DentalWorks

According to the...

Explanation of Benefits from Ms. [redacted]'s insurance, the bitewing x-rays taken were denied due to frequency (see attached EOB). That would have left Ms. [redacted] with a $45.00 account balance. Further review and a call to [redacted] shows a "roll over" credit of $37.40 was included in payment from Reliance. The account has been corrected and Ms. [redacted] now has a $34.00 credit on her account.If Ms. [redacted] would like this amount refunded to her credit card, we ask that she contact the Wendover Dental office by calling [redacted] and provide the Office Manager with the credit card information. Regards,Theresa

I reviewed the response made by the business in reference to complaint ID [redacted], and find the resolution is satisfactory to me.
Regards,
[redacted]

Initial Business Response /* (1000, 5, 2016/10/06) */
As a courtesy we are writing off the balance on this account. We are not admitting to any fault, the treatment provided was clinically diagnosed and we stand behind our diagnosis. We strongly suggest to the patient that he be compliant...

with his dental care and maintain regular and routine visits to prevent any further issues. We hope this resolves the concern. Thank you.
FYI...this patient was seen in Akron Ohio, not sure why the concern is coming from Greensboro.

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
Complaint: [redacted]
I am rejecting this response because:
1.  Office manager stated that she did receive all but one email and did not respond to some. 
2.  Patient should have been advised that visiting dr was there and was not. 
3.  Since patient was not advised, office should have accepted payment as if the dr were in network. 
4.  NC is getting this because that is home office apparently-that is where I was directed. 
5.  Office manager ONLY advised that it was precollections-not to be sent to collections-AFTER I paid. This office has underhanded business practices. 
Regards,
[redacted]

Please know that this matter has been resolved. An adjustment has been made to the account balance of [redacted]. The account balance is now zerro dollars and zero cents. Please send confirmation that this matter has been closed as resolved/satisfactory.Regards,Theresa V[redacted]Patient Quality...

Assurance Manager

Initial Business Response /* (1000, 5, 2016/05/26) */
We were informed from [redacted] insurance that patient needs to contact them. They still show patient having primary insurance with another company, [redacted] will not process any claims until the Patient contacts them to review...

eligibility. Thank you.

Initial Business Response /* (1000, 6, 2015/08/06) */
We would like to apologize for the inconvenience of this situation. Please know that we are doing all we can to resolve and here are our most recent efforts. We called the insurance company and spoke with [redacted] and originally this...

claim was processed Out Of Network. They then caught the error and reprocessed the claims. They stated they had sent us updated EOB's but we explained to the Rep. we never received them. we have corrected the account and there is no balance due from the patient. We have sent [redacted] at FFCC (collection agency) an e-mail to close the account and to remove off the patients credit report if it was reported. We hope this satisfys the patient and will resolve the concerns. thank you.
Initial Consumer Rebuttal /* (2000, 8, 2015/08/07) */
(The consumer indicated he/she ACCEPTED the response from the business.)
I accept their response because the company is now following their contract with the insurance company and not billing me for an amount that I am not responsible for paying. Thank you. If Dental Works do not follow through on their response, I will file another complaint to reopen the dispute.

[redacted]
I am very sorry to
hear about your recent complaint filed to the Revdex.com. I deeply
apologize for the misunderstanding.  I meant in no way to deceive you
regarding the refund.  When we were talking, I did let you know that the
insurance paid and...

we had the credit on the account to refund. I also mentioned
the original discount that was given and due to that discount. I am very sorry,
but we are unable to discount the procedure anymore.  The original cost of
the veneer is $1,334.  And you paid $388.52.  Your insurance paid
$545.28.  You received an initial discount of $400.20.  We tried to
help you out by giving you the $30 gas card for your inconvenience.  
As far as the
estimation goes, our system we use, estimated that your insurance would not
cover a veneer.  We are unable to double check everyone’s insurance. It is
up to the patient to also know his/her own insurance benefits.  The form
you signed clearly states, “I understand that the fees listed are ESTIMATES
based upon current fees and current known coverage.”  We file all claims
to the insurance company as an added curtesy for our patients.  Patients
are always able to call their own insurance to determine their covered benefits
if they question our estimate. 
All accounts are
reviewed quarterly on a corporate level and patients are notified of the
balance on the account.  Therefore refunds are posted to all accounts,
after they are reviewed as having a credit that is due to them. So you
absolutely would have gotten your money back.  Many patients pre-pay on
their account for their procedures, so all refunds aren’t just automatically
posted right away when they are available.  As far as your insurance
payment on your account, while the insurance company cut the check on August 3rd,
we did not have the payment posted on the account until August 11th. 
I apologize that this money wasn’t refunded sooner.  Furthermore, it is
our policy to ensure the procedure is complete prior to any refunds given.
Which in your case, you received your refund on the exact date that your
procedure was completed. 
We tried very hard
to satisfy you and make sure you were happy with the tooth every step of the
way.  The lab we generally use is out of state, however you were not
satisfied with the color of the tooth. At that point, we offered to re-make the
veneer with a local lab, so that you were able to get a custom shade match.
This is not typical protocol for this procedure.  However, we wanted to
offer this for you to ensure your satisfaction.  We apologize that this
process took longer than anticipated.    
Sincerely,
[redacted]

We accepted your payment of 200.00 and posted it to your account, we then wrote off the 264.00 balance as a courtesy.  As your statements stated, you had a balance of 464.00  Your account is now at a 0 balance.Thank you

Initial Business Response /* (1000, 5, 2014/06/27) */
[redacted] from FFCC spoke to patient and explained the process of removing his account. She explained that it goes over to the credit bureau once a month. [redacted] explained that it could take 45 to 60 days. [redacted] also sent a deletion letter to the...

patient.
Initial Consumer Rebuttal /* (3000, 7, 2014/06/30) */
(The consumer indicated he/she DID NOT accept the response from the business.)
First of All, FFCC didin't act while I called first time. Despite of mistake on their side, I have to suffer a lot!!
As per Transunion, its immediately removed if they receive information from FFCC, they don't take time.
What does this mean, if the account in collection still shows up, its been more than 3 months, I paid my bills.
Final Business Response /* (4000, 11, 2014/07/30) */
On 6/27/14 [redacted] spoke to [redacted] with [redacted] to have account removed and a deletion letter was sent to the patient.

Initial Business Response /* (1000, 5, 2016/10/06) */
As a courtesy we are writing off the balance on this account. We are not admitting to any fault, the treatment provided was clinically diagnosed and we stand behind our diagnosis. We strongly suggest to the patient that he be compliant with...

his dental care and maintain regular and routine visits to prevent any further issues. We hope this resolves the concern. Thank you.
FYI...this patient was seen in Akron Ohio, not sure why the concern is coming from Greensboro.

Through fraud or incompetence company severely misrepresented insurance coverage despite being an in Network provider.I visited Dentalworks on 4/13/16 and was presented with a treatment plan. Total charge for the plan was $1167 however they said they expected the insurance to cover $601. I went there because they are an "in network" provider. They had taken my information and looked up the plan I was on. As a [redacted] employee it is a VERY common plan here in Durham. Because of the large numbers I made it a point to ask how accurate the insurance estimates are. The told me they won't know the exact numbers until they look up my fee sheet but that they are always "very close". I took them at their word, paid my portion of the bill ($566) and had the work done. I later discovered they were off on their "estimate" by over $400 and after adjustments I was presented with an additional bill for $292.59. I spoke with my insurance company who confirmed they were in network and should have known, within a few dollars, what payment would be OR they should have asked for a fee schedule. They agreed that this was either a case of intentional fraud OR a severe mistake on the part of the office staff and suggested I file a complaint with the [redacted] and the NC [redacted] Office Health Consumer Complaint division if they were unwilling to fix the issue. I contacted the office and eventually spoke with the office administrator[redacted]. Our first conversation, on 9/2/16 was productive he was surprised by the discrepancy, agreed that they should have been much closer, and said he would work with the insurance company and corporate office "to figure out the discrepancy and work on writing off difference if necessary." He then promised to call me back early the next week. He called back on the afternoon of 9/6/16 with a COMPLETELY different story. This time he claimed that despite being a network provider hey had no way of knowing my costs (incorrect according to my insurance company) and that I was responsible for presenting the fee schedule at the time of service. I pointed out that I had specifically asked about this at the time of service and was told the opposite along with the fact that he told me on our last conversation that is shouldn't have happened this way. He refused to listen or to acknowlege either of those things and also reneged on his promise to write off the difference. I have used this plan at several other dentist offices in durham over the past 9 years, both in and out of network. NONE of those have ever mis-estimated the amount this plan would pay by more than a few dollars. This is an in-network provider who's "good faith" estimate was anything but. Missing by a few dollars is expected missing my $3-400 is either fraud or incompetence and given the response I've had from the business I believe further steps need to be taken to protect other consumers. I have also left several messages for the owner of this location, Dr. [redacted], but have not had a response.Desired SettlementI would like the remainder of the bill, $292.59, written off as I was initially told would be done.Business Response When we present treatment and the cost it is always an estimate. This particular patients insurance requires a Employer Fee Schedule that needs to be presented to the practice from the patient. We did advise this at the time of treatment presentation. The balance is true patient balance and we will not be writting off any balance. We will accept payments and place the collections on hold once a payment has been received. We do apologize for the inconvenience of this, however we did provided the treatment to the patient and will expect payment. Thank you.Consumer Response A fee schedule was never requested. I had a followup meeting with at the office this morning. They agreed to write off the balance. You may close this complaint.Final Consumer Response

Poor customer service to existing patients!I sent an email about this issue as well.I see Dr. [redacted] at the practice. She's always fantastic and takes great care of me. However, the administrative staff at the practice is SO horrible they've completely chased me away. I now have to find a new dentist, because they are so impossible to deal with! Some of the issues are below:1. Long Hold Times: I called in to verify that they took my new insurance. I was on hold for over 25 minutes before I gave up. They continually put you on hold for over 10 minutes. When I'm at their practice, I watched them put people on hold, then talk to each other.2. Extremely rude staff answering the phone: When I tried to make an appointment, I let them know that I could only have an early morning/late afternoon appointment (due to my job). I let them know that I understood I may need to wait longer for an appointment at that time. The girl complained to me that no one was taking the mid-day appointments. It took OVER 10 minutes to convince her to give me an appointment at the time I needed!3. I got a phone call the DAY of my appointment (made 2 months in advance) asking me to com in for a mid-day appointment instead. The reason? They TOLD me they just wanted to GO HOME EARLY! When I told them I couldn't switch, they told me they would call me back and tell me if they would be able to keep my appointment (I never heard back, but showed up for my appointment anyway).4. No response from corporate: My husband and I have had continuous problems with the practice over the last 5 years. I've emailed their corporate office several times, with no response. They never return phone calls, either. We have talked to the local practice manager several times, but clearly nothing has changed!Dental Works CLEARLY doesn't value their patients at all. It's very clear that they would prefer no patients, since they want to go home early and want to talk to each other instead of their clients. I'm sad to leave my dentist behind, but I can't run away fast enough from the horrible treatment I've gotten from their front desk/administrative staff. I'm concerned I won't get prompt service when I find another dentist and request my dental records be faxed to them.Desired SettlementI'm tired of being mistreated and ignored!Business Response We have attempted to reach the patient on two seperate occasions, neither time has the patient answered or returned our calls. Dr. [redacted] has also sent an email to the patient with no response and has called and left a message.In the future, please send any Revdex.com concerns to [redacted] Attention [redacted]. This is the first letter we have received regarding this concern, however the patient had contacted us thru our website.Thank you,Patient Experience Department.Thank you and I do apologize for Consumer Response I received 1 phone call and voicemail. Tried to call back, but no one answered the phone and I didn't bother leaving a message. Never received any emails or phone calls from the dentist. Will be attempting to get my files to a new dentist within the next couple weeks.Business Response I apologize that you have been unable to reach the office. I have sent a Record Release form to your personal email, please fill that out and forward back to me and I will have your records sent wherever you state on the form.I do again apologize for your experience with Dental Works and wish you the best.Thank you,[redacted]

DentalWorks is attempting to collect fees for a procedure I did not authorize. On numerous occasions I had previously told the staff at DentalWorks that they were not authorized to perform any work that my insurance did not completely cover unless they first discussed it with me. On my most recent visit a 'deep cleaning' procedure was not brought to my attention nor was I told that it would cost me over $100 out of my pocket. The reason I require my authorization is because I make $[redacted] an hour and I cannot afford to pay unless I feel it absolutely necessary. Desired SettlementRefrain from attempting to collect for this unauthorized procedure.Business Response Patient's balance was due to a cleaning that the patient has been receiving at our facility 2/2011....the type of cleaning the patient has is recommended more than his insurance company covers and patient was aware of this. We did, as a courtesy,a Patient Satisfaction Discount and wrote the balance off as of 5/20/2014. Mr. [redacted] spoke to the Office Leader at that time and was told of this. We do apologize for the delay in response, this form just made its way to the [redacted].com so that it could be addressed. We are hoping this settles the concern. Thank you!Consumer Response I was not aware you were doing a 'deep' cleaning at the time of the procedure, nor was I told it was such a procedure. Possibly because the hygenist was new (I believe my usual hygenist had left Dentalworks). My revious hygenist knew to discuss with me anything my insurance does not completely cover consistently did so. So that piece of Dentalworks response is fictitious.After sending a letter to Dentalworks declaring my position I received another bill from [redacted] and that is why I filed this complaint.Since Dentalworks says they 'wrote off' the $72 I am satisfied with their response.

Review: my now Husband had 6 teeth pulled in July of 2013, I was told by the staff that we would only owe 128.00 for this proceedure, that everything was approved by his insurance. Because they did not seek preapproval for the proceedure or listen to my request for the health insurance to be contacted first I received an additional bill for 760.00 for cost on my wedding day that were not covered under his insurance. Once I contacted them they claim to have started refiling the claim but sent only a summary invoice vs a detailed invoice to health insurance. They claimed to resend the billing statement to insurance back on October 14th. I am still waiting for this to be resolved. I have since paid the bill to keep my credit in good standing. But am hoping they are still trying to get me a refund.Desired Settlement: Being I was falsely told what the final bill would be, due to the dental office not seeking preapproval for this proceedure. And I am now out 760.00 dollars that could have been used to further my husbands treatment (ultimately removal of all teeth and dentures) I would like them to process his claim and refund me the cost that I was told would be covered. We would have never had all those teeth pulled if we were told the facts.

Business

Response:

As the patient is aware, the dental insurance has requested that the claim for the surgical extractions go thru the patients Medical insurance first. We have supplied the patient with all the information needed to file thru their medical insurance back in Oct 2013. We are not medical providers nor can we contact the medical insurnace company to receive any information. We have told the patient as recent as 12/2 to contact their medical insurance and find out the status of the claim. If the medical insurance denies the claim, we need that Explanation of Benefits from the medical carrier and we can then refile to the patients dental insurance. We have gone above and beyond to assist this patient on having these claims paid. There is no more that we can do until we receive information from the Medical insurance via the patient.

Thank you,

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.

In July I asked the company to contact the medical insurance to start the process. Unfortunately they didn’t they also did not get confirmation from the dental insurance on what was required to file a claim and how much insurance would truly cover. We were given false information which if we were told the correct information would never have had the procedure completed. On August 28th they submitted a summarized version of the claim to the health insurance vs a detailed version that all insurance companies would prefer. In October I contacted the billing office to follow up with the claim to be told that they did submit a detailed version of this claim to the insurance company. They did not forward me the information and in fact when I asked for a copy of the documentation I was denied. On December 2nd when the billing department communicated with my husband it was found that the bill sent on Oct 14th was sent to the wrong address. We have been informed that I should be expecting a copy of the documentation in the mail along with a fresh claim being sent to the health insurance. We are now waiting another 28 day wait because of this error. Still hoping to see a refund of this bill. Yes I agree due to their error I am now waiting on the medical insurance to deny or except the claim so that it can be resubmitted to the dental insurance. Dental insurance will cover ninety percent of this claim if the dental office processes the claim correctly.

Review: 10/1/15 I called to schedule appointments for my daughter and myself to have our teeth cleaned and checked. The receptionist scheduled my appointment for October 8th and my daughter's appointment for October 29th. I called their office on Oct 8th prior to my appointment because I could not locate their facility, at this time the receptionist informed me that I did not have an appointment scheduled within their system, even though I had entered all time and dates into my Google Calendar while on the phone back on the first of October. The receptionist rescheduled me for October 22nd which did get entered into their system and was completed. The only care I received that day was x-rays and a long discussion of DentalWorks offerings, but not much else. At my daughter's appointment, which went well surprisingly, I shared my frustration of wanting to have my teeth cleaned. The receptionist then scheduled me for an appointment to perform an SRP or SRC, which I do not know what that stands for other than 1.5 hour procedure while hygenist pokes around in mouth wasting time, on November 5th. At the end of this long ordeal all I want to do is leave the office which may be the norm for this facility as I believe they then use this time to push unnecessary product on fatigued clientele. I was provided with 2 bottles of rinse without being aware of the cost of $18 per bottle until after the receipt was printed. After this grueling appointment I paid the balance stated of $476.20 and was happy to just be on my way and put this event behind me. Mid-December I received a bill for a nominal amount of $7.80 and two thoughts came to my head: incompetence of office staff or this is their way of recouping costs for their holiday expenditures. I feared that paying this bill would give them the ability to continue doing so. So I called the office to inquire the reason for this additional cost, which I was informed this is what my insurance did not cover. Being unsatisfied with the rinse and having not opened 1 bottle I asked if I could return the sealed bottle to cover the additional fee and be refunded the remainder. The receptionist, [redacted], stated I could bring back the unoopened bottle on January 19th , 2016 and that Kellie would assist me. Kellie accepted the rinse and processed the request through their computer requesting that their home office credit my account for the $18 which would then take care of the $7.80 due and the balance refunded to me. After leaving the office Kellie called my phone stating that they could not in fact return the rinse which they had already taken posession of and have it locked in a cabinet for me to pick up when I am back in the area of their office.Desired Settlement: I would like this business to honor the information they provided to me over the phone of returning the unopened bottle of rinse and refunding me the difference of what is owed as stated.

Business

Response:

We attempted to contact the patient 2/5/16 and left a voicemail to contact us....We are willing to refund and adjust any balance. Please contact the practice and speak with [redacted]. Thank you

Review: I have used Dental Works dental services for over 3 years now. Anytime my insurance does not cover a service I will either waive the service or discuss it with the dental assistance Paris and pay the balance at the front desk before leaving the building.Every time I go to an appointment I have to verify my address information as well as my phone number. I recall on my last visits, 10/16/2013, 11/22/2013, and 4/22/14 and again on 11/11/2014 giving all updated information. On the last visit, however, they said they did not have my updated information for my address (where I have resided almost 3 years now) nor my phone number. During the visit they stated my insurance says my premium was exceeded and would not cover a regular exam. I found this strange; since I am allotted 2 visit per year & only had been there in April of 2014. After making me wait for a very long time I was finally able to be seen and treated.After the New Year I pulled my annual report, like always, to find out a collection agency has requested $181 for dental services. After speaking with the collection agency on 1/27/2015, I was instructed to call Dental Works about this claim. After speaking to the front desk and requesting a manager I was advised THEIR system only showed a previous address, again, not my current address and that they were taking care of the claim and having it removed.I, of course believed her. But this was never done. I am sad to say I will never use Dental Works services again. This is not my fault or error, but instead a user or system error.Desired Settlement: As I stated, I was told on the phone on 1/27/2015 they found the error and the charges were being removed from my credit report. I would like for this to be done immediately. I do have a bank statement show that $35 was paid on 4/22/2014 to Dental Works #109. I would like them to pay for the $181 claim or remove it from my report IMMEDIATELY. Also I would like a formal, written apology sent to myself, the credit bureau and to Delta Dental stating that THEIR SYSTEM was the cause of the error.

Business

Response:

From: Anne R[redacted] [mailto:[redacted]] Sent: Monday, April 27, 2015 8:56 AMTo: Kelly MaceSubject: ID# [redacted]Good Morning Kelly,In reference to the concern above, there is no balance on the account. Patients insurance paid 3/25/15. We do apologize for any inconvenience this may have caused for the patient. I have had her removed from any pre-collection efforts and these efforts by no means went towards her credit report.Please let me know if you have any additional questions.Thank you,Anne R[redacted]Patient Experience Specialist/Marketing Associate972-755-0825 Office

Review: My husband, son and I had dental appointments. In a nutshell, after checking with both my insurance and this office, I was told they were in network. My husband saw a Dr. that was in network but this office did not honor the amount the insurance said we had to pay-which they are under contract with the insurance for. For myself and my son we apparently ended up seeing a "substitute" dentist who was an out of network Dr. This was in January, I was not told we were seeing an out of network dentist until May when I was trying to fight the additional out of network charges. Every communication I had to initiate with this office. I was working with one person who acted like this happened all the time and that all I needed to do was to submit the EOB's and the additional costs were to be absorbed by the dental office. However, sometime during this time, she no longer works for Creek Crossing Dental and I started all over with a second person. This person was hard to work with. She would not reduce the costs as promised. In May I received 3 bills from this company all with different due amounts. I made several contacts in June, provided every document requested including doing much of the research myself and providing documentation why the costs should be reduced. Two phone call messages and two emails left unanswered. At this point my 18 year old sons acct. was referred to a collection agency-supposedly not by the person I was working with but by this parent company. Here are the problems:1. The office should have notified me that a "substitute" Dr. would be seeing my son and me BEFORE the appt.2. My husband's EOB amount should be what we pay.3. My son's acct. and my acct. should be charged in network.4. This is almost like a bait and switch. They found out what the insurance would pay from my husband and did not want to live up to the agreement they had made.5. Bre Johnson-contact at the office-should return ALL emails and phone message;acct not referred to collection why still being workedDesired Settlement: Refund the difference paid and the amount shown that we should have paid on my husband's EOB-this is around $75.00Refund the difference paid on my son's and my acct from out of network to in network-this is around $250.00Office needs to inform patient BEFORE any work is done that a substitute is doing the work and he may not be in network so that the patient has an opportunity to make the decision to possibly pay the additional amountOffice workers need to respond to all correspondence

Business

Response:

Why is this complaint coming from Revdex.com of NC when the patient is in Texas? Here is our response

The adjustments are correct based on the notes and account

review. The patient received the checks from delta and cashed them vs paying

the practice. During the time the Office Leader was researching the account and

conducting a breakdown, patient was sent to pre-collection. The Office Leader

let the patient know she would not go to collections as long as she paid the

practice what was inadvertently paid to her vs the practice. The emails she

states she sent were not received by the practice. At this point there is not

much else we can do other than extend our apologies again and let her know that

we have implemented some new reporting that helps those at the practice level

catch and address these issues prior to patients being sent to pre-collect. We

have also hired a new doctor and are going forward proud to be in network, we

realize this caused confusion and stress on the patients during the interim

doctor.

v

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because:

1. Office manager stated that she did receive all but one email and did not respond to some. 2. Patient should have been advised that visiting dr was there and was not.