Carmel Valley Endodontics

Review: My son was referred to Carmel Valley Endontics (CVE) for a root canal from our primary dentist.

I made arrangements with [redacted] for my son's appointment. We spoke several times and she was very nice. My biggest concern from the very beginning was how much it was going to cost my out of my pocket. She had all my insurancce information. She had let me know that the procedure would be all covered by my insurance. Based on this information I schedulecd the appointment.

On the day of the appointment my ex-wife took my son for the procedure, I received a call from a woman who worked for CVE and she let me know that my son was in the chair and she wanted to collect a payment from me. Of I said I had been told I would have to pay anything by [redacted]; she got very argumentitive and told me how she spoke to me several times and informed of this already. I had never spoke to this woman. She then put me on the phone with the office manager, and she was ionstantly belligerant. She just told me its my responsibilty to know my insurance, and became very demeaning. She asked do I expect to go the grocery store and not pay? She didnt even allow me to answer the question. She proceeded to the threaten to send me to collection tomorrow if I didnt pay. The office manager would never let me speak.

I have had many doctors accept my insurance as payment in full and set this appointment up believing this to be the case. This really amounts to bait and switch, and is a willful act of intimidation.

By the way they reacted I am connvinced they deliberately set up this procedure and told me it was all covered, only to change that arrangement when my son was in the middle of the prcedure.Desired Settlement: A refund of payment my ex wife paid at office and of approximately $75 and a waiver of the remainding approximately $75 they are demanding.

Business

Response:

September 12, 2013

has told us. We are responding to the complaint from Mr. [redacted], and quite frankly it's very simple:

Mr. [redacted] called to schedule an appointment for his son [redacted]. He wa

To Whom This May Concern;

1. Our office, Carmel Valley Endodontics, has an excellent system in place when it comes to answering questions regarding insurance. Every patient that comes into contact with our office follows a certain protocol. We help our patients to understand his/her individual plans so there are no surprises when the patient comes in. We never guarantee that the insurance company will pay, and at all times we inform our patients that any information regarding money is only an estimation based on what the insurance company nted a breakdown of benefits before scheduling, which we did. We informed Mr. [redacted] there was approximately a $75.00 co-pay because his insurance pays at 90%. (The contracted fee for a root canal on tooth #31 is $728.00 making the co-pay $72.80).

2. Mr. [redacted] informed our office that [redacted] would be brought to the office by his mother. Again it was reiterated that there was a co-pay. He stated that he would inform the mother of this. Mr. [redacted] also stated he was online on our website and would print out paperwork and send it with the patient, his son.

3. The mother brought their son, along with our paperwork, which was all signed by Mr. [redacted], along with a copy of the dental card and a summary of the patient's insurance plan (See attached documents). Please note that Mr. [redacted] was well aware of the In Network Coinsurance portion of the summary, it states Basic Restorative (Endo) is 10%. (He had it in his possession and sent it to us.)

4. When it was time to collect the estimated co-pay, one half of the co-pay was collected from [redacted]'s mother ($36.25) and we called Mr. [redacted] for the remainder ($36.25). Mr. [redacted] became very agitated and stated we never went over any of this with him. We stated that it had been discussed before making the appointment and he said that never happened. At that point the office manager took the call. The office manager informed Mr. [redacted] that she would inform our doctor of his concerns. Mr. [redacted] was very angry and hung up the phone on the office manager.

We work hand in hand with our general dentists. The doctor that referred [redacted] to our office is one of the most respected doctors in the area. His excellent staff tried to warn us that this may happen. They informed us that Mr. [redacted] does not want any surprises concerning insurance and his co-pays. We went to great lengths to make this happen.

In closing, we are contracted with the patient's insurance company, [redacted]. We are held accountable and must collect the co-pay per the rules and regulations of the contract. With that being said, we charge out the contracted fee and the patient is supposed to pay their contracted co-payment.

Thanks for resolving this in a timely fashion.

Sincerely,

Carmel Valley Endodontics

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID 9713223, and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

The dental office response is completely fabricated, they did not disclose the information stated until my son was in the middle of a procedure; which was different than they had told me when I set up the appointment. They used bait and switch tactics, [redacted] at their office made it clear that my insurance would cover everything and there would be no charge. Thus the reason we set up the appointment.

Review: In July 2008 I paid Carmel Valley Endodontic (CVE)a significant amount of money to preform a root cannel on tooth #18. The doctor indicated that the entire root had been successfully removed and I should proceed with getting a crown. Several weeks ago I was referred by my dentist to a new endodontic office for an emergency root cannel in the same tooth, both doctors indicating that CVE failed to remove the entire root causing a slow festering infection in the remaining tooth root. I contacted CVE after I recovered from the second root cannel, only to be told by Stacy that [redacted] would return my call. A week later I contacted CVE again only to be berated and hung up on by [redacted], who would not let me complete a single sentence. Amazingly she is their office manager, and apparently had no interest in listening to me explain the medical complications I was experiencing as a result of their work. As a paying customer and concerned patient I had my new endodontic office forward over a report showing before and after pictures clearly indicating infection, and the short root cannel done by their office. This effort did nothing to induce CVE to engage in a two sided conversation (where I can talk too), or produce any kind of resolution. As a result I am forced to file a complaint against this doctor for faulty work that caused me to have to pay for the same procedure twice. I will also need a new crown, as the crown I had placed after the root cannel preformed by CVE had to be punctured to allow for the second root cannel. I asked both my dentist and new endodontic office why it took so long for the infection to lead to pain, they indicated that a young healthy adult can sometimes fight off infection, but eventually the infection will multiply in the place where the partial root was left. They also indicated that had I waited, as a result of the infection I could have lost the tooth.Desired Settlement: I didn't contact CVE initially because of the painful emergency situation the infection created. I also wouldn't have felt safe returning to the same doctor who preformed the faulty work. I am asking for a refund of the money I paid them (approx. 1000), as well as 1500 for a new crown. I am unable to get the exact figure as Kristy who would not provide that information. My total request is for 2500.00.

Business

Response:

Hello Ms. [redacted],

We apologize for not getting back to you in timely fashion but were under the assumption that [redacted] had dropped her complaint to the Revdex.com. We have made every effort in resolving this issue with Ms. [redacted] and feel that she was happy with the outcome as well. On June 20, 2013, we had the patient back to our office and did a composite filling at no charge and also refunded all of the money that she paid on 07/16/2008 in the amount $634.50. We feel that we addressed all of her concerns right away and verbally she expressed that she would not move forward with the Revdex.com. We are more than happy to attach the emails sent back and forth from the patient to our office, the patient stated on June 3 , 2013 that she would rescind the complaint upon receipt of the check and the filling. We appreciate any help so that we can resolve this amicably.

Sincerely,

Office Manager

Review: I went to this office to get a quote on dental service. I provided my insurance information. The dentist then made a preliminary examination and gave me three choices as a solution. One solution was to re-do the root canal. After telling him I wanted to minimize my out of pocket cost, I asked him how much for the root canal and he with confidence said 297. I said that sounds fine. Two weeks later, I came in for the service which went fine. I then went to the receptionist and paid the 297. Three weeks later they told me that my insurance was asking for 300+ more. After further questioning, I discovered that they claimed they had told me that insurance does not always cover all costs and that they initially used an 80% coverage formula to calculate the 297, and that my insurance only covered 50%. This was never discussed with me and would have changed my decision. I should have been told that out of pocket expense could not be exactly calculated...I was only told with high confidence that my cost would be 297. I have called and emailed the dentist with no success, and now they have put in collections for my refusal to pay. I have disputed the charge, but unless I pay, the collection company is going to report this to the credit agencies as n unpaid debt thus reducing my credit score. The dentist should never have quoted me an exact amount unless they were sure. This was not my fault and yet my credit is now tarnished by this event.Desired Settlement: Please adjust billing to be only 297 and take off the debt from my credit

Business

Response:

Please let me know once you receive this attachment.

Sincerely

Carmel Valley Endodontic.

March 17, 2014

To Whom It May Concern;

We are responding to the complaint from Mr. [redacted],

Our office, Carmel Valley Endodontics, has an excellent system in place when it comes to answering questions regarding insurance. Every patient who comes into contact wit our office follows the same protocol. We help our patients understand his/her individual plans so there are no surprises when the patient comes in. We never guarantee that the insurance company will pay, and at all times we inform our patients that any information regarding money is only an estimation based on what the insurance company has told us; the insurance company dictates all pricing. So simply put,

1. Mr. [redacted] was given our office paperwork, which he filled out, initialed, and signed, (see attached). He was seen for a consultation on 8/5/13. At that time he chose the option of a root canal re treatment. He was informed that an estimated co- pay (based on the information we received) would be collected a the time of he service with Dr. [redacted].

2. Treatment was completed on 8/22/13, and his co-pay was collected. Once again, Mr. [redacted] was informed that this was only an estimate. He ha been informed several times that the insurance company, not our office dictate the patients out of pocket.

3. The Guardian Insurance Company paid $457.00. Per the explanation of benefits , the treatment is covered at 50%, resulting in a co-pay of $557.00

A statement, as well as the "EOB", was emailed per his request informing him of his balance. The patient called asking why his out-of-pocket was more than what he was informed. I explained to him again that it was only an estimate. It was explained that we bill the insurance as a courtesy. When I informed him that his covered molar root canals at 50% and not 80% (which is what they pay on a bicuspid tooth). I informed him that this was out of our hands and encouraged him to contact his insurance for any other questions he may have. I informed him that we are contracted with his insurance company and we are not able to adjust his balance due to our contract with them. We sent the patient copies of his ledger and insurance explanation of benefits.

In closing, we are contracted with the patient's insurance company, The Guardian. We are held accountable and must collect the co-pay per the rules and regulations of the contract. With that being said, we charge out the contracted fee and the patient is responsible for their contracted co-payment.

Thanks for resolving this in a timely fashion.

Sincerely,

Carmel Valley Endodontics

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.