Denture Center

Review: I am dissatisfied with Herald Square Dental & Denture Center service because the difficulty in resolving my out-of pocket cost. As a member of Aetna dental group all services are based on a list of fixed patient charges that provides group members their out-of-pocket cost. Initially I was told by Herald Square Dental after submitting my claim to Aetna that my out-of-pocket cost should be somewhere between $5000 -$5600.00. I received a call from Herald Square informing me that my annual dental limit is $1250.00 a year and my out of pocket expense was now $7500.00 for upper bridge and crowns. After assessing the cost with the dentist, he admitted a mistake was made. The new balance was $6500.00. I took out a line of credit from Care Credit--$5500.00. My dental appointment was 4/**/13. Herald Square was supposed to charge off the entire balance to secure the repayment plan of choice. I was charged $3,173.00 and each time thereafter, I had to choose a different repayment plan in order to use the card.Desired Settlement: I want Herald Square to combined the $3,173.00 & $1500.00 previous payments to reflect one monthly charge to avoid having to increase my credit line in order to utilize the remaining balance of $872.00 The Office Manager informed me that I could use the remaining balance, however; I will need to choose another repayment plan for the $872.00 as well.

Business

Response:

I would like to respond by saying that [redacted] complaint has already been resolved on 7/*/2013, therefore this complaint is considered void and should have already been dismisses. We refunded care credit for [redacted] dental care at her request in order for her combine the sums and she was then able to opt for a different care credit plan of her choosing.

However if you still need to receive our response, please read on, if regards to the matter of complaint with ID: [redacted] filed by [redacted], please note that out office has been more than accommodating cooperative and understanding in regards to [redacted] request for adjustment on her account with the third party financing company carecredit, which [redacted] refers to in her complaints. We have been extremely detailed in the explanation of the copayment information following the contracted insurance fees; therefor misquotations regarding the out-of-pocket amounts are highly improbable, since the data is obtained directly from [redacted] insurance yearly maximum coverage and this is simply not the case. We did not make any such mistake. It is [redacted] policy with Aetna and she is well aware of what her contact with Aetna Dental covers per year. Our office was quoted benefit breakdown by Aetna Dental's representatives on the day of her first appointment in our office. Therefore both side knew at the very beginning of treatment what the insurance maximum was. Should [redacted] insurance carrier, Aetna Dental.

[redacted] presented for an evaluation for her dental needs in late October 2012. A comprehensive treatment plan was presented to [redacted] the treatment options and risks were explained following standard office protocol. Following the standard office procedure with any treatment involving insurance benefit, The treatment was sent to dental carrier for consideration with any treatment involving insurance benefit, the treatment was sent to the dental carrier for consideration and benefit approval. It took Aetna Dental longer then normal to consider the benefits and a final determination was received inn the end of February 2013. During this period [redacted] has started with restoration on some of the teeth and had estimated co payment for procedures already performed, according to the benefit breakdown quoted to us by Aetna Dental's representative.

[redacted] treatment has been charged strictly following the contracted insurance fees; (please note that the insurance contract was updated was updated effective 1/*/2013. However, as courtesy to [redacted] we have honored the 2011 calender year contracted fees. The entire treatment for breakdown and insurance benefits have been addressed with [redacted] via phone 2/**/13. We further explained the cost of the procedure remaining in her treatment plan. The insurance benefits allowed by Aetna and, additional courtesy on the account.

Anytime a care credit payment is processed out office verifies with the cardholder themselves what period of time is needed by them to pay off the amount being financed. In other words, whenever a patient uses care credit to pay for their care. We varify with them before the transaction is processed how much time would they like to pay off the amount being charged. This is not something we decide, or authorize; it is the patient decision. Against care credit is an independent financing venue, one of the largest healthcare financing institutions in the country and we don's set their policies. Care credit policies were carefully explained to [redacted] however, Since this a contract between and patient and care credit, our office is not a party to these financial arrangements.

At Herald square dental, whenever dental care is rendered, payment or copayment (as in this case), Is due. Therefore [redacted] paid the correct copayment for the procedure done on the specific days of the care. If she wanted to prepay for dental care that she had not recevied yet, she never told us. We would have had no reason not to accept prepayment for full treatment when any patient desired to to so it is unfortunate that our office was ever accused of wrong doing as it is obvious that we are trying to hold and accommodate [redacted]. Regrefully [redacted] does not with to accept care credit's policy. And it is not something we can control. Although we help patients arrange care credit financing approval, [redacted] did so on her own.

Regarding the complaint that different out of pocket amounts have been quoted, We do not quote co pays until a dental pre-treatment estimate or approval is on file. There is a absolutely no way we quoted a firm amount of $5000-$5600, since even when there is an approval on file the approval is not a guarantee for payment either. This is stated on any predetermination by the insurance carrier as well, when its comes to dealing with insurance benefit everything is an estimate, until an actual claim is submitted and procesed. There is not guarantee for payment, since payment is subject is to plain limitations, current eligibility, other plan provisions, approval of benefits, etc... we have been working with insurance benefits for many years and know very well that everything regarding insurance payment is a speculation. Estimated and not a guarantee. We couldn't have quoted [redacted] any amount with certainly until the authorization from Aetna was processed, and since this took a few months, [redacted] was quoted the estimate out of pocket amounts correctly on 2/*/2013 in a phone call, only after the decision from Aetna was rendered.