Dr. Herbert Casalena, DDS, PA

In response to your letter of complaint from [redacted], please be advised that Ms. [redacted] initially gave us incorrect information regarding her insurance, stating her insurance coverage was under [redacted].We billed [redacted] and waited for payment which was denied since her coverage was no...

longer active.On May 28, 2014, she informed us that she had [redacted] Care USA which we were unaware that we did not participate in that type of [redacted] Dental without actually seeing the insurance card, which was not presented.As far as not receiving a statement, statements are automatically sent out once a month from another outside source. I do not know why she did not receive any statements.We did give her a courtesy discount of 20 % in the amount of$188.00. She is now paying$10.00 month on her balance.I have enclosed a copy of her insurance information and patient information sheet that Ms. [redacted] filled out.I hope this helps to resolve this issue. Please contact me if any further information is needed.

Revdex.com:
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.
Dr. [redacted]'s response is completely inaccurate.  Their response to Revdex.com states that I initially provided incorrect insurance information stating that my insurance was with [redacted].  I don't know when this supposedly happened because they go on to say that it wasn't until 5/28/14 that I provided them with my new insurance information.  This makes no sense, my 5/28/14 appointment was the first time I visited Dr. [redacted] using [redacted] Care USA.  Dr. [redacted]'s office received my new insurance information on the same day that I had my appointment under the new insurance.  At no time while I was covered by [redacted] Care USA did I tell Dr. [redacted]'s office that I was covered by [redacted].  My coverage with [redacted] expired on 12/31/13.  My first appointment after the expiration of the [redacted] insurance was on 5/28/14.  The Patient Information Form that Dr. [redacted] provided as an attachment in his response to Revdex.com (signed and dated by me on 5/28/14) shows that I provided his office with my new insurance carrier as [redacted] Care USA.  I also provided my Policy Number and I most certainly DID provide a copy of my insurance card as required by the office when you acquire new insurance.  Dr. [redacted]'s office went on to bill [redacted] for my 5/28/14 visit, ignoring their own paperwork.  I received a bill from Dr. [redacted]'s office indicating that [redacted] denied payment so I called them and had to remind them that I had new insurance.  They already had ALL of the information they needed to submit the claim to [redacted] because it was all provided to them at my 5/28 appointment.  Their response states that I did not provide my insurance card to them.  This is a complete and flat out lie.  They got a copy of my card on 5/28 as the office requires.  Under no circumstances would I fill out all of the paperwork regarding my new insurance and not provide them with my card.  That is a ridiculous lie.I was contacted by [redacted] Care USA in January, 2015 notifying me that Dr. [redacted] is not in their network and that they had not paid Dr. [redacted] for any of my 3 appointments during 2014.  At no point had I received a statement or bill from Dr. [redacted]'s office notifying me of non-payment.  When I called Dr. [redacted]'s office to inquire why I had not been notified of non-payment, Toni told me that she was still waiting for a response from [redacted].  8 MONTHS AFTER MY FIRST APPOINTMENT!! Toni had been waiting 8 months for a response from [redacted].  She never notified me of any issue.  I did not receive a bill from Dr. [redacted] until February, 2015, 9 months after my first non-covered appointment. 
Regards,

Review: I found out in Oct, 2013 that beginning in 2014 my dental insurance would change to [redacted] Dental. I immediately called Dr. [redacted]'s office to confirm that they took my new insurance as Dr. [redacted] had been my dentist for the prior 6 years. The office confirmed that yes, they took [redacted] Dental insurance. My first cleaning in 2014 was May 28th. I provided my new insurance card which they accepted with no issue. I received no bill after my first cleaning. I went back to Dr. [redacted] for a filling on July 11, 2014. Again, I received no bill after my visit. I went back to Dr. [redacted] on Dec 30, 2014 for my second annual cleaning. Again, I did not receive a bill for my visit. In January, 2015, I was contacted by [redacted] Dental who told me that Dr. [redacted] was not in their network and they would not be paying for my December visit. I immediately called [redacted] Dental to find out why they would pay for my May and July visits but not my December visit. [redacted] Dental told me that they never paid Dr. [redacted] for ANY of my visits. I immediately called Dr. [redacted]'s office to find out what was going on. I told [redacted], who works in the billing office what I had just been told by [redacted] Dental, that Dr. [redacted] is not in the network and would not be covering any of my visits. I wanted to know why I never received a bill if my insurance had not yet paid for visits from 8 months earlier. [redacted] told me that she sent the claim for my May visit to [redacted] Dental who then returned the claim to her and told her to send it to a different address. She said she sent it to the other address and never heard back from them. [redacted] never followed up with [redacted] Dental even after 8 months of not being paid AND she never sent me a bill. Because I never recieved a bill, I continued to go to Dr. [redacted] not knowing that my insurance did not cover his services. I received my FIRST bill from Dr. [redacted] on February 5, 2015 for services rendered in May, July and December 2014. I NEVER would have continued to use Dr. [redacted]'s services if I would have known after my first visit that he wasn't covered by my insurance. Because of the incompetence of his billing office, who never followed up with [redacted] Dental to find out why they hadn't paid my claim and never mailed me a bill, I continued to use Dr. [redacted] and rack up $940 in charges. If I had been notified after the first visit that my insurance didn't cover Dr. [redacted] (since they already told me that they DID take [redacted] Dental) I wouldn't have this bill. The billing office, [redacted], failed to do their job and now I have to pay for her incompetence. I feel that it is the responsibility of the dentist to bill me in a timely manner. It should not have taken 9 months for me to receive a bill for services rendered 9 months prior. I had no idea that my insurance never paid and it is the responsibility of the billing office to notify me of non-payment. When I called Dr. [redacted]'s office to try to resolve the situation, I offered to pay for the first cleaning as I felt that was fair but I should not be held responsible for the 2nd and 3rd visits because I was not aware that my insurance wasn't paying due to the incompetence of the billing office. Dr. [redacted] agreed to a 20% discount off of the $940 bill. I still don't think this is fair. Dr. [redacted]'s billing office is incompetent and I shouldn't have to pay for their short comings.Desired Settlement: I feel the only fair outcome is for me to pay for the first cleaning ONLY. I don't know how much this is because I never received a bill for it. The only bill I received was on February 5, 2015 which just says "Balance Forward" $940.

Business

Response:

In response to your letter of complaint from [redacted], please be advised that Ms. [redacted] initially gave us incorrect information regarding her insurance, stating her insurance coverage was under [redacted].We billed [redacted] and waited for payment which was denied since her coverage was no longer active.On May 28, 2014, she informed us that she had [redacted] Care USA which we were unaware that we did not participate in that type of [redacted] Dental without actually seeing the insurance card, which was not presented.As far as not receiving a statement, statements are automatically sent out once a month from another outside source. I do not know why she did not receive any statements.We did give her a courtesy discount of 20 % in the amount of$188.00. She is now paying$10.00 month on her balance.I have enclosed a copy of her insurance information and patient information sheet that Ms. [redacted] filled out.I hope this helps to resolve this issue. Please contact me if any further information is needed.