ComplaintsforKilleen Oral And Maxillofacial Surgery

• Initial Complaint

  05/09/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  To begin with I had an appointment with them and from the very start, I asked if I have to pay for the Mouth guard they where going to give me instead of using a **** machine to treat my Sleep Apnea. I was told that I do not have to pay at all. My last visit with them last December 8, 2021, I went to picked up my mouthguard, I was told that I don't have to pay anything at all and I actually I asked them twice they made it clear that don't have to pay anything. When I received a call in January I was shocked to hear them tell me I have to pay $769.00. I called Tricare to confirm it and according to Tricare I am responsible for at least 20%. I was really upset if they told me I have to pay 20% from the beginning I would not have proceed and rather use the **** instead because its free. I found out that they received the money on November 2021 before my appointment on December 8, and they said I don't have to pay. I got a letter from them saying that I have to pay them $769.00 and they were threatening me that they will report me to credit reporting agency if I don't. They lied to me telling me that I do not have to pay at all and failed to let me know about the 20%.

  Business response

  05/09/2022

  We received a referral from the patients' medical doctor requesting we provide a sleep apnea device in order to treat her diagnosis of OSA. 

  We inform each patient that insurance is not a guarantee of payment and encourage the patient to be involved in understanding their benefit due to ever changing policies and plans.  We also have the patient sign consent acknowledging that they are aware of this.  

  It is frustrating that Tricare did in fact change their protocol for the way this particular procedure was paid without informing us of the change.  We had no way of knowing that they went from paying 100% to paying 80%.  

  We understand the frustration pertaining to her insurance policy and did appeal the insurances decision as a courtesy however; it was denied and the patient copay remained.   

   

  ******, Operations Manager

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