Gerald J. Brown, DDS, PC

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Complaint: ***
I am rejecting this response because: the businesses response does not accurately reflect the situation, nor does it make any attempt to redress the issue.
Regards,
*** ***

In response to your inquiry ([redacted]) into a complaint filed by a gentleman, I will respond however, I need to make full disclosure that the gentleman who wrote the complaint was not the patient and the patient is over the age of 21 and of sound mind and body and does not have a power of...

attorney filed with us, therefore, I am limited as to what I can discuss since the patient did not file the complaint but rather a third party.In response to his complaint involves: there are no advertising issues. No where on the web, in the phone book, or any other place do we state that we are participating providers with any insurance company.
In response to the customer’s statement of the problem: The appointment scheduler has a standard statement she makes indicating we are not participating providers for any insurance company and the person in question was told that when they called. The scheduler noted we were looking into possibly participating but she did not know which companies, which plans, or when that would happen. She at no time indicated when we would participate if at all and with whom. The person in question came in for a visit on April 24 and was told the same thing as just stated, and yet they scheduled an appointment for April 30. On April 30 they were told the same and yet they scheduled an appointment for June 2. Each time, even though we anticipated the insurance company would pay the patient, we allowed them to pay a small amount and then wait for the insurance company to pay their portion with the understanding the patient would be responsible for the difference.
The patient received the explanation of benefits and checks, they brought the checks to us, but not the explanation of benefits. Yet they state they wanted to get credit for a certain dollar amount. I had to request the explanation of benefits (eob) from the insurance company. In those eob’s it states 1) several items were not covered at all by the insurance company and 2) the remainder of the balance is due by the patient to the office. There was also a deductible the patient owed. Moreover, the patient kept stating the insurance company should pay 100 percent of everything. Even for the items they covered it was only 80 percent of usual and customary, not the actual charges. Again, this was told to the patient at each visit.
We did review the claims for the patient and found the first claim from April 24, 2014 was sent to the insurance company but they never processed it. As a courtesy to this person in question, we filed the claim a second time for them at our expense with the hope they will receive additional reimbursements.
The person states they talked to the office on June 3, which they did not. The person in question was in the office and spoke with us on June 2 (and spoke to the persons the listed as salesperson). They note they spoke with us on June 12. They actually called the office on June 11 and spoke with a temp covering the desk that day as the appointment scheduler was out on personal leave. The appointment scheduler called them back on June 12 and when she spoke to them she reminded them she had spoken to them on repeated occasions (on April 1, April 24, April 30, and June 2) to remind them the office was not a participating provider, they said they had never spoken to her before they had spoken to someone else. She is the only one at the front desk so I cannot fathom how they could have spoken to someone else.I am concerned this complaint would be posted on a website as 1) the person who wrote this complaint was not the patient and 2) this is health care information which would require a release from the patient before anything could be posted.
We take a lot of time explaining in detail that we are not participating providers for any insurance company so it frustrates me when these types of complaints come along, as we have had the same response to all patients for the last 28 years and we have never waivered on the statement as we have never been a provider for any insurance company. We merely file the claims as a courtesy to our patients and most of the times the checks are sent directly to the patient (as was the case in this situation).I am available for questions should you need, however, please realize the email you are using is not my email therefore it take some time for it to filter to me.Thank you,Tami C[redacted]

Review: Dentist office claimed have filed paperwork to be a provider for [redacted] (4/1/14), with the expectation that they would be a provider by the time of the appointment (4/24/14). After receiving a huge bill, we contacted the insurance provider to find that they had no record of the dentist office having even filed the paperwork. After many attempts at contacting the office and trying to resolve the situation, they agreed to at least set up a payment program starting in July, which they failed to do.Desired Settlement: The dentist should honor the in-network price for the work that they claimed would be covered as a provider of [redacted].

Business

Response:

In response to your inquiry ([redacted]) into a complaint filed by a gentleman, I will respond however, I need to make full disclosure that the gentleman who wrote the complaint was not the patient and the patient is over the age of 21 and of sound mind and body and does not have a power of attorney filed with us, therefore, I am limited as to what I can discuss since the patient did not file the complaint but rather a third party.In response to his complaint involves: there are no advertising issues. No where on the web, in the phone book, or any other place do we state that we are participating providers with any insurance company.In response to the customer’s statement of the problem: The appointment scheduler has a standard statement she makes indicating we are not participating providers for any insurance company and the person in question was told that when they called. The scheduler noted we were looking into possibly participating but she did not know which companies, which plans, or when that would happen. She at no time indicated when we would participate if at all and with whom. The person in question came in for a visit on April 24 and was told the same thing as just stated, and yet they scheduled an appointment for April 30. On April 30 they were told the same and yet they scheduled an appointment for June 2. Each time, even though we anticipated the insurance company would pay the patient, we allowed them to pay a small amount and then wait for the insurance company to pay their portion with the understanding the patient would be responsible for the difference.The patient received the explanation of benefits and checks, they brought the checks to us, but not the explanation of benefits. Yet they state they wanted to get credit for a certain dollar amount. I had to request the explanation of benefits (eob) from the insurance company. In those eob’s it states 1) several items were not covered at all by the insurance company and 2) the remainder of the balance is due by the patient to the office. There was also a deductible the patient owed. Moreover, the patient kept stating the insurance company should pay 100 percent of everything. Even for the items they covered it was only 80 percent of usual and customary, not the actual charges. Again, this was told to the patient at each visit.We did review the claims for the patient and found the first claim from April 24, 2014 was sent to the insurance company but they never processed it. As a courtesy to this person in question, we filed the claim a second time for them at our expense with the hope they will receive additional reimbursements.The person states they talked to the office on June 3, which they did not. The person in question was in the office and spoke with us on June 2 (and spoke to the persons the listed as salesperson). They note they spoke with us on June 12. They actually called the office on June 11 and spoke with a temp covering the desk that day as the appointment scheduler was out on personal leave. The appointment scheduler called them back on June 12 and when she spoke to them she reminded them she had spoken to them on repeated occasions (on April 1, April 24, April 30, and June 2) to remind them the office was not a participating provider, they said they had never spoken to her before they had spoken to someone else. She is the only one at the front desk so I cannot fathom how they could have spoken to someone else.I am concerned this complaint would be posted on a website as 1) the person who wrote this complaint was not the patient and 2) this is health care information which would require a release from the patient before anything could be posted.We take a lot of time explaining in detail that we are not participating providers for any insurance company so it frustrates me when these types of complaints come along, as we have had the same response to all patients for the last 28 years and we have never waivered on the statement as we have never been a provider for any insurance company. We merely file the claims as a courtesy to our patients and most of the times the checks are sent directly to the patient (as was the case in this situation).I am available for questions should you need, however, please realize the email you are using is not my email therefore it take some time for it to filter to me.Thank you,Tami C[redacted]

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because: the businesses response does not accurately reflect the situation, nor does it make any attempt to redress the issue.

Regards,