Dental Care of Rancho Bernardo

Let me begin by correcting something in the complainant’s letterHis complaint was addressed to Dr*** ***I, Dr*** ***, was the dentist that saw both of themI also own
Dental Care of Rancho BernardoI just don’t know why the complainant addressed his complaint to Dr*** ***
Now, let’s proceed to the complaint itselfWe treated the complainant’s wife differently from the complainant because they have different casesWith ***, we were sure that insurance will cover the procedure while in Jamie’s case, we were notIn our office, if we can’t be sure if insurance will pay for a certain procedure, we file a preauthorization or predetermination with the patient’s insuranceOn the date of her dental exam, we couldn’t give a detailed description of the fees because we’re not sure what the insurance will coverSince we do not know how much the insurance will cover, we did not give her the option to pay halfWe only do that when we have a more accurate treatment plan to present
The patient, *** Wwas diagnosed to have a faulty crown on tooth # and a faulty bridge on tooth # 28-on 12/06/The problem is not very evident on the radiographHence, we wanted to send in a predetermination because we don’t want the patient to be unjustly burdened by the fees if insurance decides not to cover the proceduresIn order to increase the probability that her insurance will approve and pay for their portion of the procedure, we even sent intraoral pictures aside from the needed radiographs
On 12/07/2013, our office sent electronically a preauthorization/predetermination to the patient’s insuranceOn 12/19/2013, we called the patient’s insurance to check for the status of the predeterminationThey said they need additional info and faxed a questionnaireI am attaching a copy of the questionnaireWe completed the questionnaire, and faxed it back to the insuranceWe also informed *** about the status of the predetermination. As we were informing her, she responded by saying that she would like to just go back to the office that did the crown and bridge originally, and she will come in to sign the release of recordsOn 12/19, we emailed her x-rays to the patient’s dentist, Dr***, at ***@sbcglobal.netI am attaching a copy of the email from the “sent” folder of our yahoo account proving that an email was sent to Dr*** on 12/19/at 6:PM
On 12/23/2013, we received the insurance company’s response approving the preauthorized proceduresI am also attaching a copy of their letter just to prove that a preauthorization was sent to the insuranceSince the patient on 12/19/wanted to transfer to another office, we did not pursue the treatment or explain the fees to her anymore
On 01/21/2014, patient came in to request her x-rays to be sent to her because she said Dr*** did not receive themWe emailed her x-rays to her email address and she confirmed that she did receive that emailI am also attaching a copy of that email from our “sent” folder dated 01/21/2014, 5:PMPlease note that we can only provide evidence that the emails were sent by taking screen shots of the “sent” emails, so please disregard the ads
In closing, we regret that this miscommunication happenedOur office always aims to try to give our very best to our patientsThis is evident from the experience that *** had with our office in which he described “my local office treated me like a king”

Review: I have insurance via my wife's work, which makes me the dependent. My local dentist office treated me like a king. I was given an exam, cost of treatment, detailed description of treatment, option to pay half on first visit and overall great service. For some reason they have treated my wife very differently and I do not know why. At her first visit to the dentist office, she had her dental exam. She was not given a detailed description of treatment like I was, she was not given the same option to pay half on her first visit like I was, she was told several times to her face that they ( the dentist office ) were waiting for an approval from her insurance. I went there with her on two occasions, first one was to get a detail description of treatment, was told that they ( the dentist office ) was waiting for approval from the insurance and still had not received anything from the insurance, and that they have no control over the insurance. On the second occasion, which was 01/21/2014, my wife and I both went there wanting an explanation of why they were treating my wife differently. We received the same excuse that they ( the dentist office ) was waiting to approval, that they had not received anything from the insurance, and that they have no control over the insurance. It was at this time that we asked for her dental record to be sent to her own personal email. The office also failed to send her dental records to a new dentist office, which my wife sighed a document authorizing the information to be sent. I have called my insurance which is through my wife's work, and have documentation that a pre-authorization was made on 12/20/2013, it has codes for the procedures, cost of procedures, insurance coverage of procedures. This office has lied to the faces of both my wife and myself twice now.Desired Settlement: I would like a refund of the money that I paid for my own dental needs so that my wife can have her own dental needs taken care of at another dental office. The total of my requested refund is $987.80 dollars

Business

Response:

Let me begin by correcting something in the complainant’s letter. His complaint was addressed to Dr. [redacted]. I, Dr. [redacted], was the dentist that saw both of them. I also own Dental Care of Rancho Bernardo. I just don’t know why the complainant addressed his complaint to Dr. [redacted].

Now, let’s proceed to the complaint itself. We treated the complainant’s wife differently from the complainant because they have different cases. With [redacted], we were sure that insurance will cover the procedure while in Jamie’s case, we were not. In our office, if we can’t be sure if insurance will pay for a certain procedure, we file a preauthorization or predetermination with the patient’s insurance. On the date of her dental exam, we couldn’t give a detailed description of the fees because we’re not sure what the insurance will cover. Since we do not know how much the insurance will cover, we did not give her the option to pay half. We only do that when we have a more accurate treatment plan to present.

The patient, [redacted] W. was diagnosed to have a faulty crown on tooth # 19 and a faulty bridge on tooth # 28-30 on 12/06/2013. The problem is not very evident on the radiograph. Hence, we wanted to send in a predetermination because we don’t want the patient to be unjustly burdened by the fees if insurance decides not to cover the procedures. In order to increase the probability that her insurance will approve and pay for their portion of the procedure, we even sent intraoral pictures aside from the needed radiographs.

On 12/07/2013, our office sent electronically a preauthorization/predetermination to the patient’s insurance. On 12/19/2013, we called the patient’s insurance to check for the status of the predetermination. They said they need additional info and faxed a questionnaire. I am attaching a copy of the questionnaire. We completed the questionnaire, and faxed it back to the insurance. We also informed [redacted] about the status of the predetermination. As we were informing her, she responded by saying that she would like to just go back to the office that did the crown and bridge originally, and she will come in to sign the release of records. On 12/19, we emailed her x-rays to the patient’s dentist, Dr. [redacted], at [redacted]@sbcglobal.net. I am attaching a copy of the email from the “sent” folder of our yahoo account proving that an email was sent to Dr. [redacted] on 12/19/2013 at 6:07 PM.

On 12/23/2013, we received the insurance company’s response approving the preauthorized procedures. I am also attaching a copy of their letter just to prove that a preauthorization was sent to the insurance. Since the patient on 12/19/2013 wanted to transfer to another office, we did not pursue the treatment or explain the fees to her anymore.

On 01/21/2014, patient came in to request her x-rays to be sent to her because she said Dr. [redacted] did not receive them. We emailed her x-rays to her email address and she confirmed that she did receive that email. I am also attaching a copy of that email from our “sent” folder dated 01/21/2014, 5:24 PM. Please note that we can only provide evidence that the emails were sent by taking screen shots of the “sent” emails, so please disregard the ads.

In closing, we regret that this miscommunication happened. Our office always aims to try to give our very best to our patients. This is evident from the experience that [redacted] had with our office in which he described “my local office treated me like a king”.