Dental 911

Initial Business Response /* (1000, 5, 2015/06/23) */
In response to the complaint, I must first explain that there are 2 different dental practices involved. Dental 911 exists to see patients on an a walk-in emergency basis, and is open evenings, weekends, and holidays. After many trials and...

tribulations, it was determined that we could not take dental insurance because it is so complex, and patients were receiving payments for treatment we provided but not paying us, etc.
Dental 911 operates out of the same space as my regular dental practice, which does take insurance and has regular appointments and long-term patients. We participate in just a few preferred provider programs, most notable Delta Dental. We quit participating with Blue Cross several years ago, but do see patients with that insurance "out of network". We never tell patients that we are in network when we are not.
The person who filed the complaint in this situation was initially seen by a dentist working for Dental 911, with a situation that was long-standing and complex in nature and difficult to remedy. A temporary repair was attempted twice, at a minimal cost, but that repair failed.
The patient agreed to be seen as a regular patient to use his insurance, and gave insurance info to us. Our receptionist was not able to get a printout of the benefits for the patient, but was only able to get a verbal listing, by phone, of the percentages of coverage for out of network dentists. At the point where I saw the patient for the first time, all I had was this list that indicated 50% coverage.
After discussing all options with the patient, we provided the agreed-upon treatment and collected approximate 50%. I did indeed think that was the percentage that would be covered, and told the patient that it was our best estimate but that we never know exactly how an insurance company will pay. At no time did we say we were in-network.
Unfortunately, the procedures were only covered at 15% by the insurance, as the procedures fall under the insurance company's definition of "major" procedures. We billed the patient for the balance. He decided he wanted a 10% discount and sent permission to charge his credit card the discounted amount, without ever asking us to give him a discount. This approach did not make us feel the necessary sympathy for his predicament, and we decided not to accept the payment. It is unfortunate, because we discount treatment on a regular basis for our regular patients.
In hindsight, it would have been prudent to pre-authorize treatment with the insurance company before proceeding, so that the patient would know the treatment options as well as the expected copays. We usually do that, but in this case there was an esthetic issue that the patient wanted to resolve. We did provide the treatment that was agreed upon, on a Saturday, at reasonable fees.
Initial Consumer Rebuttal /* (3000, 7, 2015/06/25) */
(The consumer indicated he/she DID NOT accept the response from the business.)
The business stated the they indeed thought it was covered at 50% and charged me accordingly at the time of service - if they indeed thought that how was it that I was to believe or understand anything differently? I indeed thought it was covered at 50% also, same as the business. It was their job to find out and advise me. This mistake warrants a small compensation.
As far as this statement: "did not make us feel the necessary sympathy for his predicament" that is just plain arrogance. How about this: oh, please dr [redacted] I don't have the money and I didn't know it would be so much can you help me please, please, please. Is that enough invocation to be treated fairly and given a small 10% discount?