Hodge and Lancaster Family Dental Reviews (%countItem)
Hodge and Lancaster Family Dental Rating
Address: 321 N 22nd St, Lafayette, Indiana, United States, 47904-2601
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I received a letter from Hodge and Lancaster Family Dental instructing me to pay $702 for my appointments in February, 2020 . However, I think this is unfair because they did not participate in Delta Dental PPO but they gave me the wrong information that misled me to accept services which I would not accept if knowing that they are Delta Dental PPO non-participating dentist.
1.The receptionist and dentist have misled me to accept services which are not covered by my insurance. On Feb.13, 2020 (1st appointment), I went to Hodge and Lancaster Family Dental for mild sensitivity teeth issues. I gave the receptionist my insurance card and asked the receptionist if they participated in Delta Dental PPO insurance plan so that my insurance would cover part of my costs. The receptionist at that time assured me that they did take part in my insurance plan. I relied upon the receptionist’s information that they participated in my plan. I started with an oral examination (Code 150). During my appointment, the dentist recommended radio image and said with my insurance coverage, I would not need to pay anything out of pocket for a radio image, so I accepted it (Code 210). I also accepted perio scaling and root-planing for a quadrant of my teeth with the assumption that they participated in my insurance plan (Code 4341). And at the end of the appointment, when I received my statements, it was printed in several columns showing that I should pay $142 on that day and the rest $318 balance was expected from insurance. I paid $142 on that day before leaving. The dentist suggested perio scaling and root-planing for the entire teeth. So I asked receptionist to estimate how much I should pay out-of-pocket if doing perio scaling and root planning to decide whether to accept of not. She said $48 /each quadrant based on calculation, so I continued to do 2Xquandrant perio scaling and root planning during my Feb. 19 appointment. My 2nd appointment costs $480 in total and I paid $96 on that day. The $96 I paid on Feb.19 should be the amount we have agreed upon for which I should pay out-of-pocket for my second appointment. They expected the rest $318(balance from my 1st appointment)+$480-$96=$702 to be paid by my insurance.
2.The employee M has provided misleading information about how Delta Dental works
On July 8, 2020, I received a phone call from one of their employees M asking me to pay $702. She said they requested $702 from Delta Dental and was declined, which did not make sense to her. Therefore, she told me that this is not how Delta Dental would work. Instead, I should pay them $702 and Delta Dental would mail me checks to compensate me afterwards. However, this is not true and completely misleading. Delta Dental says Hodge and Lancaster Family Dental DOES NOT participate in my insurance plan and Delta Dental would not cover anything. Moreover, even if the amount would be covered by Delta Dental, Delta Dental would never instruct beneficiary to pay the dentist directly and reimburse the beneficiary later. This means, even if I paid them $702, Delta Dental would not mail me the check. In the “Par Network section” of the statement their employee mailed to me on July. 8, 2020, it is clearly stated that you are “Nonparticipating Dentist”. Because this is the letter their employee mailed to me, it is impossible that they did not have this information. Therefore, I believe their employee purposefully misled me to believe that they participated in my insurance plan on July. 8, 2020 so that they could get the money from me. I think this is an unethical dental business practice.
On July 9, 2020, I called M and asked her whether they participated in in Delta Dental PPO Standard plan. First, she replied “um-hum”, which is an expression of affirmation. I asked again, then, she changed her words and said “we are in network with nobody”. This is contradictory with what she explained to me on July.8, 2020. She admitted that the receptionist provided the wrong information. However, she said, the receptionist, H, was no longer working at Hodge and Lancaster Family Dental. This is not a responsible attitude to solve this dispute.
Overview About My Office Regarding Insurances:
Hodge and Lancaster Family Dental is not in network with any insurance company. We do not advertise that we are in network, nor do I or any of my staff (current or past staff members) tell patients that we are in network.
As a courtesy to our patients, we file all insurance plans presented to us, and attempt to give each patient an estimated cost that he or she may have to pay out of pocket. With that being said, those are estimated costs (as it states on the “statement of services rendered” printouts). The actual amount covered by insurance and any amount an individual patient may have to cover out of pocket is finalized once the insurance claim has been reviewed and either accepted or denied by the individual’s insurance company. Each patient’s specific policy is an agreement between that individual and his or her insurance company, and all policies are different. It is ultimately the patient’s responsibility to know what is covered by his or her individual’s insurance plan.
Overview of Delta Dental Insurance:
In recent years, when Delta Dental Insurance plans have been approved, the insurance company sends the checks directly to the patient instead of to our office. It is then the patient’s responsibility to give that check to our office to pay for the services rendered. Sometimes this can be confusing to the patient, as he or she might think they are getting some sort of a refund and will use that check for other purposes not realizing it is for his or her dental bill.
Where I think the confusion lies with this specific individual’s conversation with my current front desk staff member, is that my staff member was just giving her a general overview as to how Delta Dental Insurance Company operates now. To compensate for this potential dilemma on our end, we collect the full amount of services billed for at the day of the appointment ahead of time for all patients that use Delta Dental Insurance in our practice. That way, all rendered services have been completely paid for and whenever the patient receives a check from Delta Dental Insurance, he or she can just keep the check. I really hope that makes a little bit more sense.
Treatment Plan, Appointments and Charges:
This individual was a new patient to our office on Feb. 13, 2020. A comprehensive exam plus a complete series of radiographs were done first. Based on clinical and radiographic findings, it was determined that she was in need of 4 quadrant perio scaling and root planing (SRP) and a couple restorations, in which she consented to and decided to start 1 quadrant of SRP that day. My hygienist worked on one part of her mouth that day and scheduled her for Feb. 19th to work on a couple more quadrants. She came in as scheduled on Feb. 19th and had that work done. She was scheduled for March 3rd to finish her last quadrant of SRP and to have the restorations completed but failed that appointment. The following charges reflect what was done each day:
Feb. 13th Charges:
Comprehensive exam ($90)
Complete Radiographic Images ($130)
1 quad of SRP LL ($240)
Total amount charged: $460
“Estimated Insurance Coverage”: $392
Feb. 19th Charges:
1 quad SRP UL ($240)
1 quad SRP LR ($240)
Total amount charged: $480
“Estimated Insurance Coverage”: $384
Overall as of Feb. 19th:
Grand total of production billed = $940
Grand total paid out of pocket at this time = $238 ($142 paid on Feb. 13 and $96 paid on Feb. 19)
Remaining balance = $702
Since this individual uses Delta Dental Insurance, we would have normally and ideally collected the full amount of $940 by the end of the appointment on Feb. 19th, but agreed to only collect $238 at that time. Please refer back to the “overview of delta dental insurance” section if there is still some confusion.
After Insurance Was Filed:
Insurance was filed and was denied, meaning that her specific Delta Dental Insurance plan will not cover anything because I am a “nonparticipating dentist.” That means the remaining balance of $702 is her responsibility to pay out of pocket.
Closing:
Unfortunately, her plan did not cover anything, and ultimately that is not my responsibility to know what is covered with her insurance plan and what is not. My staff and I try our best to estimate and educate each of our patients as to what extent his or her insurance(s) may cover, but estimates are not always accurate. All insurances are different and not fun to work with at times obviously.
I would like to thank you for notifying me of her concern, and I personally apologize for any confusion that may have been created. Please do not hesitate to contact me at my office with any further questions or concerns that you or this individual may have.
Sincerely,
Dr. Matthew C Lancaster
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID and find that this response/resolution is satisfactory to me. Thank you!
Regards