Greater Boston Smiles Pediatric Dentistry

We are so sorry to learn about the misunderstanding that is happening here. This is the first time since opening our doors over five years ago that we have been reported to the Revdex.com. We take this matter and any complaint about our practice extremely seriously. Dr. *** and the entire staff at Greater Boston Smiles attempt to do our best to provide quality care to all patients and families, regardless of insurance limitations. This includes sending and receiving a pre-treatment estimate to the patient’s insurance prior to the date of service. In this process we become cognizant of a family's out of pocket expense ahead of the visit, with the caveat that certain procedures and circumstances do not allow us to always predict it completely accurately. Pre-treatment estimates do state that they “are not a guarantee of payment from the insurance. Benefits are calculated based on current available benefits and payment eligibility. Estimates are subject to modification based on eligibility, coordination of benefits, the contract allowance, and the benefit plan in effect at the time services are completed.” Payment policies and consents to treatment are signed by the parent or guardian for all patients in their new patient paperwork. Although we estimate what the insurance will pay, you are responsible for any portion of charges not covered by insurance. The remaining balance in this situation was not added or incurred fraudulently or improperly “months after treatment." During certain procedures, often treatment can change. Dental x-rays are 2-dimensional images, and when one starts treatment on the actual teeth, unanticipated things can occur (such as tooth structure fracturing, decay being closer to the nerve than expected, nerve exposure resulting in the inability to save the tooth.) During this procedure, a tooth that was planned to have a stainless-steel crown placed due to the depth and severity of decay required extraction as the caries was in the pulp of the tooth, which was subsequently infected and non-restorable. This unfortunate situation was compounded by the fact that a space maintainer was required to be inserted to hold space until the adult tooth erupts (due to the young age of your child at the time the procedure was performed.) When changes occur, we verbally confirm with the parent (parental consent) that treatment has veered from the original plan. This was the case in this situation. Unfortunately, the change in treatment resulted in dental benefits being maxed, thus the patient/parent was responsible for more than originally quoted. As we stated, we cannot get instant quotes on how much treatment changes will cost when these changes occur. The other issue is that due to the severity of dental disease, young patient age and behavioral issues, the patient was under oral conscious sedation which is a non-covered service that our office provides in lieu of more expensive and risky general anesthesia. We did not want to have to put the patient or the parent through this procedure again.We have provided the parent a chance to let us explain, but she continues to dispute the charges and refuses to pay, even though the treatment was done in good faith provided well beyond the standard of care. Care provided for children in summary: - 3/7/2017 Child A and Child B had their first visit at our office, including exam, xrays, cleaning and fluoride. We also provided same day service for one child for the convenience of the family to address tooth decay. All treatment was performed with laughing gas and went well. The other child was very young and had more involved treatment, so the parent opted to have them treated under general anesthesia. Both children were provided extra strength fluoride prescription toothpaste and we recommended a 6-month recall preventing further decay. General anesthesia appointment was scheduled for younger child and subsequently cancelled by parent; she opted for oral conscious sedation instead. 4/22/2017-Oral Conscious sedation appointment for child cancelled one week before appointment and not rescheduled. Multiple failed attempts to recall children for appointments 2/8/2018-Child presents for recall appointment with tooth pain, one periapical xray taken of lower left quadrant (source of pain) revealing more severe caries on two teeth. Stressed to parent the importance of treatment as things were worsening and that we would take a complete set of bitewing x-rays to check other areas in need of treatment during the sedation as there may be new or more severe decay. 2/15/2018-Dental rehab for child done using oral conscious sedation. Updated bitewing xrays (last taken 2017) and new decay was found on two teeth on lower right. Depth of prior decay worse in all other areas, including lower left area (area of pain) which may have decay into pulp (later realized intraoperatively.) Treatment finished; parent called at night to ensure patient was doing well. 3/28/2018-Other child comes in for recall exam, cleaning, fluoride and xrays. Monitoring flossing caries on baby teeth due to age, no other concerns. One child never seen at our office again; there was no follow up or recall appointment since the day of their oral conscious sedation. Other child not seen again since last recall. No request to send children's records to another dental office made.

we appreciate your feedback. We are always looking to improve and provide exceptional care for our patients and their families, and your feedback is valued. We will be using this as a learning lesson, and have already discussed and begun to implement some new initiatives to help avoid a miscommunication like this in the future with any of our patients and families. As far as the remaining balance goes, we cannot adjust it any further. Due to our contractual agreement with the insurance company, we are unable to write off or adjust the balance that the insurance company says the patient is responsible for. We have applied all proper write offs per our contract with *** of ***. If you have any questions in regards to the benefits, coverage, or accuracy of the balance regarding the procedures done that day, we encourage you to reach out to your employers HR department to discuss the plan they chose, or the insurance company directly. If you would like to discuss this matter further with us or have any furtherquestions, we'd be happy to talk with you directly if you reach out to the office. Thank you.