High Peaks Dental Professional Partnership

The staff at High Peaks in Plattsburgh unfortunately was not apart of this patient's experience as she was seen in Lake Placid and that office is no longer openUpon review of the notes the patient did sign a financial agreement, not a contractThe financial agreement is an ESTIMATE of what the insurance the patient stated she had would coverThe day of her sedation appointment a note was entered into her chart by Lauren who is also a friend of the above patient"Do not billShe is going to work with me on paymentsHusband approved of her added on treatment because she wanted to get it all done at onceWaiting to see what insurance pays firstLB- Wed - Oct 28, -" While the patient may not have agreed due to sedation on the one extra filling would not have made her account balance as high as it isThe issue with here her balance comes from is because her insurance was terminatedOut financial estimates state very clearly that any out of pocket remaining from the insurance is the responsibility of the patient.The patient had over $2,in dental treatment doneThe day of the treatment she only paid $In the above note from Lauren they agreed to work on paymentsThis was the only payment made on her accountOnce the insurance denied everything she was set billing statementsNot once did she contact the office and question the amount owedShe was call on 2-9-by the Plattsburgh staff to discuss her balance...."- Fri - Feb 19, -spoke to pt she was not happy that the ins did not pay...I told her that the insurance is stating it was terminatedShe said my staff told her it was covered and its my staffs faultI told her that she can call guardian if she knew she had coverage because that is something we cannot fix since we are not the subscriber, She seemed reluctant to do so and never said that was something she would doShe kept saying it was my staffs fault I told her that she should have some responsibility for her own ins, and if by my staff she means Lauren because Lauren referred her in and is her friend then I apologize if Lauren mislead her but she should call guardian if she was supposed to have active benefits and that regardless of the outcome she is responsible for the charges."We gave the patient options to which she did not agree to nor followed through withWe reached out with calls and billing statementsWe would have been more then happy to come to a payment arrangement if the patient had communicated to usWe apologize for her frustration and wish her luck in the future

Dear Complaint Handler,We received you letter in regards to [redacted] We apologizefor any miscommunication that has appeared to cause the patient much frustrationOn12/5/the patient was contacted by [redacted] to address the issue, apologizefor the miscommunication, and to verify how he would like the information sent to him.A message was left for the patient so the information requested was mailed out on12/5/2014.It is not High Peaks Dental's intention to upset a patientThis appears to be amiscommunication issue and we are extremely sorry for the trouble it has caused thepatientWe are hopeful that the patient has received all he needs and we are willing towork with the patient to meet his needs.Regards,***- [redacted] Accounts ReceivableHigh Peaks Dental

Revdex.com: Thank you for handling my caseThey promptly sent out an itemized listI have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me Regards, [redacted]

April 1, 2016To whom it may concern,High Peaks Dental in Piattsburgh you like to provide some information inregards to complaint # [redacted] .It appears that the patient originally had this crown done on 10/28/Hecame in for a cleaning on 3/28/During this appointment he stated to the hygienisthow the (original) crown was giving him some issues as far as it came to food impaction.She advised him to keep the area clean and that there was no decay.In June he was seen to have a new crown made as the old one adfracturedAt his final cementation appointment he was satisfied with the outcome withthe new crownHe was not in again since July He failed to keep up on his hygieneappointments which guarantee him a warranty.Our doctors would have been more than happy to fix any issues the patientwould have been having as we had already done it once for himThere are no notes thatthe patient had called stating he was dissatisfied with the productThis is the first timewe are hearing of the issue he is havingIf he were to communicate to us we could havefigured out a mutual agreement to satisfy both partiesHigh Peaks Dental, unfortunatelydoes not have the capability to produce in office crownsImpressions are mailed to a laband then sent back to be insertedIf there was an issue we could have followed up withthe lab that was usedWith so much time having passed and no communication fromthe patient unfortunately there is nothing that can be done to rectify the situation.See the attached clinical notes for further information.Thank you for your time.Peggy

In regards to complaint ID ***,would like to further explain andapologize for the patients frustrations.Our office is a non-participating providerMeaning, dental insurance will payhowever, it might not pay as much as they would pay a participating providerThis is afact that is
communicated to our patients and we often find our patients are poorlyeducated on their own insurance policiesThe providers at High Peaks choose not toparticipate with Dental Insurance because the insurance companies can then controlhow our providers treat the needs of our patientsFor example, if someone wanted awhite filling on a molar this would not be allowed if we were a participating provider.We have some expectation that our patients would have some responsibly when itcomes to their own policies.We definitely see the frustrations that the patient has concerns withShe wasgiven a verbal financial due to our system being downThe verbal was given to provideless frustration for herWe wanted her to have prompt serviceThere was no ill willlooking to be done with this optionOur financials explain that they are just estimatesdue to the fact we do not participateWhen a call is made to an insurance company toget a quote we are told the same thing because again we do not participate.When the payment came in and the bill was sent to the patient she treated ourfront desk staff in a poor manor so much so that they had looked to get the officemanager involved to handle the situationThe admin team did try to explain why theinsurance did not pay as much as expect however she was not willing to listenHer goalwas to have the balance adjusted offShe was told several times by several staffmembers that we are more than willing to work with her on payment optionsNeveronce were we told she was uncomfortable or unhappy with the work providedWepride ourselves on our patient care and their comfortIf that was presented in thebeginning of this situation she would have been added to the schedule no questionsasked ASAPFollow up appointments when it comes to treatment recently provided arenever expected to be something the patient is responsible to pay for.We do apologize that Nikki was unavailable to speak to her as she was onvacationShe however, would have told the patient the same data the front deskprovided her.At her follow appointment she agreed to pay the out of pocket owed for thecleaningShe then explained to the clinical staff and the doctor that the front deskwould not schedule her and she was in painWhen this was presented to the staff fromthe clinical team and the doctor, there was discussion of the patient's history and howthe front desk is treatedThe doctor agreed that it's highly unlikely she was beingavoided when it came to her discomfortThe patient did contact the office several timesbut she was looking to have money written off her account and that could not be donewithout Nikki's approval.It's unfortunate for the miscommunication and we wish her the best with herinsurance and dental futureWe apologize that this situation caused her stress.Thank you for your time

To whom it may concern,The complaint sent in by *** *** ID #*** will be taken veryseriously and our staff and doctors often find complaints useful as a way to learn andgrow into a better practice.However we would like to take the time to explain our side of this interaction.Below is the
legal clinical note from the date of service.exC, pas #18-areaPt reported no change med hx but plans to quit smoking by herbirthdayInformed pt of unusual lesion on mandible where would beFolded tissuewith pedunculated portion of reddish color with white top, resembling a fistula but onthe top surface of the mandibular tissueInformed pt that lesion could be serious ornot but she needs to see an oral surgeon for Pan and probable biopsy to determinehow serious the lesion is21, and all tested vital to coldPt got upset, pulled offbib, said DrC was "freaking her out" and that she 'had to leave immediately", evenprior to me taking an intraoral photo of the lesion or providing SPTI will follow upwith a call to patient to encourage her to see DrB*** asap and to reschedule herSPTNV:SPT, fl tx, bw4, ex, intraoral photo of lesionSigned on Monday, June 08, by Margaret AM***, RDH-Appended on Monday, June 15, at 2:02:PM by XXX9-Radiolucency with irregular borders noted in the body of mandible in the area of theintraoral lesionsPt was advised that the presentation of the lesions could be severalthings, some not so serious and some very serious and that the only certain way todetermine the diagnosis was through a biopsyIt was at this point that the patient gotup, removed her bib and ran out of the office.William PC*** DMDPresenting a patient with findings that are abis the responsibility of the doctorsand hygienistIt's very understandable that hearing of a potential serious issue can bevery stressful and scaryIt was made clear to the patient in the chair and via phone callsfrom our hygienist as well as assistant office leader that DrC*** was doing is job byproviding the information and that he was not diagnosing.Below is a note from our admin team about a phone conversation had with Susan6/24/a couple weeks after her appointment in our office.Susie called upset and spoke to *** stating that we should be paying for her visitwith her physician because dr c*** was wrong about giving her the scare or the ideawhat she has something wrong with herPer Nikki I called the pt back.She explained that DrC*** had poor beside manor and was very rude and wouldnot tell her what was in her mouth and demanded that X-rays where takenI assuredher that's not how DrC*** practices and that he was doing his job has a doctor tomake her aware of any issues and presenting her with the issue to refer her to get adiagnosisI read to her the clinical note from that day because her account of the daywas very different then what the clinical note statesShe then began to stop talkingabout the poor way she was treatedShe wanted to have the amount she paid to herphysician covered and the amount she was charged for seeing us written offI told herthere would be some fee depending on what was done that dayAfter speaking toPeggy who informed me no cleaning was done did take off the cleaning varnish andXrays.I did keep the exam fee on there per DrC***I called her back to make heraware of her balance since she has a balance prior to this appointment and the chargeof the day I had to leave a message PCARThe patient was made aware of her balance and that it was not steaming completelyfrom her visit on 6/8/She was also mailed a complete break down and a bill for theservicesThe only charge she occurred for date of service 6/8/was for the examDueto her abruptly leaving our full check out process with our admin team was not possible.At that time we would have worked out her charges for the day and also an attempt tocollect her previous balance would have happened.We are very pleased to hear that the lesion has turned out to be nothingseriousWe hope that the patient understand our providers where merely doing theirjobs and presenting her with options and with the evidence that she did at that pointhave something going on.Attached you will find a copy of the clinical note, journal note, letter ofdismissal, and break down of her balance.Thank you for your time,Peggy C***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below
The reason I stopped going to High Peaks Dental was because
I felt that their work was substandardTheir response that I had not
previously contacted them about this issue is a flat out lieI did in fact
contact them before filing a complaint through the Revdex.comThey informed me that
because I started going to another dentist that violated my warranty with High
Peaks Dental and that there was nothing they would do about the defective
CrownI have since had the crown redone by a competent professional and I am
happy with his workUnfortunately, I have since found out that High Peaks
Dental had lied to me beforeI asked at my first appointment with them if they
were in my network and was told yesI would have gone to another dentist had I known this. When I recently contacted my insurance
provider they told me that I was out of network for High Peaks Dental, and thus
had to pay out of pocket for the replacement
Regards,
*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below
I do not agree, this was very unprofessional and almost all of what they wrote is a lieI agree that I did sign paperwork to pay anything Insurance would not cover however, I was NEVER given information needed to make a decision on services I was receiving.Again for the times I went to High Peaks Dental each and every time I asked was there anything I needed to pay and all times was told "no, you have the best dental plan and you are covered" this was also told to a fellow employee *** *** who also was hit with an enormous billAnd We, Bill and I were told by High Peaks Dental that this had happened to others as wellIf my Insurance did not cover services then I should have been informed the 2nd visit so that I could make an informed decision on whether I would like to move forward with their servicesOn the rd visit I was asked if I wanted the fluoride treatment that my Insurance would cover.It seems that I was left in the dark on what was covered so that they could get me to run up a largeer billI can assure you if you contact my former dentist Dr*** he would tell you I never had a problem paying my billbut, then again he always was up front and clear what was paid and what was notIf I had not asked each time I went for service and was told I owed nothing I would not be complaining about the billIf High Peaks had in fact provided me with their so called complementary Insurance benefit check, I would never had more work done the 2nd and 3rd time I was thereNo I was not forced to have the work done but, if you are telling me it is covered in full then YES why not have the work doneFinancials were NEVER given before treatmentI am sure that if you ask *** *** if he was told about any cost to him on his services , he would in fact say the same thing '"We weretold we had the best insurance and everything was covered"
Regards,
*** ***

I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Regards,
*** ***

We apologize for the time from it took for Mrs*** to receive her refundShe was seen in our office on 3/25/Her insurance was submitted the following day and paid a portion of her balance on 4/14/She was left with an account balance of $Mrs*** paid her balance on 8/25/
Upon further review of her account it was noticed the insurance company never paid for her XraysThe claim was resubmitted on 8/25/and the insurance then paid $on 9/1/On 9/14/the request was sent to our accountants who are out of state, to have a check processed and mailed to Mrs***Mrs*** corresponded with me several times as of the status of the checkUnfortunately the information is not readily available for me as we use a company in another state with a timezone difference with multiple employeesOn October 8th she sent me an e-mail requesting again where her check was and that she was frustratedI let her know I would look into it and sent an e-mail to a point of contact for usFinally on October 15th I was made aware that the check was being processed and sent out that dayI sent an e-mail to Mrs*** letting her know of the status changeIt's not our intention to hold moneyWe have a system that we need to use per our doctors and at times request for refunds can take up to weeksWe are sorry for the inconvenience this has caused our patients and are looking of ways to speed up the processThank you for your time, Peggy C

June 15th 2015We received the second notice from complaint ID ***Again weapologize for the frustration the patient is experiencing.However, High Peaks Dental and its employees did not lie to the patientAgain,we attached signed financials as well the explanation of benefits from the insurancecompanyThese two documents will show that the patient was made aware beforetreatment was provided as well as after.We understand the frustration the patient is feeling due to the out of pocketcost from what her insurance did not coverHowever, we cannot guarantee thepayment from the insuranceThis is why we document it on our financials more thanonce and we train our staff to use words such as "insurance estimate." When theinsurance company is called and we are told that everything is covered at 100% our staffif very cautious when saying to a patient that this is going to be fully covered becausethat is just not the case with 99% of insurancesThis is why when the financial waspresented the staff member added an additional note stating there might be out ofpocketThis is an additional hand written note on a form that says several times thepatient will be responsible for any cost after the insurance paysThis is the same formthat the patient signed and initialed understanding the treatment and cost.We received a letter from the patient expressing her frustrations with thesituation and our officeAfter reaching out to the patient a message was left a messagestating there was nothing we could do to correct what her insurance paid however wecould work with her in regards to payments.The patient to our knowledge had never followed up with us until we receivedthe letters from the Revdex.comHigh Peaks Dental is very willing to work with the patient andwe welcome any feedback to aid with better training of our staffWe hope that is issuecan be settled to please both parties.Sincerely,***Assistant Manager

High Peaks Dental would like to respond to complaint ID ***It's veryunfortunate that the patient is dissatisfied with the service provided however, I assurethat all aspects where handled properly and professionally.The patient appears to be upset in regards to the cost of treatmentOur
office isa non-participating officePatients are made aware of this fact when financials arepresented if not beforeOur insurance estimates are just an estimateThis fact is madeclear several times on our financial formsThe form also provides a separate box thatdiscusses this subject making it additionally clear to our patients that if there is an out ofpocket greater than what we are estimating they will be the responsible party of theremaining cost.The patient who submitted the complaint had signed one of these finical forms.Also, the patient initialed the separate boxes showing that they were well aware of anypossible out of pocket costThe form also contains a hand written note from the finicalcoordinator "patient may have some out of pocket after the insurance pays."The administrative staff at High Peaks Dental provides all patients with acomplementary insurance benefits checkHowever, on these phone calls theinformation provided to our staff is made clear that this is not a guaranteeThis is whywe cannot guarantee the amount insurance will cover.As far as treatment done, noting is forced on our patients especially when weare providing them with ample informationFinancials are provided prior to treatment.Our providers take the time to explain each step of the procedure being provided.It's not our mission nor in our core values to upset or cause a concern with ourpatientsIn the case such as this we offer many payment arrangements as well as anyextra information to help educateAttached you will find the patients clinical note aswell as financial agreement.Thank you for sharing this concern and complaint so that we can better trainour staff and providers to maintain our five star service to our patients

Dear Complaint Handler,We received you letter in regards to [redacted]. We apologizefor any miscommunication that has appeared to cause the patient much frustration. On12/5/2014 the patient was contacted by [redacted] to address the issue, apologizefor the miscommunication, and to verify how...

he would like the information sent to him.A message was left for the patient so the information requested was mailed out on12/5/2014.It is not High Peaks Dental's intention to upset a patient. This appears to be amiscommunication issue and we are extremely sorry for the trouble it has caused thepatient. We are hopeful that the patient has received all he needs and we are willing towork with the patient to meet his needs.Regards,[redacted]-[redacted] Accounts ReceivableHigh Peaks Dental

Revdex.com:
Thank you for handling my case. They promptly sent out an itemized list. I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. 
Regards,
[redacted]

April 1, 2016To whom it may concern,High Peaks Dental in Piattsburgh you like to provide some information inregards to complaint #[redacted].It appears that the patient originally had this crown done on 10/28/2013. Hecame in for a cleaning on 3/28/2014. During this appointment he stated to the...

hygienisthow the (original) crown was giving him some issues as far as it came to food impaction.She advised him to keep the area clean and that there was no decay.In June 2014 he was seen to have a new crown made as the old one adfractured. At his final cementation appointment he was satisfied with the outcome withthe new crown. He was not in again since July 2014. He failed to keep up on his hygieneappointments which guarantee him a warranty.Our doctors would have been more than happy to fix any issues the patientwould have been having as we had already done it once for him. There are no notes thatthe patient had called stating he was dissatisfied with the product. This is the first timewe are hearing of the issue he is having. If he were to communicate to us we could havefigured out a mutual agreement to satisfy both parties. High Peaks Dental, unfortunatelydoes not have the capability to produce in office crowns. Impressions are mailed to a laband then sent back to be inserted. If there was an issue we could have followed up withthe lab that was used. With so much time having passed and no communication fromthe patient unfortunately there is nothing that can be done to rectify the situation.See the attached clinical notes for further information.Thank you for your time.Peggy

The staff at High Peaks in Plattsburgh unfortunately was not apart of this patient's experience as she was seen in Lake Placid and that office is no longer open. Upon review of the notes the patient did sign a financial agreement, not a contract. The financial agreement is an ESTIMATE of what the...

insurance the patient stated she had would cover. The day of her sedation appointment a note was entered into her chart by Lauren who is also a friend of the above patient. "Do not bill. She is going to work with me on payments. Husband approved of her added on treatment because she wanted to get it all done at once. Waiting to see what insurance pays first. LB- Wed - Oct 28, 2015 -" While the patient may not have agreed due to sedation on the one extra filling would not have made her account balance as high as it is. The issue with here her balance comes from is because her insurance was terminated. Out financial estimates state very clearly that any out of pocket remaining from the insurance is the responsibility of the patient.The patient had over $2,000 in dental treatment done. The day of the treatment she only paid $400. In the above note from Lauren they agreed to work on payments. This was the only payment made on her account. Once the insurance denied everything she was set 7 billing statements. Not once did she contact the office and question the amount owed. She was call on 2-9-16 by the Plattsburgh staff to discuss her balance...."- Fri - Feb 19, 2016 -spoke to pt she was not happy that the ins did not pay...I told her that the insurance is stating it was terminated. She said my staff told her it was covered and its my staffs fault. I told her that she can call guardian if she knew she had coverage because that is something we cannot fix since we are not the subscriber, She seemed reluctant to do so and never said that was something she would do. She kept saying it was my staffs fault I told her that she should have some responsibility for her own ins, and if by my staff she means Lauren because Lauren referred her in and is her friend then I apologize if Lauren mislead her but she should call guardian if she was supposed to have active benefits and that regardless of the outcome she is responsible for the charges."We gave the patient options to which she did not agree to nor followed through with. We reached out with calls and billing statements. We would have been more then happy to come to a payment arrangement if the patient had communicated to us. We apologize for her frustration and wish her luck in the future.