Dental Health & Aesthetics Center

Review: The overview is that they claim that my insurance didn't cover basic services such as non metal fillings and fluoride treatment, so I paid for them. I called my insurance company and learned they DID cover these services. I had to get refunded for both of those services from the dental office on two seperate occasions. My insurance called them to straighten out the situation on the fillings, and they still claimed it wasn't covered when I got to the office to have that procedure completed.They deal with insurance day in and day out. They know what insurance will cover and what it will not. It's not rocket science. I shouldn't have to bring in a stack of paperwork to double check what they say.They also have other "fees" tacked onto my bill, such as sterilization fee, and office visit for observation, when this should be included in my co-pay.I feel this dental office is charging the customer AND the insurance companies for the same service, when this is illegal to do so.Desired Settlement: There should be some sort of investigation into illegal billing or insurance fraud. If found in violation of state law, have their business and dental license revoked.

Business

Response:

Dear Revdex.com of San Diego,

This is a response to your letter of Complaint ID [redacted].

Following is an explanation of his complaints:

Fluoride treatment - If you read the patient's plan "exclusions and limitations" it is stated that fluoride is covered only up to age 18. Refund was given when it should not have been given.

Co-payment for his composite filling(D2335)- $40+desensitizer fee(not a covered benefit). Since patient insists his insurance covers it, we gave him the refund.

"Office Fee"(D0999)- clearly stated in the patient's plan schedule as being $5.

Office is charging patient AND insurance - Patient is on a "managed care dental plan" which means there is no billing to the insurance and no reimbursement is received from them.

I hope this answers his questions. It is most unfortunate that patients don't understand how their insurance plans work. It does not help that insurance company operators don't really have the proper training or understanding and can give patients wrong information.

If there are further questions, please give us a call at ###-###-####.

Thank you.

Office Manager

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.

"It is most unfortunate that patients don't understand how their

insurance plans work. It does not help that insurance company operators

don't really have the proper training or understanding and can give

patients wrong information"

They also CC'd me on that email back to you, which seems very unprofessional. Earlier they sent me a very condescending letter stating they "couldn't make me understand my insurance".

When I ask my insurance and they say they will cover what the dentist says they will not cover, I shouldn't be the intermediary between them. It only makes sense to me that the Dentist is the one profiting from the situation because of the majority of clients lack of regard to follow up with their insurance to see what is covered and what is not. They "fired" me as a client because I asked too many questions about my bill and asked for too many refunds for things that are covered. I shouldn't have to double check every charge with my insurance company.

Here is a list of other unsatisfied people on [redacted], the largest website for reccomendations. Don't take my word for it. Take another 47 people who had the same bad experience, and say basically the same thing I am.

Since they know I placed a complaint with the Revdex.com, I am afraid they will come after me with a lawsuit.

Regards,