Cal North Insurance Brokerage/Intellisurance

Complaint: [redacted] I am rejecting this response because: The Business in question was providing the incorrect informationWhen asked on three different occasions during the process of my visit, if they were a in network provider for my insurance, I was assured they were The receptionist is the only one who took the time to ask where my insurance claims were filed and advised me after the treatment that they are not a in network provider for the BCBS program that I was covered under If any of the other individuals had taken the time to review my cardI would have never scheduled with them The situation is due to the incompetence of the staff not taking care of the client and reviewing the insurance card The receptionist was very aware of the different plans, however the individuals processing and verifying the insurance lacks awareness Regards, [redacted]

[redacted] December 3, 2015To Whom It May Concern,In response to complaint # [redacted] -Patient was seen in our office for dental servicesArecommended treatment plan was proposed to the patient after diagnosis was given by thedentist.At Central Texas Dental Care we would certainly never try to up-sell any dental procedure & wewill only recommend treatment that is necessary for the patient's dental health.Many patients come in expecting their mouths to be in a healthy state and that they will qualifyfor the preventative service that their insurance states they will cover twice per year.Under CDT dental code D(Adult Prophylaxis-Removal of plaque, calculus, and stains fromthe tooth structures in the permanent and transitional dentitionIt is intended to controlirritational factors & patient cannot have any pocketing over 3mm)If pocketing is over 3mm ormore then the patient would then fall under CDT dental code Dor Dnon-surgicalperiodontal service (Periodontal scaling and root planing 1-or or more teeth per quadrant).This procedure involves instrumentation of the crown and root surfaces of the teeth to removeplaque and calculus from these surfacesIt is indicated for patients with periodontal disease andis therapeutic, not prophylactic, in natureRoot planing is the definitive procedure designed forthe removal cementum and dentin that is rough, and/or permeated by calculus or contaminatedwith toxins or microorganismsSome soft tissue removal occursThis procedure may be used asa definitive treatment in some stages of periodontal disease and/or as part of pre-surgicalprocedures in others).If you have any further questions please, feel free to contact me @ [redacted] .Sincerely, [redacted] -AdministratorCentral Texas Dental Care

Complaint: ***
I am rejecting this response because: I have not received any check from the insurance companyI will have to check with the insurance company to see if one is being issuedI have everything setup that all payment is setup that all payments go directly to the clinic
Regards,
*** ***

To Whom It May Concern, In reference to a complaint submitted by Ms*** concerning her dental insurance & date of service 2/1/Ms*** insurance was verified for date of service 2/1/& we are considered out of network with BC/BS FEP BlueDentalIt does state on our
Proposed Treatment Plan that insurance coverage is only an estimatationGuarantor is responsible for all treatment not covered by insuranceThe fees listed on this treatment plan will be honored for daysMs*** did have a comprehensive oral evaluation & intraoral-complete series of xrays that were needed to give Ms*** the proper diagnosis & the claim was submitted to the insurance company for paymentUpon reviewing Ms*** account history, I do see where we received an EOB from the insurance company with a zero paymentPayment for date of service 2/1/was mailed to the patient in the amount of $for date of service 2/1/6 and not mailed to the provider for services because, we are out of networkA note was made on 2/9/that patient had received the payment & it would have left Ms*** a balance here in our office of $not a balance of $that she still owes due to payment going to her. Five statements have been sent to Ms*** along with a day letter, day letter, & a day certified letterCTDC has not had any response from Ms*** concerning any of this communication that has been sent from our office since 2/11/to dateWe would have been more than happy to discuss any concerns with Ms*** had in reference to her account
Please see attached treatment plan, account history, & EOB from insurance company
Sincerely,
*** ***
Central Texas Dental Care

I understand Ms***'s frustration & we do file insurance as a courtesy to our patients in or out of networkOur deepest apologies for the miscommunuication of our in or out of network statusThe individuals handling the insurance are no longer with usI will be more than happy as a one time courtesy to adjust off $of the balance that is now at $(which includes finance charges & charges for DOS 2/1/16) on Ms***'s accountThat is the difference of what insurance did not cover & any finance charges that had accrued on the accountThat would leave a remaining balance of $in which insurance paid but, the check was mailed to Ms***I will adjust the account today 6/23/to reflect the adjustment of $& the balance will remain $until paid by Ms*** from the check she received from insurance
Regards,
*** ***
Central Texas Dental Care

Complaint: ***
I am rejecting this response because: The Business in question was providing the incorrect informationWhen asked on three different occasions during the process of my visit, if they were a in network provider for my insurance, I was assured they were. The receptionist is the only one who took the time to ask where my insurance claims were filed and advised me after the treatment that they are not a in network provider for the BCBS program that I was covered under. If any of the other individuals had taken the time to review my cardI would have never scheduled with them. The situation is due to the incompetence of the staff not taking care of the client and reviewing the insurance card. The receptionist was very aware of the different plans, however the individuals processing and verifying the insurance lacks awareness
Regards,
*** ***

[redacted] December 3, 2015To Whom It May Concern,In response to complaint #[redacted]-Patient was seen in our office for dental services. Arecommended treatment plan was proposed to the patient after diagnosis was given by...

thedentist.At Central Texas Dental Care we would certainly never try to up-sell any dental procedure & wewill only recommend treatment that is necessary for the patient's dental health.Many patients come in expecting their mouths to be in a healthy state and that they will qualifyfor the preventative service that their insurance states they will cover twice per year.Under CDT dental code D1110 (Adult Prophylaxis-Removal of plaque, calculus, and stains fromthe tooth structures in the permanent and transitional dentition. It is intended to controlirritational factors & patient cannot have any pocketing over 3mm). If pocketing is over 3mm ormore then the patient would then fall under CDT dental code D4341 or D4342 non-surgicalperiodontal service (Periodontal scaling and root planing 1-3 or 4 or more teeth per quadrant).This procedure involves instrumentation of the crown and root surfaces of the teeth to removeplaque and calculus from these surfaces. It is indicated for patients with periodontal disease andis therapeutic, not prophylactic, in nature. Root planing is the definitive procedure designed forthe removal cementum and dentin that is rough, and/or permeated by calculus or contaminatedwith toxins or microorganisms. Some soft tissue removal occurs. This procedure may be used asa definitive treatment in some stages of periodontal disease and/or as part of pre-surgicalprocedures in others).If you have any further questions please, feel free to contact me @ [redacted].Sincerely,[redacted]-AdministratorCentral Texas Dental Care

Complaint: [redacted]
I am rejecting this response because:
The catch here is. the dentist had not even evaluated me yet when I was told the cleaning would not be covered by my insurance and would  be an additional $149 or, I could go home untreated. This dentist's office has done the same thing to my wife, and, to my son. Their response is intentionally misleading as are their business practices.We  do not accept this response and assert that not one word of it is applicable to this case, nor essentially truthful.We will contine to pursue all means at our disposal to alert other consumers as to this dental offices deceeptive and unfair business practices.We feel it is essential that the Revdex.com keep a public record of this complaint so that other unknowing clients or potential clients of this busines do not fall into the same trap as we unfortunately did.
Regards,
[redacted]