Bittel & Anderson, Inc.

Review: I took my daughter for a cleaning to Dr [redacted],DDS. We were told that she has two cavities and would need fillings. I recently received Bitewings which are four radiographic images and realized that cavities are not visible on x rays. In addition Dr [redacted] did a topical application of fluoride that was not necessary and I did not give consent.

I am trying to get his office fully investigated. It is a disgrace the way they treat patients including children.Desired Settlement: Explanation of charges and full refund.

Business

Response:

We received your letter concerning the above referenced complaint on Tuesday, August 18, 2015. We have spoken with you several times concerning this complaint. We will attempt to address his stated concerns which seem to be:1. Dr. [redacted] states that the cavities are not visible to him on the x-rays. Reply:Any individual with training in reading dental x-rays would not expect to be able to diagnose decay involving the chewing surfaces (occlusal surfaces) of teeth or the lingual (next to the palate) surfaces of teeth utilizing bitewing x-rays unless the areas of decay are large and had been present for an extended period of time. Bitewing radiographs are known to reveal certain types of dental decay (between teeth where flossing is required) and other pathology. However, bitewing radiographs typically do not reveal the presence of decay affecting the chewing surfaces of teeth (occlusal surface), the sides of teeth next to the cheek (buccal surface), next to the lips (labial or facial surface), next to the palate (palatal or lingual), ornext to the tongue (lingual surface).The decay that concerns Dr. [redacted]involved the occlusal (chewing) surface and the lingual (next to the palate) surface.We in our practice would neither attempt nor expect to detect decay affecting these occlusal surfaces and palatal surfaces with bitewing x-rays. Also, we in our dental practice probably are no better trained or able to interpret the medical tests Dr. [redacted] would order for patients in his medical-neurology practice than he is able to interpret dental bitewing radiographs for patients in our pediatric dental practice.However, the x-rays have been sent to [redacted] to the Virginia Department of Health Professions / Virginia Board of Dentistry for their professional evaluation and interpretation as a part of the formal investigation into his complaint concerning the dental care that was provided to his child by me. 2. Dr. [redacted] states that the topical fluoride treatment was not necessary and he did not give his consent. Reply: Dr. [redacted]’s children have been patients in our practice since March, 2006, and a review of his family’s dental records and his family’s account with ourpractice reveals that the fluoride treatment that concerns him is the twelfth (12th)that has been provided for his family. The family scheduled all twelve (12) of the appointments for the fluoride treatments with the knowledge that fluoride treatments would be completed during each of those check-up appointments. This is the first (1st) time,out of twelve(12) times, that he has raised a concern about this procedure. Some families do request that that their children not receive fluoride treatments, and we always honor these requests. The [redacted] family never made that request.3. Dr. [redacted] is trying to get this office fully investigated. Reply: Dr. [redacted] has filed a somewhat similar complaint with the Virginia Department of Health Professions / Virginia Board of Dentistry which resulted in a “full” and formal investigation. A copy is included of that complaint,a copy of our reply to that complaint, and the results of the investigation of the Virginia Department of Health Professions / Virginia Board of Dentistry. In the complaint to the Virginia Board of Dentistry, he states that Dr. [redacted] provided “unnecessary and costly fillings of two teeth.” In the complaint to the Revdex.com, he states that “the cavities are not visible on the x-rays.” We agree that the cavities are not visible on the x-rays, and we would expect them to not be visible on the x-rays. We do not know why he believes these cavities should be visible on the x-rays or why he thinks he should be able to see them radiographically. The concern with the cost is addressed later in this letter. The dental bitewing x-rays used in combination with a clinical examination can be used as a diagnostic tool to help interpret the clinical examination findings.4. Dr. [redacted] requests an explanation of the charges. Reply: The family never contacted our office for an explanation of the charges. The first we knew of his concern was when we received our copy of his formal complaint that he had filed with the Virginia Department of Health Professions / Virginia Board of Dentistry.Since a formal investigation had been initiated by him, we did not believe it was appropriate to contact him outside of the investigation process to initiate a consultation with him. The family still has not contacted our office for an explanation of the services we provided or an explanation of their insurance coverage for these services. If he would want us to review his child’s history with our office, recent examination findings, treatment plan, course of treatment, and his dental insurance coverage, we would be happy to do so. A review of local dental practices and the fee charged locally by other dentists for procedure code D2392 would probably reveal that our fees are in line with other local fees for this same procedure (D2392). A review of the EOB (explanation of benefits) statements from Dr. [redacted]’s dental insurance company reveals that amount of our fee for this service is considered “approved.”5. Dr. [redacted] states that he wants a full refund. Reply: We note that the family had scheduled eleven (11) previous appointments that included a topical fluoride treatment prior to scheduling this twelfth (12th) appointment that included a fluoride treatment. We also note that Dr. [redacted] was involved in the informed consent process relating to the restorative treatment (fillings) for his daughter, and Dr. [redacted]did personally give written consent for the treatment restorations. Insurance claims to the family’s dental insurance company were promptly submitted, and the insurance company sent the “explanation of benefits” to the family.6. Dr. [redacted] states that “it is a disgrace the way they treat patients including children.” Reply: We are board-certified pediatric dentists, and we only treat the pediatric population for whom we are trained. We believe that the successful completion of the voluntary board certification process shows the desire of a practitioner to strive to continuously offer care as well as he or she is able. We have submitted ourselves to this certification process and have continued to maintain the board certified status. A review of the treatment record reveals that even though Dr. [redacted] declined the use of nitrous oxide analgesia for his daughter’s treatment appointment, his daughter responded well to the restorative appointment: her response that day was documented as a (++) on the FranklScale. Also, our records reveal that there have been no complaints concerning the quality or longevity of the care provided for his daughter. Most of Dr. [redacted]’s complaints seem related to his inability to interpret dental bitewing x-rays and his concerns about the dental insurance benefits that he has (or has not) received. He uses the term “disgrace” in describing our treatment of “patients including children.”Dr. [redacted] does not offer a description of the treatment we offer in such a way that either supports or substantiates his claim of our treatment being disgraceful. We are, however, always looking for ways to improve the way we treat our patients and otherwise serve the public. So, if he has either any constructive criticism or a description of what part of our treatment was disgraceful, we actually would like to hear from him.Comments: Although Dr. [redacted] does not come out and directly state it, we believe he may be bothered by the small amount his dental insurance company has paid relating to these services and the remaining amount of the fee that is his responsibility. Interestingly, this same child had the exact same restorative procedures (ADA-CDT procedure code D2392) on two other teeth in 2012, and the same insurance company paid approximately 29.47% of the professional fees for those procedures at that time. The procedures he refers to in 2015 were the same procedures as in 2012, and the same insurance company paid 29.04% of the professional fees in 2015. This is not surprising for a family covered by this particular insurance company. Had his coverage been with any of several hundred other dental insurance companies, there would likely have been a much greater payment on the part of the insurance company, leaving him with a smaller out-of-pocket payment. However, by having a potentially low cost dental insurance policy covering his family andhaving treatment provided early in the calendar year resulting in deductibles and copayments for which he is contractually responsible, he received what he may consider a low rate of payment for the professional services rendered resulting in a higher out-of-pocket payment than what he may have wanted. Potentially cheaper insurance policies/premiums may result in cheaper payments from the insurance provider. As noted in our reply to the Virginia Board of Dentistry, his dental insurance company’s EOB did acknowledge that the feeswe charged were within their range of being “approved”. The investigators, including dentists, involved in the Virginia Department of Health Professions / Virginia Board of Dentistry investigation have reviewed our fee structure and likely find our fee to be less than the fee some of them charge for this same service (D2392). Other than the new “ACA/Obamacare” policies which may pay nothing ($0.00) for dental services provided, the only insurance company paying us less than Dr. [redacted]’s insurance policy/company is Virginia’s Medicaid program. It is interesting to note that the family has had their children in our practice since March, 2006, and there have been no noted complaints about the check-up appointments with the cleanings, fluoride treatments, and examinations (clinical and radiographic) during those years. Three (3) years ago, this same child had the exact same dental procedures (D2392) for two other teeth with a very similar payment (29.47%) by the family’s dental insurance company. The family did not contact our office for an explanation, they did not report us to the Virginia Department of Health Professions / Virginia Board of Dentistry, they did not request a full refund, they did not request a full formal investigation, and they did not file a complaint with the Revdex.com. It seems that Dr. [redacted]may be upset.I might also be upset about the low level of insurance payments with the resulting out-of-pocket costs. However, if my child had similar areas of decay as three (3) years ago, required the same type of treatment restorations (D2392)three (3) years later to which I personally had given writtenconsented, I still had the same dental insurance coverage, the insurance company still stated that the fees charged by the dental office were considered to be “approved fees,” the treatment was provided early in the year (January) resulting possibly in annual personal and family deductibles along with the copayments contractually required by the insurance company, and the insurance company paid essentially the same amount (29.47% vs 29.04%) in 2012 as it did in 2015, I do not think my frustration would be directed towards the dentist and/or the dental office. With subscriber “cost-sharing” principles becoming more prevalent in today’s healthcare (medical and dental) market, we all are seeing out-of-pocket costs which may be greater than we may wish, whether it be for neurology (Dr. [redacted]’s profession) or pediatric dental care. [I would not be surprised if some of Dr. [redacted]’s patients may have similar concerns about costs of “covered” healthcare services in his practice, and he may have faced similar concerns/complaints from patients in his practice.] If this complaint and reply is to be posted online, since Dr. [redacted] has initiated a full and formal investigation by the Virginia Department of Health Professions / Virginia Board of Dentistry, and since that investigation has been completed by seasoned dental investigators (including dentists) who have experience with and access to individuals who have training in reading bitewing dental x-rays, I believe it may be appropriate to include that complaint and response of the Virginia Department of Health Professions / Virginia Board of Dentistry, completewith their findings. The results of the Virginia Board of Dentistry review will be sent when completed. With all due respect, if this reply is edited for publication online, we would appreciate it very much if you would list Dr. [redacted]’s name and occupation if you list our name and business. If you are unable to do so, at the very least, please explain that he is a local physician/neurologist so the public will understand that he is someone who should understand that his training has not prepared him to read dental bitewing x-rays and that he should know how to read and interpret an EOB from a health/dental insurance company. This distinction would help to make it perfectly clear to the public that we are dealing with an individual who should have a reasonable understanding of the healthcare insurance industry but little training or understanding when it comes to reading and interpreting dental x-rays. We thank you for the opportunity to address Dr. [redacted]’s concerns with you. If we can be of any further assistance, please feel free to contact our office. Again, please note that, we will be sending a copy of: (1) Dr. [redacted]’s complaint to the Virginia Department of Health Professions / Virginia Board of Dentistry, (2) our response/reply to the that complaint to the Virginia Department of Health Professions / Virginia Board of Dentistry, (3) and the reply/response of the Virginia Department of Health Professions / Virginia Board of Dentistry that includes the results of their full and official investigation. Sincerely,[redacted], D.D.S.