ComplaintsforTMJ & Orofacial Pain Treatment Centers

• Initial Complaint

  05/29/2024

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  My wife needed a mouth guard for tmj issues. We went to tmj & orofacial pain treatment centers of Wisconsin our visits were covered by our insurance. We were informed that her mouth piece was $1200 and will need to be paid for out of pocket if not covered by insurance. After receiving pre approval from our insurance it was determined that the billing department never reached out to insurance for approval so I had to call myself. We then received an email directly from the tmj billing department saying the mouth piece was approved and covered by our insurance. So we went in for our next appointment to pick up mouth piece to which the billing manager **** stated we must pay out of pocket because they dont like dealing with insurance. This was not what they told us via the email they sent saying the mouth piece was covered. The billing manager **** was extremely rude and yelled at both myself and wife saying its not her responsibility to handle insurance issues. This was after we had already received pre approval for the mouth piece. After stating I would file a complaint with BBB she stated they will not be Threatened to which I told her Im not threatening her Im stating they are not following what they had told us in the email. I would be happy to also provide all written documentation about this issue.

  Business response

  06/17/2024

  Better Business Bureau
  Attention: ****************
  Re: Complaint # ********
  
  
  Dear ********************,
  
  We are in receipt of a complaint letter from *****************************************.  Thank you for giving us an opportunity to comment on this matter.
  
  Our office verifies insurance benefits as a courtesy to the patient.  Per BCBS of IL policy TMJ/TMD non-surgical appliance is listed under benefit exclusions: Treatment of temporomandibular joint syndrome with intraoral prosthetic devices or any other method which alters vertical dimension..  Our office did advise patient and her spouse of no splint coverage on 4/17/2024.  *********** policy, as of the beginning of this year, has been updated to reflect no splint coverage for BCBS of IL.  Our office did offer discounted rate to the patient for the appliance.  However, patient spouse insisted we submit prior authorization request to his insurance for coverage.  BCBS of IL did approve services, however, it is also stated in the letter Approval does not guarantee payment. 
  
  The BCBS insurance representatives have confirmed that there is no coverage for TMJ/TMD splint through BCBS of IL.  Our office, including manager, have tried to explain this matter to the patient and her spouse.  The patient did proceed with the services and has paid the discounted price at the time of visit. 
  
  
  If there are any additional questions please do not hesitate to contact us.
  
  
  Sincerely,
  
  TMJ & Orofacial Pain Treatment Centers of WI
  
  
  
  
  
  
  
  Enc: Temporomandibular Joint Disorder (TMD) BCBSIL Policy

  Customer response

  06/17/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
  
  My biggest concerns with the response received are first, they fail to address the issue of the unprofessional attitude of the billing manager ****. Secondly they state that they spoke to an insurance agent who stated the mouth piece was not covered. I have personally spoken to my insurance rep who has guided us through the process to get reimbursed for the cost of the mouth piece. Also informing us that we will be reimbursed directly through our insurance. There is a difference between telling the patient their insurance WILL NOT cover the mouth piece and telling the patient that the billing department is refusing to accept the insurance. Had it been explained from the beginning the office chooses to not accept the insurance rather than stating the patients insurance doesnt cover the mouth piece, this entire issue wouldve been avoided and we wouldve gone directly through our own insurance for reimbursement. The patient should be made aware of your new policy to not accept BCBS for your reasons stated rather than falsely stating the mouth piece is not covered. The reimbursement process takes anywhere from 6-8 weeks but Ill be glad to provide proof that our insurance covered the cost and has reimbursed us when it becomes available.
  
  Regards,
  
  *************************************

• Initial Complaint

  06/08/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I went to **************************** Treatment Centers of Wisconsin on 11/09/21 because my existing splint for TMJ had cracked. The doctor discussed different options and I discussed with him that cost would be a factor in my decision. He recommended a replacement splint. I asked on several occasions how much it would cost, and was told my insurance would cover all but $250. This was more than I wanted to spend, but I agreed to it and paid. After receiving the splint, I got a **** for an additional $925.38. The billing office told me my insurance only covered part of the submitted amount. I was also told they never provide definite amounts to patients even though they had told me on two occasions that my cost would be $250. They told me I should have confirmed with my insurance, which in retrospect I should have done. I had never had an issue with this office before, and had no reason not to believe them when they told me an amount. I then asked the billing office about a payment plan, and was told repeatedly they cannot reduce the amount owed. I left a voicemail for the billing supervisor to discuss. I never received a return call, but instead got a printout in the mail of the charges. At my next appointment with the doctor, he recommended physical therapy. I told him I was not going to do that because last time I agreed to something (the splint), I ended up being billed over $900 more than I was told, which I cannot afford. He was actually helpful and got the billing manager to speak with me. She told me they do have a payment plan option for 3 months. She also recommended applying for a card with Care Credit. I told her I cannot apply for a new credit card while applying for a mortgage, she told me it didn't impact my credit, which I found out is false. I feel that when a patient is concerned about cost, the business should share the full amount they may have to pay, not a low amount so they agree to the procedure. When an issue arises, they should work with the patient.

  Business response

  06/14/2022

  Better Business Bureau
  Attention: *************************
  Re: ID ********
  
  Dear *******************,
  
  We are in receipt of a complaint letter from *************************.  Thank you for giving us an opportunity to comment on this matter.
  
  Our office verifies insurance ******** as a courtesy to the patient.  However, we highly encourage our patients to inquire about the same with their insurance company.  On 11/03/2021 our representative verified ******** online through WEA where it stated that they cover non-surgical TMJ/TMD (Temporomandibular joint disorder).  Based on the coverage information from the insurance company our office calculated the estimated amount due based on our allowable amount and patients co-insurance amount.  However, we provided patient with an estimated amount insurance company makes the decision on patient responsibility amount based on ********.  Our office submitted prior authorization request to insurance on 11/23/2021, as required per patients plan, for coverage of TMJ/TMD appliance.  On 12/6/2021 we received approval from insurance for the appliance and patient proceeded with services on 12/23/21.  Insurance processed claim towards *** benefit with $1,114.60 as patient responsibility and they paid $535.40.   Currently the outstanding balance is $925.38 after insurance processed claim for x-ray and TMJ appliance.
  
  Our office did provide patient with few payment plan options and we havent heard back from **************.  The patient has an option to appeal *** ******** with insurance if she disagrees with how they processed claim for TMJ appliance.
  
  If there are any additional questions please do not hesitate to contact us.
  
  
  Sincerely,
  
  
  ************
  AR Manager
  
  
  
  
  Enc: Explanation of Benefits for X-Ray and TMJ Appliance
  Tell us why here...

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