Clifford Melnick, DMD PC

This patient presented to my office in extreme pain from an infected tooth. She brought in a hand written estimate that showed her insurance company would cover a percentage of the costs of...

extraction and implant replacement. Before treating the patient, I informed her that if she wanted an implant, we would need to provide additional procedures including laser sterilization, bone grafting and guided tissue regeneration to build up the bone adequately for subsequent implant placement. She said we should do what we need to do so she can have an implant. This patient (and all our patients) was advised that anything not covered by her insurance she is responsible for. In light of the fact that she was in extreme pain, there was no time to submit for a pre-estimate, so we proceeded to treat her and prepared the site for future implantation. She paid the copay for the above procedures. The insurance denied the coverage due to plan limitations and the patient refused to pay the uncovered costs. We attempted an appeal to her insurance carrier but they said it is not a covered benefit. We called her medical insurance carrier but they only cover dental claims due to accident. We did everything and more to try to work on the patient's behalf to resolve this. We suggested a small ($25) weekly payment from the patient but she refused. I have been a periodontist for over 30 years and we advise all our patients that uncovered insurance claims are the patient's responsibility. If the patient told us to extract the tooth only and she wasn't interested in replacing the tooth with an implant, none of this would have occurred. We are still willing to work with this patient regarding the balance to resolve this issue amicably.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID# [redacted], and have determined that my complaint has NOT been resolved because:

The response from the dentist is not truthful.  I was never in extreme pain.  I called the office on Thursday for an appointment on Monday (four days later).  During the four days I was told the billing assistant, Kim, would call my insurance to see what I was covered for.  Kim never called the insurance company.  I called my insurance company during the four days between the time I made the appointment and going to the office.  When I showed up at the office I had a complete breakdown of the costs and exactly what I would be responsible for out of pocket.  Kim informed me she had not gotten in touch with my insurance company and asked me for the breakdown of costs.  I took the time to show her that the extraction would cost me $80 and allowed her to make a copy of the breakdown of the implant costs.  At that time I was brought to the back to have the extraction done.  When the dentist was finished with the extraction, Kim told me I owed $455.  When I asked her why it wasn't $80 as I had been told by the insurance company, she told me the laser was not covered.  Therefore, the office knew before contacting the insurance company that the laser was not covered by insurance.  I was never informed this treatment or any other treatment given during the time of the extraction was not covered by insurance.  I have spoken to two professionals both of whom have told me that not only is laser treatment not necessary, but is usually not used when doing an extraction in preparation for an implant.  I have contacted the dentist to try to resolve this issue, but the dentist is unwilling to work with me.
 
 
In order for the Revdex.com to appropriately process your response, you MUST answer the question above.
Sincerely,
[redacted]

Review: I was given service I did not ask for. The dentist knew I was concerned about cost. I told the dentist and the assistant in charge of billing that I had contacted my dental insurance company and was given exact costs. The dentist and office assistant did not dispute the costs when I informed them what the insurance told me. When I went to the reception to pay the bill after the procedure I was charged 10x what insurance told me bill would be. Dentist told me he gave me other procedures not requested. Tried to resolve with dentist and was not able to resolve. I never would have had these procedures done if I had been informed of the cost.Desired Settlement: I have already paid $375 more than what my insurance company told me it would cost me and the dentist is trying to charge me another $548. Ideally I would want my $455 back (paid in office immediately after procedure), but will settle for no more charges.

Business

Response:

This patient presented to my office in extreme pain from an infected tooth. She brought in a hand written estimate that showed her insurance company would cover a percentage of the costs of extraction and implant replacement. Before treating the patient, I informed her that if she wanted an implant, we would need to provide additional procedures including laser sterilization, bone grafting and guided tissue regeneration to build up the bone adequately for subsequent implant placement. She said we should do what we need to do so she can have an implant. This patient (and all our patients) was advised that anything not covered by her insurance she is responsible for. In light of the fact that she was in extreme pain, there was no time to submit for a pre-estimate, so we proceeded to treat her and prepared the site for future implantation. She paid the copay for the above procedures. The insurance denied the coverage due to plan limitations and the patient refused to pay the uncovered costs. We attempted an appeal to her insurance carrier but they said it is not a covered benefit. We called her medical insurance carrier but they only cover dental claims due to accident. We did everything and more to try to work on the patient's behalf to resolve this. We suggested a small ($25) weekly payment from the patient but she refused. I have been a periodontist for over 30 years and we advise all our patients that uncovered insurance claims are the patient's responsibility. If the patient told us to extract the tooth only and she wasn't interested in replacing the tooth with an implant, none of this would have occurred. We are still willing to work with this patient regarding the balance to resolve this issue amicably.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID# [redacted], and have determined that my complaint has NOT been resolved because:

The response from the dentist is not truthful. I was never in extreme pain. I called the office on Thursday for an appointment on Monday (four days later). During the four days I was told the billing assistant, Kim, would call my insurance to see what I was covered for. Kim never called the insurance company. I called my insurance company during the four days between the time I made the appointment and going to the office. When I showed up at the office I had a complete breakdown of the costs and exactly what I would be responsible for out of pocket. Kim informed me she had not gotten in touch with my insurance company and asked me for the breakdown of costs. I took the time to show her that the extraction would cost me $80 and allowed her to make a copy of the breakdown of the implant costs. At that time I was brought to the back to have the extraction done. When the dentist was finished with the extraction, Kim told me I owed $455. When I asked her why it wasn't $80 as I had been told by the insurance company, she told me the laser was not covered. Therefore, the office knew before contacting the insurance company that the laser was not covered by insurance. I was never informed this treatment or any other treatment given during the time of the extraction was not covered by insurance. I have spoken to two professionals both of whom have told me that not only is laser treatment not necessary, but is usually not used when doing an extraction in preparation for an implant. I have contacted the dentist to try to resolve this issue, but the dentist is unwilling to work with me.

In order for the Revdex.com to appropriately process your response, you MUST answer the question above.

Sincerely,

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me and the matter has been resolved.

Sincerely,