Thursday, May 27, 2010

I Have Issues!

Remember, how I told you that we were going to get a refund from Anna's wisdom teeth? So I called and yes, they(the oral surgeon's office) said that they had been paid by us, our dental insurance and our health insurance company. Hmmmmm, and now they won't send the money back. There were a few problems in the beginning that they were trying to straighten out. The dental insurance company wanted their money back and sent us a bill. Yeah, that was a fun call! I said why do I have to pay the bill and you too. They(dental insurance company) called the oral surgeon's office and said they worked it out. It doesn't feel worked out to me!
Anna had the surgery in January. They said in March that we would getting our money back and now we are pushing June. I feel like I don't have the right to complain because we were never supposed to get our money back in the first place. Our health insurance approved it afterward so we caught a break or so we thought. Any ideas of how to handle this one? I did call the oral surgeon's office a few times(very nicely, I might add) and they said that the woman that does the billing only does the bills in the middle of the month. So, we would have to wait for her to cut a check.
The transmission is going on Den's car and this would help quite a bit and not to mention paying for some college bills and tithing to the food pantry. But maybe, I'm spending money(well, hoping to spend) that really wasn't mine to begin with.
Any ideas,
SonyaAnn

15 comments:

Sheila said...

I would probably call and ask nicely again. Did your insurance company send you a letter stating that they paid they bill? Maybe you could copy it and send or take it to the oral surgeons office to show it was paid twice and you would like your refund.
Can't the office personnel leave a note for the billing person to call you back when she is in to do the billing? Also, I think if the oral surgeon was paid by you and the insurance company--even if it was approved later--you should receive the refund.
Good luck--I feel for you as I am going through almost the same thing right now for a mammogram I had last October!!

slugmama said...

Just trying to follow the chain of events here....so you paid the OS(oral surgeon)....then your dental insurer paid the OS and then your health insurer paid the OS?

Then the dental insurer reneged on the OS and when the OS wouldn't refund them the insurer's money the dental insurer sent you a bill(so them got their money back from someone) and that second bill meant you were going to pay twice?

Then dental insurer got their payment back from OS....so the OS was paid twice at this point(from you and health insurer)so the OS still owes 1 refund to either you or health insurer.
And now the OS is slow in refunding 1 of the 2 payments they received for the work, yours?

First thing is I would talk to the dental insurer directly and see exactly what happened between them and the OS...don't take the OS staff's word for what happened and when. You should have gotten an EOB(explanation of benefits) from your dental insurer...make sure what everyone is telling you matches up with what that statement lays out.
If that part of things is correct, call the health insurer directly and see when the OS was paid, etc. by them....did the health insurer send you an EOB too...they should have!

Have all your facts straight before you call the OS again and STOP being nice. Inform them in no uncertain terms that you are NOT pleased about them holding your money for x months. The staff sounds like a bunch of buffoons so I'd prolly just write a letter instead...maybe threaten legal action if they don't return the overpayment immediately.
At least inform them that you expect interest on the money they have kept illegally from you or you'll be seeing them in small claims court.

And next time, once the health insurer tells you they have agreed to pay, send them evidence that you already paid and get them to cut YOU a check directly for reimbursement.

I can't believe that a full fledged OS office ONLY has a billing person on site a few days in the middle of the month to take care of financial business.....someone is jerking your chain my dear. OS's don't sit around for weeks at a time NOT billing patients! Patients don't get billed, OS doesn't get paid, OS can't pay his/her Mercedes bill, country club bill, etc. I am sure they have someone there making CLAIMS for payment to the insurance companies at least weekly, if not daily!
If you have a lawyer friend, I'd have them write the OS on your behalf on their letterhead....that might be enough to get the OS off his ass and off your cash.
Maybe you can ask Donna(think media exposure=investigative reporter exposure)to give the OS office a call for you? ;-)
Good luck!!!

SonyaAnn said...

Sheila-I really don't know what to do with this one. I've paid, our health insurance paid and the dental insurance paid. The health insurance is the primary so they are the ones that should have paid in the beginning. The dental insurance has gotten a refund. We have not. I have all of the paper work and so do they. The girl in the office that was taking care of it verified it. They know they owe us and have admitted it. I just don't know where to go from here. I've tried everything that I can think of. My last resort would be to call a lawyer(we have a family friend that would probably do it for free) and see if he could give them a quick call.
So what have you done to get your money back from the mammogram? Maybe the newspaper would be a good way to put some pressure on them?
I love how we have to pay at the time of services but they don't have to give a refund at all! Even when they know that the money is owed us!

SonyaAnn said...

slugmama-"Just trying to follow the chain of events here....so you paid the OS(oral surgeon)....then your dental insurer paid the OS and then your health insurer paid the OS?" Yes in that order. I know that it is confusing!
"Then the dental insurer reneged on the OS and when the OS wouldn't refund them the insurer's money the dental insurer sent you a bill(so them got their money back from someone) and that second bill meant you were going to pay twice?"-Once the dental insurance found out that the health insurance(blue cross) paid they wanted their money back right then! The Oral surgeon really drug their feet. So the dental insurance went after us. They wanted their money and they didn't care who they were leaning on. The oral surgeon finally paid them but not us!
"Then dental insurer got their payment back from OS....so the OS was paid twice at this point(from you and health insurer)so the OS still owes 1 refund to either you or health insurer.
And now the OS is slow in refunding 1 of the 2 payments they received for the work, yours?"-We have been paying our health insurance and this is a procedure that they cover. We never should have had to pay in the first place. The problem was no one told us we could use our health insurance. It never dawned on me to use health insurance for her teeth. Our dentist and the oral surgeon dropped the ball!
"First thing is I would talk to the dental insurer directly and see exactly what happened between them and the OS...don't take the OS staff's word for what happened and when. You should have gotten an EOB(explanation of benefits) from your dental insurer...make sure what everyone is telling you matches up with what that statement lays out.
If that part of things is correct, call the health insurer directly and see when the OS was paid, etc. by them....did the health insurer send you an EOB too...they should have!"-I do have a copy of the EOB and when I called the OS the numbers matched up. And when I called the dental insurance company it matched up again. In the end, the OS said they owe us. I have all the paper work and the proof they just won't cut a check!
"someone is jerking your chain my dear. "-AGREED!
Big Dennis my FIL has a good friend that is a lawyer, I'll threaten first and then see if he won't do something.
If I owed them money do you think that they would wait!

SonyaAnn said...

I'm off to clean1!!!Have a great day!

Beth said...

I would keep calling until the dental office got tired of hearing from me. Why should you have to wait any longer for YOUR money?!

slugmama said...

Big Dennis the FIL....Big Dominick would sound more imposing...lol
I hope the OS sees things Big Dennis' way right quick! ;-)

I'm off to clean too....

Together We Save said...

That is a tough one but I think I would call the dentist office at least one one time!

SonyaAnn said...

Beth-I went back through my notes and the last time that I called was 10 days ago. I think I should call more often!

McVal said...

Shoot! That's too bad! I agree with Sheila. Call again and ask nicely again. And have all the documentation to back you up.

SonyaAnn said...

slugmama-I think Guido sounds better. That is what I call Den when I need him to clear a path through a crowd. He would be a great body guard. I asked him to do that at Anna's graduation and he said he wasn't in the mood cuz he was holding my purse!
Who's house are you clean?

SonyaAnn said...

Together We Save-I want to play nice but they are making it hard!

SonyaAnn said...

McVal-I try to be nice and then I blow my lid when I think that they have taken it too far. We shall see what happens next. At least, I'll have something to write about!

Frances said...

Sorry you are having to deal with this SonyaAnn.

Maybe you could try sending a letter to the oral surgeon himself. Send it certified, return receipt requested and mark it "confidential." Certified makes people think it is more important and marking it confidential may discourage the staff from opening it.

Lay out the details and let him know how dissatisfied you are with his billing practices. And demand that he make sure your refund is sent immediately. If he is not the owner of the practice, copy the owner as well.

Often, you need to just bypass the staff and get to someone in charge. Whose response is usually to tell his staff to make this issue go away. :-)

SonyaAnn said...

Frances-I called again and i was told that it is for sure in the mail. Hmmmmm, I think that I have sucker written on my forehead.
Good ideas, I think that is what I will do. I'll give them until Monday to see if the check really was in the mail and then do what you said and send a letter to the Oral surgeon.
Thank you for always being here for me!