Joseph W. Worthington, DDS, P.C.

I would like to thank the Revdex.com for forwarding this complaint
to me so that I can respond to it. As
you well know I pride myself in the fact that I have been a member of the CT RevDex.com since with an A+ rating without a single complaint until
today
As a quality
practitioner who is not an in network provider
with any insurance companies my treatment proposals are never guided by
insurance company bureaucrats. Many patients
choose to have their dental care with us for this reason. Insurance companies rarely have the patient’s
best interest at heart. I have no relationship with the insurance
companies other than to submit claims as a courtesy to my patients The insurance contract is between the patient
and the insurance company explaining why in the complainant’s case she had to
contact the insurance company herself in order to find out the reason for the
claim being denied. Most
insurance companies pay for hygiene visits per calendar year regardless of
the of the time span between those visits.
A few stipulate that the visits must be exactly months apart. Since the contract is between the patient and
the insurance company unfortunately it is the responsibility of the patient to
understand the limitations of their individual insurance plan
In defense of my staff, I get constant compliments on their performance and in particular my Office Manager
with whom the complainant discussed her situation. She called the complainant for me for two
reasons. One being I was with patients
and explained that to her as opposed to what was stated in the complaint that I
simply would not call and two because she handles all administrative activities
while I concentrate on delivering dental care.
During my Office manager’s conversation with the complainant, she was
the one to offer to help by extending a 15% Professional Courtesy. In the complaint the complainant stated that
she didn’t agree with this offer but on the contrary did agree and gave my
Office Manager her credit card information to clear up the balance minus the
15%. It was only after that that the complaint
with the CT Revdex.com was lodged
The blame here lies not with the complainant nor my
office. The blame should be directed
with the complainant’s HR department for not clearly explaining the unfortunate
limitations the insurance company placed on the patient’s dental
treatment. Unfortunately insurance
companies place these limitations hoping that this very situation occurs
leaving only the insurance company the winner
Since the complainant has been happy with the clinical care
she has had here in my office she is welcome to continue as a patient in my
office without prejudice with regard to this complaint.Thank you, DrJWorthington

I would like to thank the Revdex.com for forwarding this complaint
to me so that I can respond to it. As
you well know I pride myself in the fact that I have been a member of the CT RevDex.com since with an A+ rating without a single complaint until
today
As a quality practitioner who is not an in network provider
with any insurance companies my treatment proposals are never guided by
insurance company bureaucrats. Many patients
choose to have their dental care with us for this reason. Insurance companies rarely have the patient’s
best interest at heart. I have no relationship with the insurance
companies other than to submit claims as a courtesy to my patients The insurance contract is between the patient
and the insurance company explaining why in the complainant’s case she had to
contact the insurance company herself in order to find out the reason for the
claim being denied. Most
insurance companies pay for hygiene visits per calendar year regardless of
the of the time span between those visits.
A few stipulate that the visits must be exactly months apart. Since the contract is between the patient and
the insurance company unfortunately it is the responsibility of the patient to
understand the limitations of their individual insurance plan
In defense of my staff, I get constant compliments on their performance and in particular my Office Manager
with whom the complainant discussed her situation. She called the complainant for me for two
reasons. One being I was with patients
and explained that to her as opposed to what was stated in the complaint that I
simply would not call and two because she handles all administrative activities
while I concentrate on delivering dental care.
During my Office manager’s conversation with the complainant, she was
the one to offer to help by extending a 15% Professional Courtesy. In the complaint the complainant stated that
she didn’t agree with this offer but on the contrary did agree and gave my
Office Manager her credit card information to clear up the balance minus the
15%. It was only after that that the complaint
with the CT Revdex.com was lodged
The blame here lies not with the complainant nor my
office. The blame should be directed
with the complainant’s HR department for not clearly explaining the unfortunate
limitations the insurance company placed on the patient’s dental
treatment. Unfortunately insurance
companies place these limitations hoping that this very situation occurs
leaving only the insurance company the winner
Since the complainant has been happy with the clinical care
she has had here in my office she is welcome to continue as a patient in my
office without prejudice with regard to this complaintThank you,
DrJWorthington

Review: I initially had a dental appointment on 04/23/15 from Dr. Worthington's office. The office then scheduled me for the future date of 10/20/15. The frequency of my cleaning is 6 months to the date, so therefore, my cleaning was done 3 days prior to the authorized date. I was not aware that my insurance company declined the claim until today 02/18/16 - almost 4 months after the fact. When I called the doctors office to find out why I received something from my insurance company, they assured me that they would call my insurance carrier to figure things out. I then received a call back from the Doctor's office with them stating that I needed to call the insurance carrier myself and that there was nothing they could do on their end. After speaking with the insurance carrier myself, they determined that the time frequency as aforementioned above was why it was denied. They stated that I could not even appeal the 3 days as they are automatically denied. As a result of their findings shared with me, I decided to call the Doctors office again to try to figure out a fair solution. They were rather irritated that they had to explain to me why they would not or could not do anything for me. She simply stated that the hygienist and the dentist simply needed to be paid. I mentioned that it was their responsibility to schedule my cleanings within the time frequency allowed (as all other dental offices do). She said that it was not their responsibility and that their computer only is formatted within 3 month intervals. I continued to ask her what she could do. She finally said if I paid the amount today she could give me a 15% discount (which I still didn't agree with).Desired Settlement: I would hope that they at least would have paid half or written the entire thing off AND they could've been a little more friendly. I actually enjoyed going to their office and the hygienist was the best person to have a conversation with (yes even while she was cleaning). I would like an apology also for how I was treated over the phone. They should learn how to deal better with upset clients who just want a resolution. I tried having the doctor call me, but he would not. I would appreciate that he understand what happened and that he could at least send me a letter of apology or even a phone call would be appreciated.

Business

Response:

I would like to thank the Revdex.com for forwarding this complaint

to me so that I can respond to it. As

you well know I pride myself in the fact that I have been a member of the CT RevDex.com since 2003 with an A+ rating without a single complaint until

today.

As a quality practitioner who is not an in network provider

with any insurance companies my treatment proposals are never guided by

insurance company bureaucrats. Many patients

choose to have their dental care with us for this reason. Insurance companies rarely have the patient’s

best interest at heart. I have no relationship with the insurance

companies other than to submit claims as a courtesy to my patients. The insurance contract is between the patient

and the insurance company explaining why in the complainant’s case she had to

contact the insurance company herself in order to find out the reason for the

claim being denied. Most

insurance companies pay for 2 hygiene visits per calendar year regardless of

the of the time span between those visits.

A few stipulate that the visits must be exactly 6 months apart. Since the contract is between the patient and

the insurance company unfortunately it is the responsibility of the patient to

understand the limitations of their individual insurance plan.

In defense of my staff, I get constant compliments on their performance and in particular my Office Manager

with whom the complainant discussed her situation. She called the complainant for me for two

reasons. One being I was with patients

and explained that to her as opposed to what was stated in the complaint that I

simply would not call and two because she handles all administrative activities

while I concentrate on delivering dental care.

During my Office manager’s conversation with the complainant, she was

the one to offer to help by extending a 15% Professional Courtesy. In the complaint the complainant stated that

she didn’t agree with this offer but on the contrary did agree and gave my

Office Manager her credit card information to clear up the balance minus the

15%. It was only after that that the complaint

with the CT Revdex.com was lodged.

The blame here lies not with the complainant nor my

office. The blame should be directed

with the complainant’s HR department for not clearly explaining the unfortunate

limitations the insurance company placed on the patient’s dental

treatment. Unfortunately insurance

companies place these limitations hoping that this very situation occurs

leaving only the insurance company the winner.

Since the complainant has been happy with the clinical care

she has had here in my office she is welcome to continue as a patient in my

office without prejudice with regard to this complaint.Thank you, Dr. J. Worthington