Dr. Joseph M. Boesch, DDS

Review: After visiting Dr. Joseph's practice on 2/2/2013 for my regular bi-annual clean up, I was asked by personnel (Mr. Joseph's wife) to provide her with my dental insurance information. After entering my insurance data, Personnel informed and confirmed that everything would be covered by the insurance when I inquired about the various benefits covered by my insurance. After taking the information I was told to wait for the Doctor. At the end of my dental visit, on my way out I was approach by the front desk personnel in regards to payment. When I asked her why She is asking me to pay when in fact she took all insurance information, she reiterated that all would be covered by My insurance and said that their procedure was to collect from all patients after doctor visit and assumed me that my money will only be held for 3 business days until the insurance company pays. With this information I agreed to pay $300.00. After about a week the money was not refunded back to my [redacted] credit card account. When I called to find out the status, the same front desk personnel informed me that they have gotten a confirmation from my insurance company that the service rendered will fully be paid for by them and to wait a few more days for the transaction to finalize. After a week I called back again and got the same story as the initial call on several back to back calls to Mr. Joseph's office. As the next step, I called my insurance company to find out what had happened and why they weren't reimbursing the clinic. I was informed that Dr. Joseph's office was not in the network of Doctors. I was highly recommended to file this complaint soon after.After several attempts to collect from Dr. Joseph's office, I also contacted [redacted] to file a fraudulent charge. After my bank conducted their investigation, I was sent a letter that concluded the charge not being fraudulent. I was however, recommended by [redacted] rep. to file this complaint with Revdex.com.Desired Settlement: I would like Dr. Joseph's clinic to refund my money based on the fact that I was mislead on several stages intestinally. I was informed by my insurance company that the font desk personnel was well informed that Dr. Joseph's office was not in the network plan. Not only I was mislead in to thinking that my insurance would cover all costs, I was also mislead when she told me that they take collection from all patients after visit no mater insurance status.

Business

Response:

August 21st, 2013

Dear Revdex.com,

In response to the complaint filed by the above person to your organization, I will attempt to set the record straight from my perspective. This patient first came to my office on 7-21-2010. A comprehensive dental exam, x-rays, treatment plan and dental prophylaxis (cleaning) were performed. She was placed on a bi annual, 6 month recall program for cleaning. She next came to the office on 7-12-2011, one full year later to have a wisdom tooth removed without keeping her 6 month, bi annual appointment for her dental check up. She then made and kept an appointment on 7-27-11 for a checkup and dental prophylaxis and made a 6 month appointment on 2-2-13 for the same.

During the fast week of January 2013, she telephoned the office to give the office new dental insurance information for her upcoming visit. The office manager called the insurance company, as she does for all patients, to verify the coverage information and get the benefit and reimbursement policy. The information received was that the reimbursements or assignment of benefits would go directly to the patient and not to the office, she could choose her own dentist and they calculated the benefits from a fixed fee schedule. The patient came in for her appointment 20 minutes late, provided her insurance card and afterward, was informed the insurance company was contacted earlier in the week and it was explained she would have to pay her fee in full at the time of service. The office would file the claim on her behalf. She would receive the benefit directly, not the office. She paid the full fee of $300.00 on a charge card, [redacted]. It is timely to note here that in the office policy the patient read and signed in 2010, it clearly explains to the patient that they need to understand their insurance benefits and that the patient and insurance company have the relationship. The office will assist the patient with their claims as much as possible. The patient is ultimately responsible for their financial obligation for services rendered. Insurance benefits usually take 10-30 days before they are received. She was told she should receive the benefit in that time frame. The office has never received an insurance benefit in 3 days!

In a few weeks she called about her benefit and was informed the office had not yet received the explanation of benefits from the insurance company and it should be sent in the next few days. The office received the EOB shortly thereafter and it was then found out that the insurance contract is not a preferred provider network (PPO) as the office manager was told the day she called for the patient to verify her coverage, but rather a dental maintenance network (DMO) with which the office does not participate and there is no benefit for services provided by an out of network dentist and that she had to go to someone on the list of participating providers, not what the office manager was told when she called to verify coverage information. She called again, this time to request a refund and it was explained to her that the office was not fully informed of the limits of her coverage at the time the office called the insurance company. Oh, by the way, 2-2-13 the day of her appointment was Saturday and insurance companies are not open and can't be contacted to verify insurance and enter data information on weekends. She received the services she was charged for and was told that she needed to contact her insurance company and settle the dispute with them. The office next heard from [redacted] a month or so later that the mutual customer was requesting a chargeback. Before responding to the request from [redacted], she was phoned to try to resolve the misunderstanding on 5-8-13 and again on 5-16-13. On both days, only an answering service/machine/voicemail was contacted and messages were left. No return calls were made. She persisted with [redacted] to refund her money filing multiple chargeback requests, never calling the office to try to resolve the dispute. [redacted] decided that there was no fraudulent action on the part of this office and denied her chargeback. Now she has contacted the Revdex.com with this same complaint.

Professionally,