Oral Surgery Reimbursement Claim

Sure, ****, here's a draft for your demand letter:
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[Your Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
[Oral Surgeon’s Name]
[Oral Surgeon’s Office Address]
[City, State, ZIP Code]
Dear [Oral Surgeon’s Name],
I hope this letter finds you well. I am writing to formally request a full reimbursement of $*,* paid upfront for my urgent oral surgery on [date of surgery]. Despite your office being listed as in-network with Aetna, I was required to pay the total cost upfront.
After submitting the necessary paperwork, Aetna issued payments totaling $*,* to your office, with an Explanation of Benefits (EOB) indicating $*.* patient responsibility. Additionally, Cigna Dental Insurance paid $*,*. The total payments from both insurers amount to $*,*, which fully covers the upfront cost I paid.
The No Surprises Act prohibits balance billing for in-network services, and your office, listed as in-network by Aetna, is bound by this regulation. Therefore, I am entitled toa full reimbursement of the $*,* paid upfront.
Below are the relevant details:
- No Surprises Act: Prohibits balance billing for in-network services.
- Aetna’s EOB: Indicates $* patient responsibility.
- Total Payments: Aetna ($*,*) + Cigna Dental ($*,*) = $*,*.
I request that you issue a full refund of $*,* to my credit card promptly. Should this matter not be resolved, I am prepared to file a formal complaint with the Florida Department of Financial Services and the Consumer Financial Protection Bureau, and seek additional legal remedies.
Please confirm receipt of this letter and the processing of my refund within 14 days.
Thank you for your prompt attention to this matter.
Sincerely,
[Your Name]
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