Dental Health Associates

*** *** the office manager will be contacting the parent to bring the child in to see the pediatric dentist for the consultation

I called to clinic to schedule an appointment. The receptionist told me they couldn't schedule me an appointment until I paid my bill. The receptionist transferred me to the billing department. The billing department told me the same thing that the receptionist did and gave me the phone number to the collection agency that handled my past due bill. She told me they would schedule my appointment as soon as they received confirmation that the bill has been paid. I called the agency and paid the bill. The next two days I called the clinic back to make an appointment. The receptionist told me that I was banned from the clinic and all other businesses that they owned because I had a bill that went to collections. I was furious. I felt like I had been lied to and manipulated. The bill was $114.00. I had no problem paying the bill when I did. I did not deny the fact that I owed the bill. The lady called me back and was kind of rude and firm about me being kicked out. Her tone of voice was firm and sturdy. I felt very disrespected. She kept saying "There is nothing you can do about it to change it, You can never come back" I asked to speak with a supervisor and she kept telling me that nothing would change even if I spoke with a supervisor" all in all I felt disrespected, manipulated and unaccepted.

I am rejecting this response because:
After their complete unprofessionalism, we do not feel comfortable bringing our son to their office.

Review: I requested an estimate for dental work. I was very clear that I wanted an exact amount that I would have to pay. I am an insurance agent and I bought [redacted]. I have a waiting period that I have not satisfied. Therefore I was prepared to pay the full cost of my crown and anything else delta would not. The estimate I was given was for White fillings only which I requested. I told them that I only wanted white fillings so be SURE what the cost is. The dentist asked for $1000 down. I gave them the money and my procedure was scheduled for two weeks later. My final bill when I left was $130. Over a month went by and I never received a bill. I called them to get the bill. To my surprise they said it was $550. [redacted] first blamed [redacted]. Then told me the office made a $400 dollar mistake and it was extremely rare that they make mistakes like this. then she said I just had to pay because I signed a disclaimer. I said that was not acceptable and I asked her to her manager to waive the mistake. She proceeded to tell me that was insurance fraud. I called Delta. They never submitted a written estimate. I asked [redacted] why they did not do that and her reply was because you did not ask us to.I am now outraged of course becuase I wouldnt even know to ask them to do that. Delta assured me that if a written estimate was requested this would have never happened.I wrote a certified letter to Dr Lagrua. He has never even addressed it or responded. I have all the documentation to back up my claim.Desired Settlement: I would like them to waive the $400 mistake. I should not be responsible to pay for mistakes that their 20 year experienced billing coordinator makes. She had all the time in the world to submit a proper written estimate. I could not have been cleared when I told them I did not want any surprise bills at the end of this. I did not know to ask for a written estimate because I was ignorant to that. Delta set me straight going forward. I paid them $200 of the bill today.

Business

Response:

Response to ID#[redacted]Revdex.com[redacted] was seen in our office on February 26, 2013 for an initial exam. At that time treatment was recommended for which Ms. [redacted] elected to proceed with all of the treatment in one visit as soon as possible. Our office will request a down payment for services when the length of the appointment is more than two hours. Ms. [redacted] paid the requested down payment to secure her appointment on March 18, 2013. She gave the scheduling coordinator the check and indicated that she was in a hurry to pick up her kids and left the office. The scheduling coordinator noticed that Ms. [redacted] did not take her treatment plan with her and mailed it to her. We give patients a copy of and review their treatment plan which lists our office fee for the procedure and the estimated insurance payments. The patient is expected to pay the amount that is estimated not covered by the insurance company. We have a disclaimer on the bottom of our treatment plans that states; “Insurance coverage is only an estimate. Guarantor is responsible for all treatment not covered by insurance”. We always contact the insurance company and get a basic breakdown of dental benefits. We do not routinely submit pre-determinations to the insurance company, only upon patient requests. Even with an approved pre-determination there is no guarantee of payment form the insurance company. For example, when pre-determinations are sent and returned to our office from the insurance company there is typically a disclaimer stating “This statement reflects estimated benefits based on the claim submitted by your office. Actual benefits will be subject to Eligibility Status, Coverage Year, Contract Benefits, Deductible, Maximum, Primary COB Benefits, and Fee Schedule in effect on the date of Service’. We make every reasonable effort to verify insurance benefits as to not delay patient care. Delay in treatment, even weeks, could potentially mean the difference between a filling or root canal therapy, or worse yet, losing a tooth. The patient receives a statement of the transactions that occurred that day. That statement indicates a line item ‘estimated insurance’. Final bills are not issued to patients until all claims have been paid by the insurance company. . In reference to this specific case, the insurance company did not pay for the fillings as submitted based on contract limitations and applied an alternate benefit at a lower fee and paid a lower percentage on the alternate fee. Contract limitations and alternate fee percentages are not a part of our basic insurance verification process. Contract limitations are specific to a patient’s dental plan and are outlined in the member’s coverage book. We did not tell Ms. [redacted] that our office made a $400.00 mistake, but rather that her insurance company did not pay what was estimated and told her what [redacted] has written as an explanation for the lower payment. Ms. [redacted] was upset and we advised her to contact her insurance company for further information. Our office did receive the certified letter sent by Ms. [redacted] and it was put into her chart. Ms. [redacted] desires a settlement that requires our office to write off a co-pay deemed by her insurance company as her responsibility as stated in her Explanation of Benefits. This type of write off is considered a fraud by [redacted]. Please review [redacted] statement via link: http://[redacted]Ms. [redacted] came by the office on Tuesday, June 25, 2013 to make a payment on the account of $200.00. She indicated that she would be in the office at the end of next week when she gets paid to take care of the balance.

Consumer

Response:

I will say again. I asked for an exact estimate for white fillings only. If that meant that they needed to submit a written estimate to [redacted] thats what they should have done. They opted to call in and get a rough estimate. Clearly there was plenty of time between February 26 and the time I received the work to get a proper estimate. I have spoken to two other people right here in the community that had the same exact experience with this office. They were told one price and when the bill came it was a lot more than they were told. I will be happy to get written statements from those people. The staff their should be able to give a proper estimate. I am not paying for a $400 dollar mistake. Furthermore ive heard about 4 different excuses. 1. [redacted] mentions my employer dental plan. Problem I dont have an employer dental plan. 2."We file insurance as a benefit to our patients and accept assignment of benefits and balance bill as needed. When we call to verify benefits we ask basic information about the policy and get a fax or verbal confirmation." She called. I wanted an exact estimate. why is she calling? she should have known to get a written estimate from [redacted]. 3." The reason your bill is higher than estimated is because your policy has a clause that provides for an alternate benefit for tooth colored fillings" Why would that be the issue?? I asked for WHITE fillings onlyfrom the very beginning. 4."It is frustrating when insurance companies do not pay what is estimated. We are not in a position to write off any unpaid balance on the account because that would be considered insurance fraud" blames the insurance company. 5. Finally they just sent me a letter saying I signed a waiver so they werent taking any responsibility. No one in that office has taken any responsibility for this additional $400 bill. They clearly dropped the ball and instead of doing the right thing they just said "oh well you signed a disclaimer". You signed a disclaimer is not an acceptable response. The fact that I sent the certified letter to the dentist and he did not respond speaks volumes. I did that because I thought he should know how his front office staff deals with their clients. To my surprise he did not care either. Its not about the money. The fact is this office is unprofessional, rude and condescending.. I will encourage the other patients I spoke to about this to file their complaints as well. This office is a sham!!

Review: Aetna offers a Dental DMO Plan. Our 8 year old son now needs pediatric work. We contacted Aetna to obtain the required authorization number & referral for a consultation with a pediatric dentist so they can determine what work our son would need. We gave both to the in network dentist. We made an appointment with the dentist. On the day of the appointment, the dentist informed us that we cannot see the pediatric dentist because our son is over the age of 6. We are paying for dental insurance and cannot receive care for our 8 year old son who requires 2 spacers and some fillings.Desired Settlement: A letter of explanation to Aetna and us as to the reason why they are refusing to see our son.

Business

Response:

[redacted] the office manager will be contacting the parent to bring the child in to see the pediatric dentist for the consultation.

Consumer

Response:

I am rejecting this response because:

After their complete unprofessionalism, we do not feel comfortable bringing our son to their office.