Carlsbad Esthetic Dentistry

Review: Due to extenuating circumstances I went to Dr. [redacted]'s office with an in-progress crown treatment. I worked with my dental insurance and Dr. [redacted]'s office to come to the agreement that as long as the dentist who started the process did not submit a claim for services, Dr. [redacted]'s office would submit an insurance claim for payment, but at the time of service I would pay $1300.00 out of pocket. Dr. [redacted]'s front office assistant ensured me repeatedly once the claim was submitted and they received payment, I would be reimbursed for the out of pocket expenses that were covered by my insurance. The crown was placed in May of 2013. I had a cleaning done in June and asked about the status of the claim and was told it had been submitted. I understand insurance claims and payment take time, but when a claim was still not on record with my insurance company in early September I called Dr. [redacted]'s office and submitted a copy of my receipt to insurance company as proof of payment. Dr. [redacted]'s office called me back explaining that it was common for insurance companies to lose claims and she would resubmit the claim. I worked with my insurance company to verify receipt, approval and payment of the claim. I contacted Dr. [redacted]'s office on November 26th to ask about the status of my reimbursement and was informed that although they receipt payment from my insurance company I would not reimbursed the $1300.00 I had paid. The front office now denied our previous agreement taking both the insurance payment and my payment. At this point I made a claim with my insurance company. On December 23rd I received a letter from my insurance company informing me that Dr. [redacted]'s office had a "treatment in progress" form that I had signed, so I had signed off my right to have my insurance cover the treatment. Dr. [redacted]'s front office assistant had tricked me into signing this form while telling me the entire time I would be reimbursed for the out of pocket expenses. There's nothing my insurance will do now to help me because of this form. Dr. [redacted]'s office takes advantage of customers who do not know or understand insurance loopholes.Desired Settlement: I want to be refunded the $1300.00 as I was told would happen.

Business

Response:

Ms. [redacted] came to us on May 1, 2013 with a temporary crown on #3. She had had the tooth prepared for a crown by another dentist, said she had decided that she did not like them, and came to us mid treatment to finish the crown. We contacted Ms. [redacted]’s insurance company to determine whether or not treatment from Dr. [redacted] would be covered. We were told that no, any treatment performed on tooth #3 would not be covered because it was considered treatment in progress because her previous dentist had filed claim on it so it was on record with her insurance company. Ms. [redacted] was then handed the phone so the insurance representative could explain this to her as well.