Briggs Family and Cosmetic Dentistry

Review: Business first said procedure was covered under insurance, then after work was finished, said was not covered, then sent bill for full price after agreeing to a discounted price. Then, said they didn't receive insurance card until after work was completed. Then, said would send to health insurance and would send proof of submission but did insurance said no submission and I receive no proof.Desired Settlement: resolve dispute

Business

Response:

Roger A. Briggs, DOS, Ltd. Bradley A. Briggs, DDS February 1,2016 RE: TO #[redacted] called our office to make an appointment with us on 7-16-15. At that time, we gathered some personal information, and were told she did not have insurance info. She informed us that she was driving, and would call back with the info. See Exhibit A, attached, We then wrote an extensive note in our schedule on that same date. We scheduled her for a New patient consultation on July 17th at 9:20 am. Stephanie came in for her appointment on July 17,h, and provided us with BCBSAZ as her Insurance info, and did not even put in the insured birthdale. As you can see from Exhibit B attached, it was our staffs handwriting that changed it to Delta, and with an insured birthdatc. Stephanie's own handwriting shows mis-information. Stephanie came in the office in pain, and we informed her that we would take a $50.00 payment as that was a typical deductible, we would let insurance close, and balance bill her. She agreed, and a filling was placed to relieve her from pain.After the fact, we were given the Delta information, it was faxed to us after the appointment. On 7-28-15, we sent an invoice to the patient, as the services were not covered by her dental insurance. Unfortunately, wc can not be responsible for the patients' treatment when we are not provided with the correct information. Statements were sent to the patient on 7-28-15, 8-6-15, 8-31-15, and 10-2-15. On 10-8-15, we informed the patient that if the balance was not paid, it would be turned over for collections. Another statement was sent to the patient on 11/12/15. Wc had no response, and turned it over to Transworld, the company that does our collections. Our office spoke with [redacted], her husband, and told him as a courtesy, we would try to put the exam and x-ray through Medical insurance. See attached Invoice dated 11/23/15, showing Credit adjustment of $107.00, as it was being billed to Medical Insurance claim. Exhibit C Attached. We had asked Mr. Campbell to pay the $160.40 upon receipt, and we would wait on the $107.00 to see if Medical Insurance would cover it.Medical and Dental Insurance were billed on the patients behalf, both explaination of benefit attached. Exhibit D and H. Both of these go to our practice and to the patient. Both state "not a covered service." It is clear that the balance is the patients responsibility.The patient claims in the complaint that neither was it submitted, but that he also received no proof of submission. The insurance company sends every patient the BOB, as well as we sent him a certified copy, which was signed for on 1-26-16. Exhibit F Attached. There is no valid reason for this complaint.The patient called and stated she was on disability, they were in financial difficulily, and could we simply write off the balance. We did the service per the patient request to get her out of pain, and they are making claims against our company that are simply not valid. The patient has paid the bill to stay out of collections, and we felt it settled at that point.Please clear our company of any wrongdoing in this matter.Sincerely,[redacted]

Review: We were quoted a specific amount for a surgical dental procedure. We re-confirmed the amount prior to moving forward to ensure that all costs were correct and that the out of pocket expenses were accurate after their billing department had spoken to our insurance company. The procedure was complete and we paid for all out of pocket expenses prior to leaving the office. A few weeks later we received a random bill from them for over 400.00. After inquiring and explaining what we were quoted, the billing specialist stated that she would look into it and follow-up with us. This never happened, so we assumed it had been corrected. After a few more months we received a statement showing a past due balance, again we called the office and spoke to the billing specialist who this time tried to explain that insurance only covered a specific amount and that the amount that they quoted at the time of surgery was incorrect. I stated that we were not going to pay it because we already paid the amount that we were told was due at time of surgery and that was the amount we agreed to. She again stated that she would investigate and call us back. the call never came but again a past due statement arrived. I called the office and asked to speak to the office manager, was told that she was not available but that [redacted] would investigate and call me back. She follow-up with me a few days later to advise that after researching it that we owed the money and that the first amount was wrong. I finally gave up and paid the amount to ensure that our stellar credit rating as not tarnished. Advised that I could not believe that Dr. [redacted] did business this way. She took the payment and said she understood that we would no longer be using them. This is absolutely bait and switch and they feel that they can get away with this. The amount was agreed to prior to the surgery and should not be able to be changed after the fact, even if they made a billing error that showed the incorrect amount to be paid from the insurance company. That was there mistake and not minemDesired Settlement: I should not be responsible for the erroneous 400+ dollars.

Business

Response:

In response to Mr. [redacted] complaint regarding our billing practices.

We strive to give our patients excellent customer service in all aspects of their care.

On 10/08/2013 we presented the patient with a proposed treatment plan for a total of four procedures totaling $2810.00. The patient signed the treatment plan which very clearly states, “Insurance coverage is only an estimation. Guarantor is responsible for all treatment not covered by the insurance.” As a courtesy we verified the patient’s insurance benefits and eligibility. The patient paid $2054.80 at the date of service. Delta paid $225.00 towards the total on 11/06/2013. We are contracted as Delta Premeir providers and as such we wrote off a total of $116.00. This leaves a balance of $414.20 which was the patient’s responsibility as per the proposed treatment plan.

We do our best to ensure that our patients understand the services we provide as well as the fees we charge. No medical practices are ever able to guarantee what third party contracts are going to pay. Insurance companies themselves will not do so. On any pre determination of benefits there is always a disclaimer that there is no guarantee of payment. This is what Mr. [redacted] insurance company did in this instance.

Mr. and Mrs. [redacted] called our office three times to discuss their bill. Each time they were told of their financial responsibility. They were sent seven statements by mail. On 07/31/14 Mr. [redacted] paid the outstanding balance and reported they would not be returning to the practice. We respect his decision regarding his care.

[redacted] Family Dentistry