Galleria Smile Designs

Review: Fraudulent billing to insurance company

Dr. ** fraudulently charged my insurance company for a root planing on all 4 quadrants. This procedure allegedly took place during an hour and a half appointment without me being numbed. Dr. ** only worked on the lower part of the right side of my mouth and said that I would need to come back to finish the rest since I had to be at work that day and did not have time to complete the whole cleaning. Dr. ** never explained to me that we were doing a root planing and I was under the impression that we were only doing a routine cleaning.This appointment happened in September 2012 and I received the bill for it in April 2013. I distinctively asked how much I owed for the appointment and was told my Dr. ** that my insurance would cover it. Then I receive a bill six months later. When I called Dr.** to correct this mistake, she was extremely rude, raised her voice at me, and contradicted herself in various ways. First she told me that I was at the appointment for 3 hours and that she finished all four quadrants. But when I told her I had a time sheet from work to prove that I was at work at a certain time which proved I could not have been at her office more that an hour and a half at the most, her tone changed. She told me that I was supposed to come back so she could finish the root planing and that it was my fault because I was never able to make it. So if I was supposed to come back to finish the other 3 quadrants, why did she bill me for all 4? I filed a billing and compliance claim with my insurance company, but they denied my claim based on legal and binding treatment notes from Dr. ** that state that she did finish all four quadrants in that same appointment. Those treatment notes are clearly falsified and it is wrong of Dr.** to treat her patients like this and not be willing to work with them when an issue arises. I was perplexed at how unprofessionally Dr. ** conducted herself in this situation. Desired Settlement: I want Dr. ** to fix the billing discrepancy with my insurance company so that I can finish the root planing elsewhere. My current dentist recently determined that I need to undergo this procedure, but I cannot since my insurance only covers it once every 2 years.

Business

Response:

Business' Initial Response

Just recieved this letter from your office today,when I came in to work at this office.I just learn of this yesterday when I received your vm on our machine, and called you back right away last night and this morning, left you two messages and the third time I called I did not leave you the message. Now when I open this letter, I realized I am one day pass your deadline.

I have been working with Delta Dental Ins. since the day I spoke with miss R.C. and her new dentist office both front office and dentist himself had falsely accused me of this, and I had called her insurance and my professional liability risk management on this issue since 4/26/2013 both DD of minessota and Risk Management had told me on the phone that not to refund the money back to insurance because I had seen miss RC with her signed consent on the day of appointment explaining of what we will be doing that day. She worked only one street from our practice, had requested us to open that extra day to do all 4 quads of SRP, and we had called in to her ins. to get authorized over the phone if we could do all four quads. in one day and got OK to do so, back in Mar, we scheduled her and she broke that appt. due to her busy schedule with her new job. Back in March we even advised her to have her seek dental where is conveniece for her and she preferred to come back to us because it is close to her work, and if we could do all in one day so she does not loose too much time off work. By September she finally was able to make time to come in but has to be a Tuesday, which was our off day but we opened up to see her, that day my assistant and I came in early that rainy day to work on her, my front desk manager was not in that day so I told her our manager will send her the statement when we get paid from insurance, and she needs to schedule and post op eval in 4-6 weeks since she was also in a hurry to go to her meeting that day. we tried contacting her via web mail, phone calls , emails, she did not answer back. When we send her the statement for copay, she went to see her new dentist, this is about 6 months later. We are in this office only on Fri and Sat, so tried to answer phones and mails as fast as we can once we get them. So I contacted Miss RC same day I got her voicemail, left her a message, and also called her insurance after I spoke with her and ins. rep. when we called in April he told me that the other dentist could have continue to do perio maintenace,it has been 6 months, rahter than calling my office and demand us to refund that money to insurance so they can claim SRP get reimbursed. [redacted] office said miss ** claimed she never came in to get the work done and they believed the patient and told my receptionist that what kind of a terrible dentist I am, when she does not know who I am nor how much pride I have in my work for my patients. All of my patients who follow through our protocols improved significantly. I always give my patients the option of being numb or not as I work on them. I don't do blocks when I have to do all 4 quads. like miss RC especially when miss RC requested that she can't have he tongue numb because of her job she needs to talk. our records on that day showed we did numb her. I have worked on members of the Ca Dental board and they do admit I do a good job it is discomfort but tollerable, and pay attaention to my TBI as I worked on them and show them where they need to concentrate and improve on. I rarely have to repeat SRP every two years on my pts. Most of them improved and take better care of their teeth, those that I can't or see that it is beyond my ability, I refer them to Capitol Perio.

I have explained to miss RC from day one of her complaint, when she said her dentist Dr. K told her I am fraudulent, I explained to her what we did, the steps we go through with all our SRP pts,and that I am not fraudulent, she did not follow through on her part and if she was not satisfied with us then, all she needed to do was, call and let us know. I will partly refund back to ins. per her request but I would need to talk to her dentist, whiched we tried, and he was not pleasant, first he implied that our charting meant nothing,(as in we can lie) then he said he did not tell Pt that we did not do SRP on her but his staff may have not him. It is very unfortunate, at our office, every pts comes in that needed SRP and not yet eligible for them, I do perio maintenance/SRP as needed and follow up with good home care, till their eligibility kicks in, and at that time if they still need SRP then I will do SRP. I always go above and beyond to do what is best for my patients. if they can only have two cleaning and needed nore frequent, I even do without charge because I don't want them to loose their teeth, or have helth related problem.

At this time we have been through reviewed by DD of Minessota twice, one verbal (which I asked how I can refund the money per pt and her new dentist's demand) and by records review, both times I was informed not to refund the money to insurance. Now I am waiting for the third review by DD of Ca. It is not the matter of money, it is the matter of principle, and not that I don't want to do what Miss RC wanted or what her lawyer wanted me to do, I can't refund until I hear from DD of Ca. Even my Risk management case mananger tells me to wait till I hear from Delta Dental of Ca.and miss RC would have to be patience and wait for Delta Dental to response, I have no problem with refunding the money to ins. for one reason is is that miss RC is not satisfied, not because I am fraudulently billing her insurance and for this reason, Delta Dental has told me otherwise both times. They find that I was not fraudulant. As a profesional in the field we all know we don't get deep pockets overnight, and dentist/hygienist alone can't improve deep pockets after one SRP and no follow up on patient's part with perio maintenance nor commitment of home care.