James H. S. Whitney, DDS, P.C.

Review: In April of 2013 our family dentist recommended that our 7 year old daughter get a tooth pulled. She had an extra tooth growing in the front of her mouth and it was jamming up her other teeth,so we were referred to Dr Pandolfi. We met with [redacted] from Dr. Pandolfis office, the topic most urgent for [redacted] to clarify was that Dr. Pandolfi needed his payment for services ASAP. My wife and I were a little alarmed at the aggressiveness that [redacted] displayed. We agreed to pay Dr. Pandolfi his fee several weeks before the scheduled extraction. [redacted] then told us just in case the Dr. found a similar tooth that needed to come out, $400 extra was needed. [redacted] then explained if no extra work was needed we would get our $400 back after the surgery. We agreed and paid the fee plus $400. [redacted] explained to us that Dr. Pandolfi would only perform this extraction from the hospital. This was a red flag immediately, because I knew my knowledge of what my dental insurance covered was very vague. I explained to her that my insurance may not cover dental work preformed in a hospital, because a coworker just went through something similar with her child, and she had to pay out of pocket. We made it very clear to [redacted] that if our insurance did not cover the extraction in the hospital, we would be forced to find a Dentist who could perform this in a dental office. [redacted] assured us that they would apply this procedure to our insurance and let us know ASAP. A couple days after our meeting with [redacted] we received a call from her that she had pre-qualified our extraction with our insurance provider, and everything was covered. We set a date up at the hospital to get the work done. On May17 2013 we took our daughter to the hospital and Dr. Pandolfi extracted the tooth that our dentist recommended, and no extra work we prepaid for was needed. In the third week of July, we get a bill from the hospital for $4100. The bill stated that nothing was covered by our insurance. Extremely alarmed, my wife and I go make a visit to Dr. Pandolfis office to speak with [redacted] about how to clear this mistake up. We are told that [redacted] no longer works at the office so I asked to speak to Dr Pandolfi. I told him our situation his exact reply was thats why [redacted] no longer works here, for reasons just like that. Dr Pandolfi then said he would contact our insurance company and straighten things out. I then asked him, how come he had to have his money weeks before surgery, and two months had passed and he didnt care one bit about the money I had to pay him extra incase he had to do extra work. (they never reimbursed my $400 extra) He told me he didnt realize [redacted] had made us pay his fee early, plus any extra. I do not believe that for a second, but the poor aloof fellow then told us that he would have a check sent to us ASAP. I later contacted my insurance rep and she explained to us that [redacted] had applied for the extraction to our insurance as she had promised. The only problem was the extraction was denied weeks prior to the surgery date. [redacted] even appealed the denial 2 times and was denied each time. When [redacted] called us and told us our insurance would cover the extraction she had already been denied three times. That makes her accepting our money and scheduling the surgery at the hospital fraudulent. After I found this out I went to see Dr Pandolfi several times and he refuses to talk to me or return my phone calls. Best case scenario we were victims of Dr Pandolfis incompetence. Thats best case, after being there and seeing [redacted] aggressively trying to secure our payment like a used car salesman, my wife and I wonder if she was instructed by him to just schedule the surgery anyway even they knew we were going to be blindsided by an unnecessary hospital bill. I would be happy to ask Dr Pandolfi, but he isnt talking. I have meticulous records to prove everything I have written here.Desired Settlement: Dr Pandolfi's office was well informed prior to surgery that my insurance was not going to cover the surgery. It was denied 3 times weeks prior to our surgery date, and his office fraudulently scheduled the surgery anyway. The $4100 hospital was completely unnecessary, we could have easily found a dentist to do this surgery in a dental office, and it would have been covered. We were lied to by his office. It is just common sense we would have went the other direction had they been honest.

Business

Response:

We did indeed see the patient in April of 2013 in our office, for a possible tooth

extraction, as referred by her general dentist. We scheduled a consult appointment to

discuss our doctor's findings and suggestions for surgery. It was explained to the mother

that due to the patient's young age, we would not put the patient to sleep in our office. It

is our doctor's policy and comfort level not to provide general anesthesia to children

under 12 years of age in our office. This was plainly stated upfront, with the advice of

moving the surgery to the hospital setting or that we would completely understand if the

parents needed to use another oral surgeon for their needs. The parents elected to

continue with the surgery in the hospital setting.

As a courtesy to our patients, we do try to find out as much insurance information and

benefits as we can before surgery is done, in the office or out of it. However, it is only

done as a courtesy for our patients. The ultimate responsibility of the insurance policy is

the policy holders. We advised the parents of what we knew at the time. The surgery

continued as planned. Afterwards, the parents relayed that they were happy with the

surgery process and the way our doctor handled it. We feel that our office did everything

we could to make this a pleasant experience for all involved.

Consumer

Response:

I have reviewed the response offer made by the business in reference to complaint ID [redacted] and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

I would like to note that in Dr Pandolfis response he made absolutely no attempt to deny anything I wrote. I would also like to call attention to this quote from his response "We advised the parents of what we knew at the time" that is an intentional blatant lie. I have proof from our insurance company that on 4-25-13 (3+ weeks prior to surgery) they denied coverage to Dr Pandolfi for the extraction. Dr. Pandolfis office attempted again a couple times and it was denied each time. The information they knew at the time was we were not covered and they chose to keep that from us. If they feel strongly that the responsibility is on the patient, then they need to stop doing these incompetent "courtesies". Dr Pandolfi knows without a doubt when a young couple comes in with small children and he or an agent on his behalf tells them they are going to handle the patients insurance "as a courtesy", that the couple is going to trust him 100%. To do what they did to us, and then meekly respond with "its the responsibility of the patient" is a corrupt cowardly way to do business.

Regards,

Business

Response:

Our original response stands.

Office Manager

Consumer

Response:

I have reviewed the response offer made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

I understand Dr. Pandolfi will never admit guilt, but I have attached a letter from my insurance company where they denied the claim on 4-25-13, (well before surgery) and then my later attempt when I resubmitted the claim on 6-27-13. Hopefully the public can see this and be warned to protect themselves from unethical business practices.

Regards,