Dentistry At The Center PA

Initial Business Response /* (1000, 8, 2015/12/04) */
I apologize for the delay, our office manager was out of the office. I did not know about this complaint until Monday, November 29.
Dentistry and medicine are coded and billed according to treatment rendered. Ex: a patient is not...

charged/billed for having diabetes but rather the treatment for the disease. A treatment code is a 5 digit code and description established by the American Dental Association. Treatment for a condition can change during the course of treatment and when that happens the patient is notified accordingly. Exact codes are not finalized until treatment is complete for this reason. The procedure codes pertaining to this case are D7111 removal of coronal remnants, baby tooth is held in by tissue only, no root structure remaining and Code D7140 removal of an erupted tooth, which can be a primary (baby) tooth or permanent tooth. These codes and descriptions are established by the American Dental Association.
The patient was seen by an orthodontist for an evaluation. He recommended 4 primary (baby) teeth and 4 permanent teeth be removed and referred the patient to the oral surgeon for these removals along with the deadline to have them removed before the end of the month to keep the patient on schedule with the orthodontist. The patient's mother called our office to schedule the treatment for the patient and spoke with one of our assistants, who was also friends with the patient's mother. Our office protocol is to have the treatment request form from the orthodontist informing us which teeth are to be removed along with the xray before an appointment is scheduled in our office. This way the doctor can diagnosis, give an estimate of treatment cost and the amount of time to accomplish the treatment. Since the patient's mother was very concerned that the removals were done quickly to stay on schedule with the orthodontist and to find the time in our schedule, the assistant broke protocol and scheduled an appointment time for the patient without the needed referral and xray. She gave an estimate (never a quote) for the likely treatment that would be rendered for a patient that age to have 4 primary (baby) teeth and 4 permanent teeth removed. The patients mother was told to have the orthodontist office send us the referral for removals and copy of the panoramic xray before the appointment date so the doctor can review everything ahead of time. The appointment day arrived (the last appointment spot of the last day of the month). The patient's mother failed to bring or have the orthodontist office send us a copy of the needed panoramic xray and the referral removal instructions. With no xray of the teeth in question and no way to postpone treatment until the orthodontist office could get us a copy, and with the insistence from the patient's mother that the teeth needed to be removed that day, we were forced to take another panoramic xray to see all of the teeth and roots to be removed. Upon reviewing the panoramic xray it clear to me that the patients treatment needs had changed. The xray revealed that two of the primary (baby) teeth still had a good portion of the of their root structure remaining, and the other two primary teeth had their entire root structure remaining. This was a big concern to me since the permanent teeth form in between the roots of the primary teeth. If the roots have not experienced any resorption the roots can actually grab onto the developing permanent tooth and pull it out when the primary tooth is being removed. (Think of the "claw" machine at arcades with the primary (baby) tooth roots being the claw and the permanent tooth being the ball inside the claw). I showed the patient's mother and the patient the panoramic xray and explained this is not what we had anticipated for the normal dentition considering the patient's age. Therefore, removing these teeth was going to be much more difficult than first thought, I explained what we were expecting to see and do (remove coronal remnant) and what we needed to do now (removal of an erupted tooth) this change was because of what the teeth were, not because "I said so". I was not sure if we would need to cut the teeth in half to avoid removing the permanent teeth below the primary teeth. I was not sure if the permanent tooth would come out with the primary tooth and we would have to re-implant it. Therefore I could not give a definite code for what treatment that would be rendered to remove these teeth. I strongly recommended to only remove four teeth that day since these teeth were going to be much more difficult to remove and therefore be much harder on the patient with a lot more pain and discomfort. The assistant (the patient's mothers friend) also tried to persuade the patient and the patient's mother to consider only doing half of the removals. The patient's mother and the patient both insisted on having all eight teeth removed that day. Even half way through the procedure I asked the patient and the patient's mother to please reconsider and have the other four teeth removed another day. Both the patient and the patient's mother were adamant to continue with removing all eight teeth. I removed all eight teeth in exactly the same way, elevate and forcep removal (code D7140). No root tips fractured that would of necessitated needing surgical removal, I did not remove any permanent developing teeth along with the primary tooth removals. Basically treatment went as perfectly as it could have been expected except for putting the patient through extensive treatment (eight full tooth extractions at once). I confirmed the treatment codes with the assistant, all D7140. Actually two of the primary teeth were much more difficult to remove than any of the other teeth, including the permanent teeth. All 8 teeth were coded the same and the fees were all the same. I did not increase the fee on any treatment code because of difficulty contrary to what the patients mother reported. I feel we repeatedly went out of our way for the patient in every way. When the patient's mother failed to produce the needed xray to render treatment I did not charge the patient for the xray ($120), nor for the nitrous oxide gas the patient was on during the procedure ($60). I kept my staff way past our normal closing time on a Friday because of the insistence of getting these teeth removed by the patients mother. When I heard the patient's mother was dissatisfied with the fees I gave more discounts off ($128) in hopes of appeasing her. The original appointment was made against our protocols to accommodate the patient and the patient's mother. I believe we went above and beyond for the patient and patient's mother multiple times and gave the best treatment possible. The patient's mother's complaint that I changed the fee of the removals, yes, because the treatment necessary to remove them was different and I informed them of that as soon as I knew and before ever starting treatment. The complaint stating that all of the teeth were removed exactly the same, yes, I agree, therefore the code and the fee were the same (D7140). I do not know what the patient's mother is referring to as the "baby tooth rate" and the "permanent tooth rate". I am assuming she wants the primary teeth to be coded as if they were coronal remnant removals, which they were not. Mis-coding is considered insurance fraud and if that is what the patient's mother is insisting us to do we will not. I do not, nor have I ever, charged more than our standard fee for any dental treatment, even if more difficult. This statement, wherever it originated, is false. I would like to reiterate that I did give over $300 off on the patients bill. I am deeply hurt by the patients mother accusations that I, or my practice, is unethical and dishonest. We were completely upfront about everything and all treatment to be done as soon as we had a correct diagnosis rendered from the xray image. I focused on how this change was going to affect the patient, (much more pain, discomfort, stress)because that is who I cared about and where my concern was, not the fee. No fees were discussed because I didn't know what treatment codes would be necessary to complete treatment. It is very uncommon to discuss fees in a medical setting during the actual treatment. Dental offices use treatment codes, not diagnosis codes, and the course of treatment can change during the procedure. We also do not know what a patient's insurance will cover so it is very difficult to give an exact amount. The fact that I said to the patient and the patient's mother, this is not what we expected and they are going to be much more difficult to remove, was me informing the patient and the patient's mother that there is a change. We take pride in being fair and honest and feel we were. We will not zero out her account. We feel the patient's mothers has demonstrated bullying behavior and has made false accusations.
Initial Consumer Rebuttal /* (3000, 10, 2015/12/14) */
(The consumer indicated he/she DID NOT accept the response from the business.)
It was discussed with the office that I had no such knowledge of this protocol until after I had received said estimate which was not to exceed $500 on the "very high end" At no time while in the process of checking in was I in any way rushing the assistants or insistent they proceed. The x-rays were in fact requested to be sent to the office and were (at no fault of my own) sent to the wrong dental clinic. The assistants were able to located them, explained that they would take another panoramic and I was informed that they would indeed proceed. At no point did I ever insist that this take place or "force" anyone to continue. I was never told to bring them myself. There was no conversation about the procedure at any point. After numbing her lower right the dentist expressed "this can be a lot for a kid her age to handle" meaning... that many extractions. At NO point was there an explanation that the procedure would be more difficult OR that I would be charged differently. My only inclination was as we were leaving the office and when I asked why I was informed by the individual at the desk that this particular dentist has a history of increasing charges during procedures routinely. Additionally, when the dentist contacted me after the fact as soon as I voiced my concern about the ample amount of time we were in the office for her to have a conversation with me concerning the procedure or any changes she actually transferred me instead of having a conversation with me. I was with my daughter the entire time in the room, at no point was there a discussion about ceasing for any reason. I was not informed of any concerns or any issues whatsoever until we were ready to walk out the door. To have the term "bullying" attached to me in this situation is by far the most ludicrous thing I may have ever come across. If the dentist was actually in a position as to say at any point this was a big concern we would NOT have proceeded. Obviously this was omitted from the conversation. I at no point "insisted" that ALL teeth be extracted that day. I was told it could be done and at no point was ever "insistent" on anything being done in any particular order. By omitting all of these points, being deceptive and withholding this information I feel as though this is definitely not good business ethics and the fact remains that there was and continues to be great dishonesty occurring with each rendering of the various versions of this story. I have complied with the outstanding balance not because of satisfaction of service, not because of services received, but simply to end ties with this practice and ensure that this will not happen to my family or other families again.
Final Business Response /* (4000, 15, 2016/01/06) */
Dentistry at the Center would like to apologize to the patient's mother for any miscommunication that took place in our dental office. Please know that we take great pride in being as informative as possible to our patients so there are no surprises, as well as being fair and honest, and providing the best treatment possible. We agree that there was a breakdown of communication at the time the appointment was scheduled. This breakdown in communication was between staff and the patient's mother and did not involve the Doctor (the Doctor was not aware at the time of the patient's treatment appointment that the patient's mother was incorrectly informed of codes/fee's) Approximately 5 different staff members in our dental clinic have directly spoken with the patient's mother in hopes that she would better understand, we have done fee discounts to try to please her. We feel we have made good faith efforts in trying to resolve these accusations both verbally and through this correspondence with no success. We again apologize to the patient and the patient's mother, we had only the best intentions first and foremost in every step of the way. This will be our final response regarding this complaint.