Fairfax Oral and Maxillofacial Surgery

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: [redacted] I am not accepting this response because of the following: First of all, I appreciate the timely response from DrS [redacted] at Fairfax Oral and Maxillofacial Surgery I have several problems with this response which are not in congruence with my original complaintI should have been more specific in my initial complaint, I apologizeI was understandably (I hope) distressed at the time My complaint to the Revdex.com was made on August 16th DrS [redacted] is correct that I was advised FFX Oral is not a participant with [redacted] MedicalThis was indeed confirmed when I checked with a receptionist AFTER I received the bill in AugustNot beforeAt no point before was this made absolutely 100% clear to me My initial visit to the office to discuss surgery and payment was April 9th [redacted] wasn’t alone in not providing me with a ““straight answer””The billing specialist and receptionists at the time never specifically stated the difference in FFX Oral’s contracts when I asked No one really gave me a ““straight answer””I asked specifically for the billing folks to check out what the payment situation would be with [redacted] AFTER our proposal was agreed upon and no one never told me I would be paying well over the Payment Proposal figures My surgery was performed on May 24th The patient was not “advised that we are not a participant with [redacted] Medical.” It was implied, I suppose, but I only realize that after my surgery, after feeling 100% better without the pain in my head, after being blamed for not foreseeing all of this, and after I was made to pay $more than I thought I wouldAnd pay it I did -- out of good faith and after asking for help from a lot of people I did my share of research, probably more than most people, and carefully added and subtracted my way to understanding my bill on my ownDrS [redacted] did a good job of summarizing my payment proposal which I am still 100% aware of but as he is aware, it is not a guarantee of the end billBut having to pay over a thousand dollars over the estimated amount was just unreasonableBurdening me with this without offering to help me find a better solution and re-check the claim submissions with [redacted] even when I asked was unreasonableI'm going to go ahead and attach the bill and the numbers I have brought to ***'s attentionThe bill AND these numbers were allegedly my responsibility with no reason for review or assistance I also frankly don’t appreciate DrS [redacted] saying I should have been alerted “to a potential issue with the future claim” In fact, this should have alerted the office and [redacted] that they had some issues to work out amongst themselves before burdening me with the stress of an extra bill I had no business paying in fullAs someone with a diagnosed and treated mental illness AND considering I was in ridiculous pain at the time AND I was paying and asking FFX Oral to help me out with this specific issue, I find it ableist and condescendingHe has no business discussing what did and did not put pressure on me because he isn’t me and he was not in my situation I was under the impression that if I asked and made it clear that I wanted to know, that the office would inform me of any changes in my billThey didn’t, so I assumed I was okayI got my surgery done and focused on recovering which took me over a week due to the severity of my impacts and cyst sizes In addition, I was not offered an extended payment plan when I called to sort my bill out in AugustMichelle in billing told me I could pay half now and half before the bill of $was due on 8/20/in case I had worked something out with ***She was nice about it at least As stated in my initial complaint, Dr D [redacted] did a wonderful job on my surgeryI continue to give him and his surgical assistants kudosI’m just still disappointed in the service I was given preparing me for paying for the actual surgery costs and the way it was handled when it came time to draw more money out of meIt was lacking and I was not helped in the ways that I had asked to be helped Whether or not FFX Oral thinks my complaint has merit (of course they wouldn’t), if [redacted] decides to pay its share of my cyst removal it swore up and down it doesn’t owe me (which it looks like it NOW has -- at least partially), that money should be refunded to my credit card post-hasteI'm working that out with [redacted] as I typeThank you Regards, [redacted]

September 10, 2014Dear *** ***,Thank you for your letter of August 18, regarding Avery BaileyI was out of the country from August 23rd through August 30th and was therefore unable to respondWe are always disappointed when a patient is unhappy with any aspect of the
service we provideI have researched *** ***'s complaint and am comfortable that the service rendered was appropriate and that our staff acted diligently to provide *** *** with sufficient information to make her decision from a medical and financial perspective.As you noted there is no complaint with the surgical services renderedThe complaint centers on the procedure coding and where the claim was submitted and the response of her insurance companyIn review, the patient initially researched if the claim would be directed to the medical or dental insurance with ***She never received a “straight answer” from the insurance companyThis should have alerted her to a potential issue with the future claim*** *** is correct that the practice was aware that she had *** Dental and Medical and advised her that the removal of the teeth would be submitted to dental but the biopsy/cyst removal would go to medicalThis is not just a matter of recollection but is supported by the estimate given to the patientOn that estimate you will see two percentages for the co-pay amountThe 30% figure is only consistent with the biopsy/cyst removal being submitted to her medical insuranceThe patient was advised that we are not a participant with *** MedicalThe patient acknowledges this in her letterObviously the patient felt pressure to get her procedure completed but this pressure in no way came from the practice but rather was a result of the upcoming expiration of her insurance coverageThe patient acknowledges that she had “Full responsibility for treatment fees" and acknowledges that we acted within the practice polices described to the patientThis practice has never and will never knowingly mislead a patientIn this complex insurance environment it is impossible to know exactly how much the insurance will cover for a serviceWe can only give our best estimate but it is just that- an estimateWe dispute the statement that treatment options were not fully discussed with the patient
We are a caring practiceWhen a patient calls in a situation like *** ***'s we are compassionate and frequently offer an extended payment plan or relief from some of the expenseNo request for consideration was made by the patientUnfortunately her response was to file a complaint that inour opinion has no meritWe therefore respectfully decline the patients request for reimbursement.Peter S
DDS Practice Administrator

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
 Complaint: [redacted]
I am not accepting this response because of the following:
First of all, I appreciate the timely response from Dr. S[redacted] at Fairfax Oral and Maxillofacial Surgery.
I have several problems with this response
which are not in congruence with my original complaint. I should have been more
specific in my initial complaint, I apologize. I was understandably (I hope) distressed at the time.
My complaint to the Revdex.com was made on August 16th
2014.
Dr. S[redacted] is correct that I was advised FFX
Oral is not a participant with [redacted] Medical. This was indeed confirmed when I
checked with a receptionist AFTER I received the bill in August. Not before. At
no point before was this made absolutely 100% clear to me.
My initial visit to the office to discuss
surgery and payment was April 9th 2014.
[redacted] wasn’t alone in not providing me with
a ““straight answer””. The billing specialist and receptionists at the time
never specifically stated the difference in FFX Oral’s contracts when I asked.
No one really gave me a ““straight answer””. I asked specifically for the
billing folks to check out what the payment situation would be with [redacted] AFTER
our proposal was agreed upon and no one never told me I would be paying well
over the Payment Proposal figures.
My surgery was performed on May 24th
2014.
The patient was not “advised that we are
not a participant with [redacted] Medical.” It was implied, I suppose, but I only
realize that after my surgery, after feeling 100% better without the pain in my
head, after being blamed for not foreseeing all of this, and after I was made
to pay $1372.96 more than I thought I would. And pay it I did -- out of good
faith and after asking for help from a lot of people.
I did my share of research, probably more
than most people, and carefully added and subtracted my way to understanding my
bill on my own. Dr. S[redacted] did a good job of summarizing my payment proposal
which I am still 100% aware of but as he is aware, it is not a guarantee of the
end bill. But having to pay over a thousand dollars over the estimated amount
was just unreasonable. Burdening me with this without offering to help me find
a better solution and re-check the claim submissions with [redacted] even when I
asked was unreasonable. I'm going to go ahead and attach the bill and the numbers I have brought to [redacted]'s attention. The bill AND these numbers were allegedly my responsibility with no reason for review or assistance.
I also frankly don’t appreciate Dr. S[redacted]
saying I should have been alerted “to a potential issue with the future claim”.
In fact, this should have alerted the office and [redacted] that they had some
issues to work out amongst themselves before burdening me with the stress of an
extra bill I had no business paying in full. As someone with a diagnosed and
treated mental illness AND considering I was in ridiculous pain at the time AND
I was paying and asking FFX Oral to help me out with this specific issue, I
find it ableist and condescending. He has no business discussing what did and
did not put pressure on me because he isn’t me and he was not in my situation.
I was under the impression that if I asked
and made it clear that I wanted to know, that the office would inform me of any
changes in my bill. They didn’t, so I assumed I was okay. I got my surgery done
and focused on recovering which took me over a week due to the severity of my
impacts and cyst sizes.
In addition, I was not offered an extended
payment plan when I called to sort my bill out in August. Michelle in billing
told me I could pay half now and half before the bill of $1372.96 was due on
8/20/14 in case I had worked something out with [redacted]. She was nice about it at
least.
As stated in my initial complaint, Dr.
D[redacted] did a wonderful job on my surgery. I continue to give him and his surgical
assistants kudos. I’m just still disappointed in the service I was given
preparing me for paying for the actual surgery costs and the way it was handled
when it came time to draw more money out of me. It was lacking and I was not
helped in the ways that I had asked to be helped.
 Whether or not FFX Oral thinks my complaint
has merit (of course they wouldn’t), if [redacted] decides to pay its share of my
cyst removal it swore up and down it doesn’t owe me (which it looks like it NOW
has -- at least partially), that money should be refunded to my credit card post-haste. I'm working that out with [redacted] as I type. Thank you.
Regards,
[redacted]

Review: I had wisdom tooth removal surgery at the [redacted],VA office of Fairfax Oral and Maxillofacial Surgery on May 24th 2014.

I was insured with dental and medical with [redacted] through my father's insurance. His employer lost its contract in April of this year so on May 1st my father and I were without insurance. By that point I had developed severe pain from ALL of my wisdom teeth becoming impacted in my jaw fairly rapidly. I had seen Dr. Michael L[redacted], a dentist, in March and he referred me to Fairfax Oral and Maxillofacial Surgery. This is the largest serving oral surgeon office in the area.

I initially called [redacted] to discuss wisdom tooth extraction and whether or not it would be under dental or medical. Multiple service representatives said it depended on the office sometimes and that this was not clear, so I never really received a straight answer. I figured the office would straighten the issue out for me. I am a recent college graduate from a lower middle class family -- I was still in school at the time. Needless to say, I am not rich. The most I have ever made in a year is a little over $11k. I cannot afford more than the minimum. I have also been diagnosed bipolar disorder for 5 years, which had been negatively triggered by my worsening head pain. I constantly worry about money and not falling into debt like most people in my generation. I want to make absolutely clear that I was conscious and paying attention to the cost of my surgery.

I showed up for my consultation. They took my insurance card and I even asked the receptionist as I signed in to make sure they were in network with [redacted]. She said yes. I felt okay. The surgeon assistant even asked about my insurance. Pretty much everyone I had met with knew I had [redacted] for both dental and medical at this point. I learned that my teeth were severely impacted and I needed to have them out ASAP. I also had cysts behind my lower teeth. A biopsy was recommended. I needed a CT scan before my surgery. As I was leaving my consultation, a billing specialist in the [redacted] Office drew up a Treatment Plan Proposal for me. The Treatment Plan was estimated to cost $3843 for my surgery. She looked over my information and did some calculating, knowing I had [redacted] -- they had my card on file -- and said I would pay 20% for the surgical procedure and 30% for the extraction of my tumors. This seemed reasonable and I was glad I had insurance coverage. I would come out paying $931 on the plan (it ended up being $958, but that was fine, I expected that). Naturally, I asked to make sure that this was correct as far as she knew and she said yes. It put my mind at ease after all of my questions and double-checking.

I paid $355 out of pocket for the CT scan because it wasn't covered by insurance, as the billing specialist said. I felt pressured and even though I wanted my teeth out, I felt very nervous about insurance and billing. It didn't seem entirely right. [redacted] actually called me to help me find a facility to do the scan instead of FFX Oral and Maxillofacial but due to time constraints and logistics this seemed like more trouble than it was worth. I had my scan on April 16th. At this point it was made clear that I was not going to have my surgery done before our coverage through [redacted] ran out. My surgery was then scheduled for May 24th.

So that I could remain insured for my surgery, my father, now unemployed, paid about $700 out of pocket via a COBRA plan so I could have insurance for the month of my surgery.

I specifically told the office to bill [redacted] before the end of the month because I would not be able to afford the bill if they somehow didn't. At any rate, my surgery went really well. My surgeon, Dr. D[redacted], did a great job and my extraction sites healed very well. I paid $958 immediately after my surgery. Judging by our initial treatment plan proposal, this was the big lump sum I owed the office. I also had $600 to pay out of pocket for my biopsies. At this point, my father and I had collectively paid over $2600 for my surgery. This was a lot but we managed okay. My insurance coverage was gone by June. I am hoping to be insured again as soon as I find a job.

Earlier this week, I received a bill from Fairfax Oral and Maxillofacial. [redacted] did not pay $1372 and now it was my responsibility. The total amount I paid the surgeon's office AND [redacted] for my surgery was now closer for $4000. The total cost of my surgery was about $4333. [redacted] paid $1300 for my procedure. I paid far more than 20%.

While they technically acted within their policy and I agreed to "full responsibility for treatment fees regardless of coverage", I think the billing specialist acted unethically and KNOWINGLY mislead me when drawing up and explaining my treatment plan proposal.

I recently called the office and asked the receptionist outright "Do you have both dental and medical contracts with [redacted]?" She said only dental is in network. The receptionists are aware of this, so why would a billing specialist who handles insurance claims treat my surgery as if it were a dental procedure on my form when it turned out to be chock full of medical claims? The treatment plan reads: "During your recent visit, we reviewed treatment options specifically for you." Clearly this was not the case. I paid them to do a job for me and help me find the best way to pay for it. I did not receive proper assistance.

It's easy for both the surgeon's office and [redacted] to blame me for not checking first. I was both in a LOT of pain from my severely impacted wisdom teeth creating unbearable pressure in my head as well as the constant headache I had developed from making a career of making sure I was insured in the first place. The amount of stress I was under made me an easy desperate to just get it all over with.

I am filing this complaint because I am tired of both of the businesses I paid to help me blaming me for being confused and mislead. I put in 2 calls to [redacted] over this issue alone as well as one call to the main billing office in the Fairfax office of Fairfax Oral and Maxillofacial Surgery. Both told me I had made a mistake and should have checked first (I did) and sent me back and forth. This should never have been a problem to begin with. Had I known, I would have just asked my dentist to refer me to a different surgeon.Desired Settlement: I want a partial refund at least as the whole experienced has caused me a great deal of financial and mental stress. I think it is ethically wrong to mislead a patient who is in pain and handling their own affairs especially knowing what kind of insurance they have and what the businesses agreement with said insurance company is. I also think it is very shady for an oral surgeon's office to ONLY have a dental contract with an insurance company when they perform medical procedures. It is a dangerous grey area.

Business

Response:

September 10, 2014Dear [redacted],Thank you for your letter of August 18, 2014 regarding Avery Bailey. I was out of the country from August 23rd through August 30th and was therefore unable to respond.We are always disappointed when a patient is unhappy with any aspect of the service we provide. I have researched [redacted]'s complaint and am comfortable that the service rendered was appropriate and that our staff acted diligently to provide [redacted] with sufficient information to make her decision from a medical and financial perspective.As you noted there is no complaint with the surgical services rendered. The complaint centers on the procedure coding and where the claim was submitted and the response of her insurance company. In review, the patient initially researched if the claim would be directed to the medical or dental insurance with [redacted]. She never received a “straight answer” from the insurance company. This should have alerted her to a potential issue with the future claim. [redacted] is correct that the practice was aware that she had [redacted] Dental and Medical and advised her that the removal of the teeth would be submitted to dental but the biopsy/cyst removal would go to medical. This is not just a matter of recollection but is supported by the estimate given to the patient. On that estimate you will see two percentages for the co-pay amount. The 30% figure is only consistent with the biopsy/cyst removal being submitted to her medical insurance. The patient was advised that we are not a participant with [redacted] Medical. The patient acknowledges this in her letter. Obviously the patient felt pressure to get her procedure completed but this pressure in no way came from the practice but rather was a result of the upcoming expiration of her insurance coverage.The patient acknowledges that she had “Full responsibility for treatment fees" and acknowledges that we acted within the practice polices described to the patient. This practice has never and will never knowingly mislead a patient. In this complex insurance environment it is impossible to know exactly how much the insurance will cover for a service. We can only give our best estimate but it is just that- an estimate. We dispute the statement that treatment options were not fully discussed with the patient. We are a caring practice. When a patient calls in a situation like [redacted]'s we are compassionate and frequently offer an extended payment plan or relief from some of the expense. No request for consideration was made by the patient. Unfortunately her response was to file a complaint that inour opinion has no merit.We therefore respectfully decline the patients request for reimbursement.Peter SDDS Practice Administrator

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am not accepting this response because of the following:

First of all, I appreciate the timely response from Dr. S[redacted] at Fairfax Oral and Maxillofacial Surgery.

I have several problems with this response

which are not in congruence with my original complaint. I should have been more

specific in my initial complaint, I apologize. I was understandably (I hope) distressed at the time.

My complaint to the Revdex.com was made on August 16th

2014.

Dr. S[redacted] is correct that I was advised FFX

Oral is not a participant with [redacted] Medical. This was indeed confirmed when I

checked with a receptionist AFTER I received the bill in August. Not before. At

no point before was this made absolutely 100% clear to me.

My initial visit to the office to discuss

surgery and payment was April 9th 2014.

[redacted] wasn’t alone in not providing me with

a ““straight answer””. The billing specialist and receptionists at the time

never specifically stated the difference in FFX Oral’s contracts when I asked.

No one really gave me a ““straight answer””. I asked specifically for the

billing folks to check out what the payment situation would be with [redacted] AFTER

our proposal was agreed upon and no one never told me I would be paying well

over the Payment Proposal figures.

My surgery was performed on May 24th

2014.

The patient was not “advised that we are

not a participant with [redacted] Medical.” It was implied, I suppose, but I only

realize that after my surgery, after feeling 100% better without the pain in my

head, after being blamed for not foreseeing all of this, and after I was made

to pay $1372.96 more than I thought I would. And pay it I did -- out of good

faith and after asking for help from a lot of people.

I did my share of research, probably more

than most people, and carefully added and subtracted my way to understanding my

bill on my own. Dr. S[redacted] did a good job of summarizing my payment proposal

which I am still 100% aware of but as he is aware, it is not a guarantee of the

end bill. But having to pay over a thousand dollars over the estimated amount

was just unreasonable. Burdening me with this without offering to help me find

a better solution and re-check the claim submissions with [redacted] even when I

asked was unreasonable. I'm going to go ahead and attach the bill and the numbers I have brought to [redacted]'s attention. The bill AND these numbers were allegedly my responsibility with no reason for review or assistance.

I also frankly don’t appreciate Dr. S[redacted]

saying I should have been alerted “to a potential issue with the future claim”.

In fact, this should have alerted the office and [redacted] that they had some

issues to work out amongst themselves before burdening me with the stress of an

extra bill I had no business paying in full. As someone with a diagnosed and

treated mental illness AND considering I was in ridiculous pain at the time AND

I was paying and asking FFX Oral to help me out with this specific issue, I

find it ableist and condescending. He has no business discussing what did and

did not put pressure on me because he isn’t me and he was not in my situation.

I was under the impression that if I asked

and made it clear that I wanted to know, that the office would inform me of any

changes in my bill. They didn’t, so I assumed I was okay. I got my surgery done

and focused on recovering which took me over a week due to the severity of my

impacts and cyst sizes.

In addition, I was not offered an extended

payment plan when I called to sort my bill out in August. Michelle in billing

told me I could pay half now and half before the bill of $1372.96 was due on

8/20/14 in case I had worked something out with [redacted]. She was nice about it at

least.

As stated in my initial complaint, Dr.

D[redacted] did a wonderful job on my surgery. I continue to give him and his surgical

assistants kudos. I’m just still disappointed in the service I was given

preparing me for paying for the actual surgery costs and the way it was handled

when it came time to draw more money out of me. It was lacking and I was not

helped in the ways that I had asked to be helped.

Whether or not FFX Oral thinks my complaint

has merit (of course they wouldn’t), if [redacted] decides to pay its share of my

cyst removal it swore up and down it doesn’t owe me (which it looks like it NOW

has -- at least partially), that money should be refunded to my credit card post-haste. I'm working that out with [redacted] as I type. Thank you.

Regards,