Healthy Young Smiles

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed as Answered] Complaint: [redacted] I am rejecting the response I do not accept the offer for partial payment and request that my name and account be taken out of collections and closedThis fee was not disclosed at any timeThe office was called during business hours and they did not disclose the feeAgain all clinical services provided to my son were undisputed and paid in fullYour surcharge amounts to nothing more than lack or transparency and deceptive billing practiceRegards, [redacted]

As a final response to this matter, I would like to offer the following points:Our office did exactly what we normally do to provide insurance information to the parent regarding the anticipated treatment requiredWe do not "guess" or falsify our preauthorizationsWe stated in person and in writing that the information we had was only tentative and was only an estimate pending the X-rays and final diagnosis made at the time of surgeryWe assist our patients with their insurance benefits however their insurance is a contract made with themWe cannot change the terms or the benefits of THEIR insurance to suit their financesWe also cannot alter the condition of their child's teeth when they come to usIf there is disease present, I am legally and ethically obligated to diagnose and treat the diseaseIf there was a significant financial concern prior to the surgery, the complainant should have requested (and signed) that we only treat what was clinically diagnostic and no other treatment would have been done at the time of surgeryThis however would have left Serious disease in the child's mouthI have done this and would have done this if that was their requestThis was discussed with the parents before the surgery by my office manager and by me the day of the surgeryI understand that ultimately this complaint comes down to the money they had to spend to rehabilitate their child's dentitionAs a preventive and restorative clinician, I always hope that these situations can be prevented in young children if the correct diet and oral hygiene habits are followed starting at a young ageI did not cause this disease to occur in this patient's mouthIt is unfortunate that the disease was so extensive but I was asked to treat and eradicate the disease, which I didThe treatment was provided to completion, safely and without trauma to the childI do not feel that my office should be asked to not charge for the treatment that was rendered.Sincerely,Carolyn L DDS

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this response because:
My son's case was not emergencyShe should have fixed the more problematic issues and then tackle the others at some future timeI am not the only one complaining about the "surprise" billYou may check *** and search healthy young smilesShe should stop the way she handles her patientsIt qS abait and switch on my experience and she sees her patients as dollars, the more work done, the more money she getsShe also shouldn't question the way I care for my son's teeth, there was a reason for my son's condition, we had to push pediasure 24/7, on demandAgain if she will not pay me at least her process has to stop, before a lot more patients will be trapped and be victimized by her
Regards,
*** ***

I am rejecting the claimant's response because:As I have clearly stated, emergency care was provided to his child after the office was closed because I returned to the office from home to attend to the dental emergency at at claimant's requestFees are not discussed or disclosed at an emergency visit because, as the doctor, I am attending to the emergency needs of my patientThis is not our practice for treatment provided during business hours as I have administrative staff to calculate and advise what fees are incurred once a diagnosis is madeThis fee is not a surcharge but, as I have already explainedis an emergency examination charge which is applicable to any emergency office visit a patient enters the office forThe fee is higher for a visit that is after the office has closedWe have been attempting to collect this balance for 3+ years nowHowever, in the interest of closing this matter and account, I am willing to accept the emergency examination fee of $which is what an emergency examination fee is for a patient who is not prescheduled but needs to be seen for an emergency.This is my final response.Carolyn * LDDS

To Whom it May Concern,This letter is in response to a complaint filed with your company, Revdex.com, regarding dental care provided to one of our patients, specifically the minor child of the complainant.The patient was first examined in our office on 7-29-The parents indicated that the patient had
been examined previously by other pediatric dental officesThey were unsatisfied with the offices' assessments as they said it was "vague" and they sought a second opinion from meThe patient had not had dental X-rays taken thus far so we attempted to take X-rays to complete our diagnosisThe patient was uncooperative and crying so we were unable to obtain X-rays that dayI did a clinical examination of the teeth and noted clinically visible carious lesions as well as Several areas of decalcification or "weakened" areas of tooth enameladvised the patient's parent(s) that there were teeth that definitely had cavities and that he needed treatment for these as well as diagnostic X-rays to check all the other teeth radiographicallyDue to the patient's young age (3+), inability to Cooperate for X-rays or a proper examination and extensive and precise nature of his treatment needs, I recommended Comprehensive treatment at a children's dental outpatient surgery center for his careI advised we would take a complete set of X-rays once he was asleep, diagnose all lesions to be treated and complete his treatment while asleepThe parent(s) were agreeable to this.The process to schedule a patient for treatment at the surgery center is quite involved and requires pre-determinations with their dental and medical insurancesAs the dental provider, we send a treatment plan to their dental insuranceBecause we did not have X-rays and therefore only had a tentative treatment plan, this limited information was submitted to the dental insurance companyWe also provided medical insurance information to the surgery center to pre-authorize the facility and anesthesia costs associated with this procedureWe request a reservation fee of $to initiate this processThis is explained as a non-refundable fee that is applied to the $feel charge to provide treatment at the outpatient facilityAdditionally our initial treatment estimate based solely on the cursory clinical examination totaled $minus $insurance provision without benefit of xray examinationOnce we received the reservation fee of $250, we began the process of dental and medical preauthorization.We always request full payment for known and diagnosed treatment prior to the scheduled Surgery date and we had the parent(s) sign a consent form to give me permission to take X-rays and complete ail necessary treatment diagnosed after X-rays have been read during the surgeryWhile it is always preferable to have X-rays and therefore a more firm treatment is prior to the Surgery, with young children it is obviously not always possibleI make every effort to give an accurate treatment plan to the parents but, without X-rays, I cannot see what I cannot see and cannot anticipate disease that I cannot visualizeI have documented on the 7-29-exam that there were multiple areas of weak tooth structure and frank decay on other teeth so would not have indicated "there is not a lot of problems" to the parents.On 9-17-we arrived at the surgery centerThe patient was safely sedated and placed under general anesthesia by the medical staff at the facilityAt that time, a complete pediatric series of X-rays were captured digitally and a thorough examination was performedIn total there were primary teeth that had dental disease that required treatment proceeded with the treatment as the signed consent form allowed and indicated me to do and that I knew ethically should be done for this patientFor medical-legal reasons and patient safety, I do not leave the patient while under general anesthesia which is why I did not go out to the waiting area to discuss these findings with the parentsAlso for medical-legal reasons, it is not recommended to only treat some of the oral disease and leave disease remaining to be done again under general anesthesia at another timeWe had discussed in the pre-operative area prior to the patient going into the operating room that whatever disease was found would be treatedI believe I was quite clear about this and that the parents understood thisFurthermore, the crowns that were done were on the original treatment plan as such so the crowns were not a later addition or decisionThere were multiple areas of inter proximal decay in his posterior teeth which were visually undetectable until the X-rays were obtainedThe complainant is correct that the surgery was almost hours long due to the extreme extent of his disease involving out of teeth in his mouth! When the surgery was finished, I went to speak with the parents and review my findings and treatment with themI advised them that there were many additional cavities found and that all treatment was completed and that most importantly the patient was doing well in recoveryI also placed a follow up call that evening to check on the patient and make sure he was feeling wellAt neither of those instances did the parent(s) share their dissatisfaction with my diagnosis or treatment of their childIt was only when they were apprised of the additional cost of the additional treatment that they complained.On a post surgery follow up call placed by my office manager, the parent(s) claimed that they did not feel they should be responsible for the extra treatment that needed to be done and that they were unhappy with the outcome.There are several comments in particular that I'd like to rebut:They said they "hopped" from one dentist to anotherThis indicates that they were not trusting anyone's diagnosis of their child's poor dental condition and also possibly shopping around for the best price and simply looking for what they wanted to hear which is just to treat only what the insurance will pay forUnfortunately this is not how disease works nor how treatment of disease worksDisease needs to be treated to prevent spread, worsening and/or potential for pain and loss of teethDisease does not regulate itself based on insurance coverageIt was my ethical obligation to remove the disease that I saw at the timeThe front teeth did not have discoloration - they had gross caries and this was indicated on the original treatment planAgain, based on a cursory examination, I did not say there were "not a lot of problems"If there were not a lot of problems, I would not have recommended surgery in the first placeThe fees that we requested they pay prior to the surgery date are the customary fees we require to be paid ahead of timeIf I did not know what additional lesions we would find in the patient's mouth before X-rays were taken, how could they possibly anticipate it would not be more than extra for the other issues that they may find during the procedure"? There was no way for a dentist Of lay person to know the extent of disease ahead of timeOnce all treatment was submitted to their insurance company, and insurance payment was made then we can provide the parent(s) with the final cost (" weeks later" ) of all of the treatment completedWe do not try to guess what their cost will be but we wait until insurance has paid their portionEven though we are "in network" with their insurance, some plans allow the dental office to charge the full amount (i.eas if you were a fee-for-service client) to the patient/parent once their maximum allowance is exceededThis is a function of their insurance policy and not an arbitrary decision on the part of our officeOur fees are set and we do not charge different fees for procedures based on whether someone has insurance or notAs a courtesy towards the parent(s) because of the unexpected outcome and costs of the additional treatment, we did extend a courtesy of $to reimburse them for the hospital fee charge to provide treatment at the surgery centerApparently this was an insufficient and unappreciated courtesy extended to them.In conclusion, while I understand the parent(s) frustration regarding the cost of their child's dental treatment, believe that any dentist whose professional opinion they sought would have arrived at the same diagnosisThe child's "cavities" were present, the disease was there and needed to be treated for the health and well-being of their childTherefore I do not feel that we should refund any monies paid toward the treatment that was rendered to their child.Sincerely,Carolyn LDDS Diplomate, American Board of Pediatric Dentistry

[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 as Answered]
 Complaint: [redacted]
I am rejecting the response I do not accept the offer for partial payment and request that my name and account be taken out of collections and closed. This fee was not disclosed at any time. The office was called during normal business hours and they did not disclose the fee. Again all clinical services provided to my son were undisputed and paid in full. Your surcharge amounts to nothing more than lack or transparency and deceptive billing practice. Regards,
[redacted]

This is a response to a complaint made regarding a bill for emergency dental services provided on 2/3/2014 to the claimant's minor child.February 3, 2014 was a Monday. Our normal office hours on Monday are 8:45-4:45. There was a significant snowstorm that day and the roads were becoming dangerous...

for travel. We decided to close the office early at 3:00pm in the interest of the safety of our patients and my staff so that they could travel home safely while it was still light out and before the roads became more dangerous. arrived home approximately 3:30-3:45. I received an emergency call on my cellphone from the claimant stating his son had been injured in a sledding accident and had fractured his top front tooth and it was hurting him. I advised the claimant that our office was already closed but if he had an emergency that he felt needed my attention I would meet him at the office. I left home and my husband and daughter came with me back to the office to assist me in attending to the emergency. My husband is a general dentist and I felt his expertise with a fractured tooth on a 14 year old may be required.We arrived at the office approximately 4:30pm. I examined and x-rayed the injured tooth. It was determined that the fracture was into the pulp canal and there was bleeding emanating from the nerve canal. explained to the claimant that the treatment for this type of injury would be a "root canal" or endodontictherapy. This treatment needs to be initiated as soon after an injury as possible to prevent bacterial infiltration into the nerve canal and to prevent extreme and excruciating pain to the patient. Because my husband is experienced in and does this procedure for his adult patients, he offered the claimant to initiate this treatment right then for his son and that he would have to follow up for completion of the root canal the next day with a local specialist. The claimant consented and this procedure was then performed with no complications. The patient and the claimant were dismissed and they appeared to be appreciative of the attention and palliative treatment received.As there was no administrative staff present that evening, no fees were charged that night nor any money collected from the claimant. The following day advised my office manager of the emergency after office hours treatment that we provided to the claimant's son so that the proper fees could be billed to his insurance carrier. The charges billed included an after-office hours emergency visit for $220 ([redacted]), a periapical radiograph for $36 ([redacted]) and pulpal debridement (initiation of root canal therapy) for $310 ([redacted]). The "D" codes Eisted are the CDT codes for federally recognized terminology for report dental services on claims submitted to third party payers. Our routine emergency visit during regular office hours fee is $115. We sent a statement on March 4, 2014 to the claimant. A VISA payment for $346 was made on 3/12/2014. We sent another statement 30 days later for the remaining balance of S220 which still went unpaid. After 60 days, my office manager called claimant to inquire about obtaining payment. He insisted that he will not pay this amount as he did not think it was a fair charge as under normal circumstances our office would be open that day until 4:45. She advised him thatthe office had been closed early at our discretion due to inclement weather and dangerous driving conditions and that , the doctor, had to return to the office with 2 family members to attend to his son's emergency nonetheless. She stated this visit was indeed after normal office hours due to the circumstances of the weather. She reassured him that, most of all, his son was well-cared for and definitive treatment was provided to keep him comfortable and prevent infection in the tooth until complete treatment could be provided the following day. The claimant still insisted that he did not agree with this and that he "will not be paying this bill". We continued to send statements monthly and the account was finally sent to collections in 3/2015 as the claimant was not responding to any of our Correspondence. Additionally, the patient has never returned to our office for his dental care.In summary, our office policy (like other health professional offices) for after-hours emergency care has always included a charge for the doctor to return to the office to see and care for the patient. Much like if a person's heating or plumbing goes out on a weekend, there would be an additional charge to the customer for the professional to come out to attend to the problem outside of their normal business hours. Quite often dental emergencies require timely attention and treatment to prevent pain, infection and more severe issues for the patient. Not only did return to the office at the claimant's request (and at my personal risk due to the weather Conditions) but also brought another dental professional (my husband) to provide his expertise in treating this patient. This situation was handled with no less care, Concern and professionalism than would show towards any other of my patients. I am confident that the treatment rendered that evening was appropriate, fair and the concomitant charges were fair as well.Sincerely,Carolyn *. L DDS Diplomate, American Board of Pediatric Dentistry