to anyone. 

  JW

  Business response

  09/23/2024

  Please see attached responses based on remarks made by the patient's husband.

  
  
  - Claim: The patient balance was paid in full in a timely manner, resolved in November of 2021. 

  This is correct. See below:
  6/3/21: $110 was paid by patient first visit
  6/25/21: $110 reimbursed by insurance, therefore a credit of $110
  6/21/21: $300 deposit for the procedure
  6/28/21: $165.80 paid by patient
  8/17/21: $1205.60 paid by insurance
  11/11/21: $347.60 paid by patient
  Total payment:$2129

  
  What happened next is the problem. The insurance company then deducted what they paid from the patients account. Please see pages 13 ($131.60), Page 14 ($13.60), Page 15 ($140) and Page 16 ($907.20). They issued pay reversals on their treatment.This is not a customary thing for insurance to do, but they did in this case.Because of these charge reversals, the balance was then put back on the patient. I will reiterate again, this was the insurance companys decision, not ours.

  
  - Claim: The business failed to follow through in a timely manner with the insurance company, or offer to conference in the responsible parties to resolve the issue solely between the office and the insurance provider. 

  
  This is incorrect.Please see all attached copies, including prior submissions. You can see that we followed up multiple times with the insurance company on their behalf. I want to repeat that the insurance contract is a contract between the patient and the insurance company. We are a third party. Our role to send in claims,make calls and resubmit claims are a courtesy. After the first resubmission, it is reasonable, per our contract with the patient, for a patient to pay us in full if the insurance is not paying the claim. The contract between the patient and I states that the balance should be paid in full by 60 days. It was not paid in full until five months later in November after a date of service in June 2021.

  
  - Claim: The business did not negotiate (at least not effectively) on the patients behalf to the insurance provider.

  
  This is incorrect.We cannot negotiate with the insurance company. This is a contract between the patient and their insurance company.

  
  - Claim: The office is asserting charges that do not relate directly to any services provided, and charging for payment values withheld for other clients, not sure if this is even legal. 
  This is incorrect.The patient was only charged for the date of service on 6/28/21 and then had to be charged back when the insurance removed those funds from that patient account. The patients grievance should be with their insurance company, as they paid and then took the money back.

  
  -Claim: Collections had to be involved. The money is not the concern, it is a matter of principle and a doctor's oath to act in good faith for the patient.

  
  The patients husband has asserted from the beginning that we have not worked on their behalf, which is false. We are a small business and have spent countless hours on their claim. The patients husband seems to think that we deliberately sent the wrong codes, never resubmitted the claims, charged them for items that were wrong, etc. However, you can see from the documentation set forth, that our office was reacting to the actions of their insurance company. If he believes that we enjoy dealing with insurance that pays the claim and then takes it back, he is sorely mistaken.

  
  We are both the victims here, yet somehow he is choosing to continue saying this is our fault. I understand that hes upset, but hes upset at the wrong person/entity. To say that I am in breach of my doctors oath is not only misguided, but very hurtful. I try my best to provide great care and my staff has diligently followed up on this matter, when most offices would have stopped after the first letter to pay this balance (which was in January 2022, 6 months after the date of treatment). We removed all interest fees accrued. A year after treatment, and with the balance still unpaid, and after resubmitting the claim yet again in April 2022, we offered 10% off.  We finally sent the account to collections, as this account is over three years old and we had tried multiple times with multiple letters and calls to get this paid by the patient. Even if this money is collected, it is well below the original amount and we are out countless hours of time. Again, look at pages 13-16.

  
  -Claim: I will not be recommending this business to anyone. 

  
  Again, to be blamed for actions by the insurance company is very frustrating. We are a small business trying to go up against a large insurance company and have no power over them. Y

  I have been in practice almost 20 years and have never seen anything like this. On the rare occasion that a patient has an issue with their insurance company, the patient understands that it is their responsibility to pay for the treatment rendered. The patient should be filing a complaint with their insurance company.This complaint against my office is unfair (in my opinion).
  
  Dr. Patricia Berube

  Customer response

  09/23/2024

  I have reviewed the business response and accept this resolution. 

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