Hampton Park Dentistry

Hello,Dealing with insurance can certainly be frustrating. Unfortunately the information presented in the review is not an accurate description as to why the insurance carrier did not cover certain procedures at 100%. The patient filed a complaint with the Better Business Bureau, and our office presented clear direction to the BBB as to how this claim could be fully covered by the patient’s insurance. Our office in not able to move the claim forward without intervention on the patient’s end. The BBB acts as a mediator in situations like this. Although the patient filed the complaint, the patient is not responding to communication from the Better Business Bureau. Google will send this response to the patient, and I sincerely hope the patient reads this response and contacts the Better Business Bureau; as our office has provided very clear instructions as to how this claim can be resolved.Please review the correspondence between the Better Business Bureau and our office:Complaint 1) Claim was submitted to insurance as secondary insurance, not primary.Hampton Park Dentistry response:This is incorrect, as our office submitted the claim with Metlife as the primary carrier. I have attached a copy of the ADA claim that was submitted, and highlighted where the primary carrier information is placed. In the event of a COB situation, there would be 2 carriers on the claim. ADA claim submission forms are standardized, and the primary carrier is line item #3. In the event of a COB situation, the secondary carrier information is located at line item # 11. In (patient’s name hidden), we filed with Metlife at the primary carrier on line item # 3. MetLife PROCESSED the claim as secondary; not because the claim was submitted as secondary, but because MetLife is purporting there is a primary carrier on file. As an example, I have attached a COB claim from another patient that shows where primary and secondary insurance carriers are located on the ADA claim form. When you compare the 2 claims, you can see how (patient’s name hidden) claim has MetLife as the primary carrier; there is no secondary carrier on (patient’s name hidden) claim.Complaint 2) Insurance would have paid full amount (100%) if coded as primary plan.Hampton Park Dentistry Response:This is a false statement. Our office filed the claim with MetLife as the primary carrier; I have attached the claim as proof. Additionally, please note that COB situations vs Non-COB situations don’t get coded differently. The same codes are presented regardless of COB vs Non-COB. The statement “Insurance would have paid full amount (100%) if coded as primary plan” illustrates a lack of understanding of insurance protocols and claim submission procedures. Complaint 3) Insurance requests business to resubmit claim and key as primary. Hampton Park Dentistry Response:On July 1st our office recorded a phone call with MetLife; the insurance agent’s name was Joyce, and the call reference number is (call ref. # hidden). Based on our phone call Metlife IS NOT requesting that the provider’s office re-submit the claim as a primary claim. (Patient name hidden) was either given improper direction from MetLife, or (patient name hidden) is not familiar with the nature of a COB situation and therefore was unable to question the carrier in a manner that would illustrate a solution from MetLife.4)Business denies to resubmit claim or contact insurance for repayment.Hampton Park Dentistry Response:This is false: our office will resubmit the claim once the patient either:A) Submits a letter to MetLife that states there is no primary insurance carrier.B) Provides our office with the primary insurance that MetLife is purporting to be carried by the patient.Please note our office did our best to try to communicate the corrective measures with the patient.