A Children's Dentistry Center

Review: The dentist's office accepted what our insurance paid for my three children's cleanings for several years. Then started billing us, saying that we owed whatever our insurance didn't pay. I asked for clarification about the change, since our insurance did not change. The billings person said she was working to set up something more direct with our insurance, so that they could accept just what the insurance paid and offered to take half of the $240 she said we owed. I paid that and understood the matter was resolved. Then, six months later, they started billing me again for $119.50. I contested and they sent billing info from the insurance company, which still doesn't explain why they're billing me more at times and nothing at other times for the cleanings. As for the verbal agreement where I paid half and understood it was resolved, the billings person said the dentist decided that wasn't acceptable. They eventually said the dentist would meet with me to discuss, but never responded to my attempts to schedule that meeting. They didn't bill me for a few months, so I again thought it was resolved. I moved my children to the dentist I see and then Dr Henson's office started billing me again. I again asked to meet and resolve this, but did not get any response, and the bills continue to arrive.Desired Settlement: Stop billing me! I paid half of the disputed amount, as agreed to by the billings person in the office, Elizabeth.I have made so many good faith efforts to resolve this.We really liked the dentist's care of our children and were incredibly sad at having to leave the office due to poor communication and lack of administrative skills.This is over two years old now.

Business

Response:

Ms. [redacted]

Dispute of Resolution Coordinator

Revdex.com

ID# [redacted]

Review: Dr. [redacted] was my daughter's dentist and my daughter was treated by him on Nov-1-2010. Dr. [redacted] was not able to collect payment from Delta Dental because Dr. [redacted]/his billing company failed to summit the claim to Delta Dental in a timely manner. It took over 18 months for them to summit the claim. I contacted Delta Dental on three different occasions, and they informed me that this claim would have been fully covered / paid if they had summited the claim within the deadline. Recently, Dr. [redacted] turned us over to collections agency ([redacted] Associates). I have been trying to resolve this issue with Dr. [redacted] all these years but I got nothing but a run around. I know that I am not the only family stuck in this messy situation because of their own mistake. They admitted that they were having problems with their billing company; therefore, Dr. [redacted] did not receive any payment from insurance company during a period of time. [redacted] (lady from Dr. [redacted]'s office) also stated that there are a lot of families (Dr. [redacted]'s patients) out there having the same problems as what I am going through. If they summited the claim on time, we would not be in this unpleasant situation. It seems to me that this problem needs to be resolved between Dr. [redacted]'s office and his billing company. It is apparent to me that someone dropped the ball, and they are trying to blame it on innocent, hardworking citizens like myself. I can provide all necessary documents upon request. Please see below for details. Thank you for your time and consideration.

11/1/2010 - Date of service at Children’s Dentistry.

2/16/2012 - I received the first bill ($458) from Children's Dentistry. This was the first time I was contacted by Children’s Dentistry regarding this bill. It caught me by surprise for two reasons. First, I was appalled at the length of time they took to send the bill. Second, the cost of the service should have been fully covered by my insurance company since I have dual coverage. On that day, I paged Children's Dentistry via their emergency line and spoke with Dr. [redacted] and he stated that the billing went out late because they were having problems with their billing company. I was told by Dr. [redacted] that someone from their billing department would give me a call.

2/17/2012 - I called Dr. [redacted]'s office at 0830 and left a message regarding the bill. No return call was received that day.

2/20/2012 - I called Dr. [redacted]'s office. Since it was a holiday, no one was at the office. I left a message.

2/21/2012 - I called Dr. [redacted]'s office at 0920 and left another message. Later, Dr. [redacted] called back and told me that he would have someone from billing department call me back later. At 1040, a lady name [redacted] returned my call and informed me that it was a billing error, that I did not have to worry about this bill, and that they would take care of this bill. At this point, I thought that the bill was taken care of. I never heard or received anything from Children’s Dentistry until 6/4/2012.

6/4/2012 - At 1140, [redacted] from Children’s Dentistry called to make an appointment for my daughter’s regular checkup. Since I had her on the phone, I decided to confirm that our bill was all taken care of as [redacted] stated on 2/21/2012. [redacted] stated that she does not know anything about this bill and she will have [redacted] call me back. [redacted] also stated that [redacted] was out of the office that day. I explained the situation to [redacted] and I told her I was just confirming.

6/5/2012 - At 1225, [redacted] called back and stated that she spoke with [redacted] and understands the situation and that she will take care of this issue. [redacted] also stated that she would let me know if there were any problems with this claim. Once again, I was led to believe that the bill was taken care of.

11/27/2012 - I received a 2nd bill ($359) from Children's Dentistry. On that bill, someone hand wrote in large print "Bal Due - Avoid Collection". I felt threatened and stressed and I asked my husband to call Delta Dental.

11/28/2012 - At 1050, my husband contacted Delta Dental and spoke with [redacted]. [redacted] informed my husband that the claim would have been paid in full by Delta Dental if the claim was submitted within 1 year from the actual service date. [redacted] stated that the reason the claim was not paid was that Children's Dentistry failed to submit the claim to Delta Dental within the deadline. Approximately at 1100, my husband called Children's Dentistry and spoke with Dr. [redacted]. Dr. [redacted] informed my husband that the billing person was not available and he would have her call us back later.

11/30/2012 - No return calls from Children's Dentistry. At 1210, my husband called Children's Dentistry again and left a voice message. At 1440, no call was receive yet so my husband called again and spoke with [redacted] at Children's Dentistry. [redacted] was new to the office and could not provide explanation about the bills. My husband provided all our records to [redacted]. [redacted] stated that she would put our information in their files and give them to Dr. [redacted]. [redacted] also stated that she is a new employee, previously employed by Delta Dental three months prior. [redacted] was unable to find any documentation at Children’s Dentistry and she told my husband that she would get back to him as soon as she finds out what happened with their claims/billing company.

At this point, we felt that we were getting the run around, and not getting answers that we deserved.

12/27/2012 - [redacted] never called back. I received a third bill ($359) from Children's Dentistry.

12/28/2012 - At 1030, I called Children's Dentistry and left a message regarding third bill.

1/4/2013 - At 1700, [redacted] called back and mentioned the first claim Children’s Dentistry submitted was on 6/21/2011 which was different than what Delta Dental have told us. I asked [redacted] to provide a copy of original claim they submitted to Delta to confirm the date on their document, however she failed to do so. [redacted] stated she has been trying to contact Renaissance Billing but has been playing phone tag with them. [redacted] expressed difficultly in contacting Renaissance Billing because she only works on Mondays and afternoon on Fridays. At this point, it is obvious that someone is not telling the truth.

3/8/2013 - I received a letter from [redacted] stating "Mr. [redacted], just wanted to let you know, your claim was submitted and Delta rejected it. They could have paid on all the procedures except the one they denied." What she wrote did not make any sense to me at this time.

3/14/2013 - I sent a letter to [redacted], stating again in writing, what I have been saying all along; that Children's dentistry failed to submit the claim on time and that they are responsible for their own claims and also that patients do not have control over their claims.

3/27/2013 - [redacted] sent us another letter stating that we still owe them money. No explanation provided and she did not answer my question either.

3/29/2013 - I contacted Delta Dental again out of desperation and spoke with [redacted]. [redacted] stated that the first claim that they ever received was 6/21/2012. The second claim they received was on 11/1/2012. Both claims were rejected because the deadline for submitting claim had expired. Delta Dental had a clear answer for me and they were able to provide me with documents. At 1500, I left a message for [redacted] at Children's Dentistry to call me back. By this time, I am exhausted and stressed.

4/1/2013 - At 1607, [redacted] contacted me; she stated that there were many patients who were going through the same problems that I was going through. When I asked her how many patients were involved with the billing issues, she stated "I can’t tell you exact number, but poor Dr. [redacted] didn't get any payments from insurance companies that year because of billing problems." I replied "Doesn't that tell you that you were having problems with your billing company, and also, if the claim is denied from insurance company for any reason, don't I have a right to be informed in a timely manner?

"What took you so long to summit the claim to Delta? What would you have done if you were in my situation?" [redacted] stated "I understand but I only work here part-time and I am just doing what Dr. [redacted] is telling me to do." I asked to speak to Dr. [redacted] but she said that he was not available to talk to me. I asked [redacted] to have Dr. [redacted] call me back so I can resolve this issue with him. She said she would. I also asked [redacted] to provide me with a denial letter from Delta Dental and I was hoping to see the date on a denial letter.

4/29/2013 - I waited and waited but Dr. [redacted] never called me back. It is apparent to me that he is avoiding to have a discussion with me. I received another letter from [redacted]. Again, the letter does not include any facts, such as date of first or second claims or reason for denial. No explanation provided as to why the claim was not made in a timely manner. [redacted] simply wrote "Delta does not always issue a denial letter". It didn't make sense to me that Delta dental does not issue a denial letter.

05/02/2013 - I wrote to [redacted] requesting to speak to Dr. [redacted] to resolve this issue once again since no one in the office was able to provide me with an answer. I felt that I needed to talk to Dr. [redacted] to resolve the issue; however, he was never available to speak with me, and I always got the run around.

01/02/2014 - I received a collection letter from [redacted] and Associates. I never heard or have received anything from Children's Dentistry since 4/29/2013.

01/06/2014 - At 1432, I sent a dispute letter via certified mail to [redacted] Associates.

01/06/2014 - At 1455, I called Dr. [redacted]'s office and spoke with [redacted] and she stated that she will have someone else call me today but never received phone call from them.

01/07/2014 - At 1537, [redacted] and Associates called on my cell via their automated phone system. I called back and spoke with [redacted]. I explained the situation to [redacted] but he stated that I still owe them money. I notified him that I sent them Dispute letter via certified mail.

01/07/2014 - At 1606, I called Delta Dental and spoke with [redacted] (Representative). [redacted], once again, confirmed that they received first claim from Dr. [redacted]'s office in JUNE 2012 and the claim was denied /rejected because they did not summit the claim within deadline.Desired Settlement: To waive the debt.

Business

Response:

Thank you for the opportunity to respond to the letter you received from one of our patients. I can understand and empathize with her since we have had a similar dilemma on our side as well. While we are unable to respond in the same detail due to information confidentiality regulations, we will try to summarize another side to the matter.

The initial statement by the patient upon which the entire disagreement rests, concernered timely submission of a claim to her insurance company for treamtment that her children received. Like many offices, we utilize an insurance clearinghouse to send our electronically filed claims to the insurance company. Records that we have received from the vendor show that a claim for the four procedures we provided was submitted for processing on the day the service was performed. The patients’ insurance company rejected that claim. To this date, the insurance company has not responded adequately to our requests to detail the reason that the entire claim was initially rejected, except to say that it was not submitted within “their” one-year requirement. In reviewing the patients’ insurance coverage, it is clear that three of the procedures provided should have been covered and paid. The only procedure in question seems to have been an exam charge that was denied due to an incorrect procedure number. However, rather than deny one procedure or notify us that it required correction and pay for the others, the company denied the entire claim. (Partial payment on claims is a common insurance practice). Not only did they reject the entire claim, they didn’t accept that it was even submitted.

As I am sure anyone reading this can attest, trying to resolve such an issue with a large insurance company can be overwhelming. Typically our staff, after going through 3 or 4 telephone menus, entering patient and account information at each stop, is then placed on hold for 10-25 minutes waiting to talk to someone. After we finally get to speak to an actual person, we find out that 1) he/she doesn’t know anything about the case, 2) they must refer us to someone else who isn’t in today (same procedure all over), or 3) supposedly enters our information in the computer and says someone will call us back. Small offices frequently find it difficult to devote the time necessary to pursue these issues when insurers require claims be resubmitted, additional records be provided, or require us to file an appeal. These billing procedures we provide are at no cost to the patient or the insurer. Our efforts to secure payment for our services can be so time consuming as to result in a financial loss that is non recoverable for the office. Do you think any insurance companies know this?

We are further limited since we are not a party in the patients’ insurance contract. A disclaimer regarding the possible inaccuracy of the information accompanies any information that we may obtain on the patients’ behalf from an insurance carrier. It is difficult to find anyone who has worked in this area of the insurance industry who doesn’t report incidents of claims being destroyed, misplaced, or otherwise mishandled by one of the thousands of employees in the company. Is it then surprising that these cases can often require several months or more to resolve? We are left to pursue these matters with limited resources with a company with almost limitless resources.

Unfortunately blame for these problems is frequently directed at the people who provided the services, rather than toward the company that refuses to pay for the treatment. In this case, we did not receive payment due to one incorrect procedure number that represents less than 10% of costs of the provided treatment. It leads one to conclude that some insurance companies or their personnel are employing policies that make it difficult or impossible for small offices like ours to get reimbursed for the services we provided to their clients. This is not to say that we handle these cases as efficiently as we would like. However, over a period of months, the patient may talk to several people in our office and unfortunately get incomplete information or an unavoidable delay in response to their questions because the insurance company hasn’t responded to us.

We regret the problems this matter has caused for the patient and for us. However, we feel the insurance company could have prevented the entire situation by acting in a different manner. The patient’s financial arrangement with our office makes her responsible for services her insurance doesn’t cover, but we have requested that any action towards the patient be suspended at this time. We will continue to actively pursue the matter with her insurance company.

Consumer

Response:

I am rejecting this response because:

To whom it may concern,