Dr. John Patrick McPhillips, D.D.S., M.D

This was my very first extraction service. The surgeon was amazing. Not only did he answer all my questions, he made me feel good about his treatment plan and my recovery. I don’t take pain well at all and he made sure to not only inform me but be there every step of the way.. and that he did!! I am very thankful for his expertise. Searching for a surgeon and one that could put me to sleep has been a whole ordeal. I went with pain and knocking back several ibuprofen bottles for over 9 months. My issue is with billing, it’s probably because I work in billing for my insurance and i just know what to look for and review this stuff. Initially getting told your responsibility for the service and what your insurance doesn’t pay was very detailed and pleasant. I mean after leaving the office on my consult visit I felt that I was knowledgeable of what was being billed and covered. Not a lot of places give you the run down like that. The issue remains on the final bill. So I received a bill for like $163 outside the $48 I spent on the consult day for Aetna non covered services (description I was told) and the $378 on the day of service. When I tell you I broke down their statement a million times knowing I shouldn’t have to because my EOB clearly states what my patient responsibility is. I was trying to see how they come up with that balance. Not only did their statement not have a beginning balance, the amount the entire service was, but it also did not have my payments listed either. It had a remaining balance, insurance payment and the adjusted charges then your amount owed. There is nothing wrong with that but it doesn’t give you the entire picture which why it lead to me trying to figure it out. Prior to calling I knew two things.. my insurance adjustment is wrong and the billed charges had to be wrong. I called the office and Debbie answered she is sweet and I just adore her but if she can’t handle billing she shouldn’t ask multiple questions regarding the in’s and out’s of my reasoning of requesting to speak with billing; to not only have me transferred to repeat it all over. I’m just saying it could have been a warm transfer. This is the nature of this business so I look for certain types of client services given. Anyways I can over look that. So I get to Karen and she is telling me to not include the non covered services because I won’t get any credit for that and she can do an EOB audit but it could also be that the insurance didn’t pay anything on certain codes. Just all these shoulda coulda woulda’s and then she pulls up my claim in her system telling me what my insurance paid and the adjustment. So I just stopped her and asked her for the total billed charges because that might answer my question. Well it did.. the billed amount to the insurance is not the same billed amount in their system. So idk why it’s different.. I will ask when I get my call back returned and see why the difference wasn’t billed to the insurance. So I told her that is what I thought and the insurance adjustment is incorrect too. I must have been telling her too many errors, because she then said she had another member on the line and doing an eob audit with me on the phone was difficult and she would have to call me back. I’m ok with that because i get it. However, to be honest if you look at the eob; it clearly states what my portion is and what they was paid and adjusted. She should have saw that I over paid and I was owed a refund. I am even including the differential of billed charges.. just my refund would be smaller. I now want to ask them questions about that $48 supposedly non covered charge I paid on the consult day. They sent a separate bill to my insurance for that and the contracted rate was $30 with a payor note stating that this service was included with another service done that day and the member is not responsible which left my patient responsibility at $0. Now again.. working in this industry I know some practices don’t even want to go through the hassle of fighting or sending corrected claims with modifiers to get that payment, ok I understand but now that I am knee deep in reviewing my invoice I don’t understand why they didn’t  atleast charge the patient the contracted amount. If the insurance was billed correctly with a modifier or the codes was individually billed to be paid out separately- they wouldn’t got the billed charge just the contracted amount. So now I feel some type of way because I feel torn from the service I received from the doctor and this billing situation. I am hoping this will be an easy fix because it’s literally looking at the eob and comparing to what I paid and refunding me. If not, then I will request an itemized ledger of my charges and all payments because there is now way I should be responsible for more charges over what the insurance says I owe.