Antonia Accettura, DDS, Inc.

I am sorry that Ms*** feels that she has treated unprofessionally by the support staff regarding this issueIt is not our policy to examine each patient's insurance coverageStandard procedure for patients who have dental insurance is to review their individual policy and their list of eligible providersIn our office our policy is to notify each patient of their financial policy and their list of eligible providersIn our office our policy is to notify each patient of their financial responsibility in writing prior to treatmentMrs*** did sign a financial responsibility acknowledgement, which indicated that she was responsible for any charges not covered by her insurance
I agree with Mrs***'s statement that, "this could have been nothing more than a phone call to verify that the policy was in fact in place and with the correct coverage." Mrs*** could have made a phone call to her insurance company to verify her individual coverage or reviewed her list of providers before initiating treatment to have avoided this misunderstanding.
As a result of this misunderstanding, and in order to prevent an unforseen financial burden to the *** family, I provided a discount and eight-month interest-free payment arrangement, which was agreed to January The remaining balance $balance, which was days past due, was paid in full August 18,
I sincerely apologize for Mrs***'s discontent regarding this situationHowever, our office did not mislead or misrepresent anything to the ***sIn the time that I have been with the practice, this is the only situation of its kindTypically, patients with insurance come to our office because their insurance policy indicates that we are a providerUnfortunately, in this case, I believe that the issue was a result of assuming that because a co-worker was eligible for benefits in our office, the ***s believed that they were also eligibleUnfortunately, the ***s had a different plan than their co-worker
Best regards,
*** ***, DDS

I am rejecting this response because:
When my Husband ([redacted]) initially came to your office in such a confident manner, it was because we assumed we would be getting the utmost professional care both from the dentist, as well as the support staff.
We too feel this is a very unfortunate circumstance and as consumers should not have been treated in the manner that we were treated.
It is true that [redacted] did provide the the office personnel with the group ID number but also with his individual policy # and in fact his dental insurance card. 
This would have clearly been nothing more than a phone call from the office person to the insurance company to ensure that the policy was in fact in place and correct with the correct coverage. We in fact called multiple dental offices to verify this procedure.
Giving this person the benefit of the doubt that what they were doing is THEIR office or STANDARD policy/procedure, I find it rather disturbing that they would actually perform services for clients under false pretenses that they actually had some form of dental coverage when in fact they had not accurately verified this prior to ANY services being rendered regardless of the time frame for which these services were performed.
As for the billing; we do appreciate any discounts that may have been provided, but the final pricing still does not tabulate to a correct balance and at this point we are truly unsure of what the actual balance is and in fact the entire balance has been paid off per the invoices we have received.
At the end of the day, we are all a consumer somewhere along the line and we try to do what is right by the people or companies we do business with. It's the right thing to do! 
In this instance we as the consumer, were lead down a path that simply did not exist and we should never have been allowed treatment if insurance coverage was not there with the premise that e had coverage. 
This is why the complaint was initiated in the first place. 
We do not want to see this happen to anybody else that is in our same position and we feel it fitting that we be reimbursed the moneys that should have been paid by our insurance.
Thank you for your time and consideration.
[redacted] 
On Mon, Aug 11, 2014 at 9:52 AM, Zoey<[email protected]> wrote:
This was my original complaint:
 
 My Husband started a new job and with that, we got dental insurance! Yeah! after going to [redacted]'s office six different times, (we each went three times) my husband went to his company and THEY (his company) informed him that [redacted] was not a dentist office that accepted our insurance. He then went back to [redacted]'s office and informed them that our insurance wasn't going through because they don't take our insurance. [redacted]'s office should have never let us go for that many visits without letting us know they didn't take our insurance. As a result my husband and I had racked up our dental bill to $1289.00. [redacted] reviewed our "error in communication" and "in courtesy" lowered our bill $189.00 resulting in the bill amount of $1100.00. They expected two payments of $550.00 over the period of two months to pay off our bill. Being a family of five, we could not pay that much in such a short amount of time. My husband and I agreed that we could make them $50.00 a week payments until the bill was paid off. [redacted] then wrote us back stating, " I would like to provide you with the discounted fee as a courtesy, however I cannot extend the courtesy of $1100.00 while also breaking the payment up for six months." [redacted] then added back on the $189.00. So, in the end we paid the full amount of $1289.00. I don't understand why they let us keep coming if they didn't take our insurance. Most health offices find out before, or the day of, if they accept one's insurance. [redacted] told us that it was ultimately the patients responsibility to find out which offices took our insurance. [redacted] apologized for the "error in communication." 
This is how I asked them to resolve it:
I feel that there was obviously an error in communication, but I dont' feel that we the patient should have had to pay the full amount of the bill. [redacted] being a office that provides people with health services, [redacted] should know before hand who's insurance they take and don't take. [redacted] should inform patients with an itemized bill of the cost of services patients are going to receive BEFORE patients recieve them. I would like the amount back that our insurance would have paid.
This was their Respose:
In response to complaint # [redacted]:
When Mr. [redacted] then confidently reported being referred by a coworker. Mr. [redacted] then confidently reported that he was working for the same company and was on the same group number as his coworker, as we are all of the workers at the same company. Unfortunately, Mr. [redacted] did not realize that his coworker was a senior employee. Mr. [redacted] also did not realize that he was a new employee in a probationary period with a different dental insurance than his coworker. Mr. [redacted] believed he had Delta PPO Insurance like his coworker, however he had Delta USA-HMO. At the time [redacted] had no dental insurance coverage that I am aware of.
As we submit claims to the insurance companies, often times, time is required to process the forms and gather information. We were not aware that the [redacted]s were not "eligble" for benefits in our office until after their treatment had been completed. We do not have a contract for Delta Care USA-HMO and are therefore not providers and have no information regarding their benefit schedule. We do not however have a contract with Delta PPO. As a courtesy to the [redacted] family we did extend a few reasonable solutions to help them pay for their treatment. Not being insured their balance should have been $1,355.
As a Delta PPO patient Mr. [redacted]'s balance would have been $1034.00. Mr. [redacted] would likely have had a co-pay of some amount to be shared with the insurance company for full payment. Because Mr. [redacted] had no benefits in this office his total should have been $1,071.
Without insurance Mrs. [redacted]'s balance would have been $284. If she had Delta PPO her balance would have been $259.
In total the [redacted] family's total without insurance should have been $,355.
If they had Delta PPO their total would have been $1,289. Which would likely have had a copay to be shared with the insurance company.
As a courtesy to the [redacted], I offered a discount form a no insurance fee, to the discounted insurance fee (which they did not have). Additionally I offered them a couple of payment arrangements. They could have an additional $189 discount two $550 payments over two months or they could pay their total discounted balance in weekly $50 payments (per Mr. [redacted]s request) over seven months. In January 2014, Mr. [redacted] apologized for the miscommunication and agreed to pay his balance over seven months. As of July 7, Mr. [redacted] has made his weekly payments as planned. Since July 7th we have not received another payment from Mr. [redacted], who's balance of $75.00 is now 30 days past due.
Contrary to the accusation by Mrs. [redacted], we were not aware that Mr. [redacted] had provided our office with the incorrect insurance information. We did not intentionally "allow them to keep coming." Both Mr. and Mrs. [redacted] had initiated, scheduled and completed treatment within 45 days. This was a short window of time and unfortunately, like my office, the [redacted]s also were not made aware, by their insurance carrier that they did not have coverage immediately. The insurance claims for treatment were submitted by mail and took time to determine there was no such coverage. Typically patients know what kind of insurance plans they have and are able to get an accurate use of their insurance benefits.
As a result, I believe that however unfortunate, the error was a result of being provided with inaccurate information. Mr. [redacted] accepted responsibility for the "miscommunication," and agreed to make small affordable payments over time as we had agreed.
If you should need any additional information, please let me know.

In response to complaint # [redacted]:
When Mr. [redacted] then confidently reported being referred by a coworker. Mr. [redacted] then confidently reported that he was working for the same company and was on the same group number as his coworker, as we are all of the workers at the same...

company. Unfortunately, Mr. [redacted] did not realize that his coworker was a senior employee. Mr. [redacted] also did not realize that he was a new employee in a probationary period with a different dental insurance than his coworker. Mr. [redacted] believed he had Delta PPO Insurance like his coworker, however he had Delta USA-HMO. At the time [redacted] had no dental insurance coverage that I am aware of.
As we submit claims to the insurance companies, often times, time is required to process the forms and gather information. We were not aware that the [redacted]s were not "eligble" for benefits in our office until after their treatment had been completed. We do not have a contract for Delta Care USA-HMO and are therefore not providers and have no information regarding their benefit schedule. We do not however have a contract with Delta PPO. As a courtesy to the [redacted] family we did extend a few reasonable solutions to help them pay for their treatment. Not being insured their balance should have been $1,355.
As a Delta PPO patient Mr. [redacted]'s balance would have been $1034.00. Mr. [redacted] would likely have had a co-pay of some amount to be shared with the insurance company for full payment. Because Mr. [redacted] had no benefits in this office his total should have been $1,071.
Without insurance Mrs. [redacted]'s balance would have been $284. If she had Delta PPO her balance would have been $259.
In total the [redacted] family's total without insurance should have been $,355.
If they had Delta PPO their total would have been $1,289. Which would likely have had a copay to be shared with the insurance company.
As a courtesy to the [redacted], I offered a discount form a no insurance fee, to the discounted insurance fee (which they did not have). Additionally I offered them a couple of payment arrangements. They could have an additional $189 discount two $550 payments over two months or they could pay their total discounted balance in weekly $50 payments (per Mr. [redacted]s request) over seven months. In January 2014, Mr. [redacted] apologized for the miscommunication and agreed to pay his balance over seven months. As of July 7, Mr. [redacted] has made his weekly payments as planned. Since July 7th we have not received another payment from Mr. [redacted], who's balance of $75.00 is now 30 days past due.
Contrary to the accusation by Mrs. [redacted], we were not aware that Mr. [redacted] had provided our office with the incorrect insurance information. We did not intentionally "allow them to keep coming." Both Mr. and Mrs. [redacted] had initiated, scheduled and completed treatment within 45 days. This was a short window of time and unfortunately, like my office, the [redacted]s also were not made aware, by their insurance carrier that they did not have coverage immediately. The insurance claims for treatment were submitted by mail and took time to determine there was no such coverage. Typically patients know what kind of insurance plans they have and are able to get an accurate use of their insurance benefits.
As a result, I believe that however unfortunate, the error was a result of being provided with inaccurate information. Mr. [redacted] accepted responsibility for the "miscommunication," and agreed to make small affordable payments over time as we had agreed.
If you should need any additional information, please let me know.

Review: My Husband started a new job and with that, we got dental insurance! Yeah! after going to [redacted]'s office six different times, (we each went three times) my husband went to his company and THEY (his company) informed him that [redacted] was not a dentist office that accepted our insurance. He then went back to [redacted]'s office and informed them that our insurance wasn't going through because they don't take our insurance. [redacted]'s office should have never let us go for that many visits without letting us know they didn't take our insurance. As a result my husband and I had racked up our dental bill to $1289.00. [redacted] reviewed our "error in communication" and "in courtesy" lowered our bill $189.00 resulting in the bill amount of $1100.00. They expected two payments of $550.00 over the period of two months to pay off our bill. Being a family of five, we could not pay that much in such a short amount of time. My husband and I agreed that we could make them $50.00 a week payments until the bill was paid off. [redacted] then wrote us back stating, " I would like to provide you with the discounted fee as a courtesy, however I cannot extend the courtesy of $1100.00 while also breaking the payment up for six months." [redacted] then added back on the $189.00. So, in the end we paid the full amount of $1289.00. I don't understand why they let us keep coming if they didn't take our insurance. Most health offices find out before, or the day of, if they accept one's insurance. [redacted] told us that it was ultimately the patients responsibility to find out which offices took our insurance. [redacted] apologized for the "error in communication."Desired Settlement: I feel that there was obviously an error in communication, but I dont' feel that we the patient should have had to pay the full amount of the bill. [redacted] being a office that provides people with health services, [redacted] should know before hand who's insurance they take and don't take. [redacted] should inform patients with an itemized bill of the cost of services patients are going to receive BEFORE patients recieve them. I would like the amount back that our insurance would have paid.

Business

Response:

In response to complaint # [redacted]:

When Mr. [redacted] then confidently reported being referred by a coworker. Mr. [redacted] then confidently reported that he was working for the same company and was on the same group number as his coworker, as we are all of the workers at the same company. Unfortunately, Mr. [redacted] did not realize that his coworker was a senior employee. Mr. [redacted] also did not realize that he was a new employee in a probationary period with a different dental insurance than his coworker. Mr. [redacted] believed he had Delta PPO Insurance like his coworker, however he had Delta USA-HMO. At the time [redacted] had no dental insurance coverage that I am aware of.

As we submit claims to the insurance companies, often times, time is required to process the forms and gather information. We were not aware that the [redacted]s were not "eligble" for benefits in our office until after their treatment had been completed. We do not have a contract for Delta Care USA-HMO and are therefore not providers and have no information regarding their benefit schedule. We do not however have a contract with Delta PPO. As a courtesy to the [redacted] family we did extend a few reasonable solutions to help them pay for their treatment. Not being insured their balance should have been $1,355.

As a Delta PPO patient Mr. [redacted]'s balance would have been $1034.00. Mr. [redacted] would likely have had a co-pay of some amount to be shared with the insurance company for full payment. Because Mr. [redacted] had no benefits in this office his total should have been $1,071.

Without insurance Mrs. [redacted]'s balance would have been $284. If she had Delta PPO her balance would have been $259.

In total the [redacted] family's total without insurance should have been $,355.

If they had Delta PPO their total would have been $1,289. Which would likely have had a copay to be shared with the insurance company.

As a courtesy to the [redacted], I offered a discount form a no insurance fee, to the discounted insurance fee (which they did not have). Additionally I offered them a couple of payment arrangements. They could have an additional $189 discount two $550 payments over two months or they could pay their total discounted balance in weekly $50 payments (per Mr. [redacted]s request) over seven months. In January 2014, Mr. [redacted] apologized for the miscommunication and agreed to pay his balance over seven months. As of July 7, Mr. [redacted] has made his weekly payments as planned. Since July 7th we have not received another payment from Mr. [redacted], who's balance of $75.00 is now 30 days past due.

Contrary to the accusation by Mrs. [redacted], we were not aware that Mr. [redacted] had provided our office with the incorrect insurance information. We did not intentionally "allow them to keep coming." Both Mr. and Mrs. [redacted] had initiated, scheduled and completed treatment within 45 days. This was a short window of time and unfortunately, like my office, the [redacted]s also were not made aware, by their insurance carrier that they did not have coverage immediately. The insurance claims for treatment were submitted by mail and took time to determine there was no such coverage. Typically patients know what kind of insurance plans they have and are able to get an accurate use of their insurance benefits.

As a result, I believe that however unfortunate, the error was a result of being provided with inaccurate information. Mr. [redacted] accepted responsibility for the "miscommunication," and agreed to make small affordable payments over time as we had agreed.

If you should need any additional information, please let me know.

Consumer

Response:

I am rejecting this response because:

When my Husband ([redacted]) initially came to your office in such a confident manner, it was because we assumed we would be getting the utmost professional care both from the dentist, as well as the support staff.