Juliana Carvalho and Mohamed Hassan, DDS, MS

Initial Business Response /* (1000, 13, 2015/11/18) */
The services provided to the complainant were completed on the same day at her request. She was no longer living in the area and would be local for a specific time period. The complainant was well aware that any and all treatment not covered by...

insurance company was her responsibility prior to proceeding. This office does it's very best to assist our patients with their estimated portion. The pre-estimate sent in to her insurance company is just that, an estimate. We were not aware her periodontal maintenance appointment would not be covered if performed on the same day as the tissue grafting procedure. The periodontal maintenance cleaning is an unrelated service and the denial of such service is unusual under these circumstances. The periodontal maintenance was not included in the pre-estimate and this office does not predetermine benefits for this service. The exclusions and limitations of the patients policy are documented in the patient's benefit statement or benefit booklet. We do not have access to this information. We encourage the patient to understand the terms and limitations of their policy. It is their responsibility. We assist in claims submission but are not required to bill her insurance company. The complainant was treated by Dr. Juliana [redacted] who at the time of service was still the owner of this practice. Dr. [redacted] is not collecting any monies for the complainants care. The complainant has a pattern of disputing any balances on her account which are not covered by her insurance policy and as a courtesy to her, Dr. [redacted] made an adjustment to her account in 2013, not due to any error in services provided or billing issue, simply as a courtesy. The amount she paid on the date of service was an estimated portion of what she may owe and was based on the pre-estimate of treatment we received for the surgical procedure and the estimated patient financial responsibility for her periodontal maintenance procedure. Any and all insurance benefits are determined and processed by the insurance companies when claims are received.
Regarding the claim submittted for her son [redacted], the practice was sold to Dr. [redacted] in June, 2015. Dr. [redacted] assumed the care of Dr. [redacted]'s patients at that time. The patient's reminder postcard clearly has Dr. [redacted]'s name on it. Our patients are not "products" as the complainant states. We would have been happy to answer any questions had he called to inquire. The complainant is submitting this dispute because there was a balance owing on her son's account. Again, the insurance company determines payment. The fee had increased, that is the Dr.'s prerogative. The insurance company paid the claim at benefits determined by them to be "reasonable and customary". We are under no obligation to accept this amount and the patient's explanation of benefits statement clearly state the patients financial responsibility. As to the complainants issue with her son's service, he was covered under his own insurance policy and is clearly over the age of consent.
Initial Consumer Rebuttal /* (3000, 15, 2015/11/22) */
(The consumer indicated he/she DID NOT accept the response from the business.)
The response from Dr. [redacted]'s office seems to me has an intention to intimidate me. It will not work. Whether I have a pattern is irrelevant. I was asking a very simple question, did the office know that the insurance would not cover both services if they were performed on the same day, I asked it because I did not know. If I knew, I would not have requested them on the same day, regardless if I am local or not. I had never said I would not pay. The amount I was charged after the service was provided (without disclosing it before the service) tells me the other way, who has the pattern? Similar thing was done in 2013 and I became careful not to let the office repeat the same thing again. I will accept what the office just admitted, "We were not aware her periodontal maintenance appointment would not be covered if performed on the same day as the tissue grafting procedure." Not sure why they would not admit it for so long? If they lied, they will be held to their own conscience. This account is closed.
Complaint about [redacted]'s account
"The complainant is submitting this dispute because there was a balance owing on her son's account. Again, the insurance company determines payment. " I have submitted the complaint because I refuse to pay Dr. [redacted]'s rate as the appointment wasn't with him, it was with Dr. [redacted], Dr. [redacted] had no business seeing him and charging him his inflated rate. If we knew, it would not be Dr. [redacted], we would have cancelled the appointment. "The fee had increased, that is the Dr.'s prerogative." Yes, it is his business and he can increase his fees as much as he wants, why only $150, why not $1,500, I could not care less. Again, we were nice, offered to pay Dr. [redacted]'s rate, but it wasn't good enough for Dr. [redacted], he demanded his inflated rate. Currently, the account has a positive balance and I want it back. I want to pay Dr. [redacted]'s rate. It is worth mentioning here that I cancelled my appointment with Dr. [redacted] in September. The appointment was suppose to be with Dr. [redacted] and the office without my knowledge transferred it to Dr. [redacted]. As I said before, we are not products that the office can shuffle us around without our consent.
"We would have been happy to answer any questions had he called to inquire". Very stupid statement ... [redacted]'s appointment was with Dr. [redacted] and she was the only doctor in the office. There was no need for him to call doctor's office to make sure the appointment was still with Dr. [redacted], unless, the doctor's office informed the patients that the business was sold. Submitted are two evidences that clearly shows the office is/was hiding the fact that the business was sold and Dr. [redacted] "assumed" the care of Dr. [redacted]'s products, one attached on 10/29/15 (letter from Dr. [redacted]'s office) and the other one, a post card attached on 11/14/15. The postcard was mailed on 10/28/15 with Dr. [redacted]'s name stamped on it. The postcard was printed in Dr. [redacted]'s name. It seems this was done with an intention to let the patient believe that the appointment was with Dr. [redacted], as she was his doctor. Again, as I said before, we are not products that one doctor can sell and the other one can buy.
It's a deceptive business practice not to tell the patients that their doctor has been changed and they would be responsible to pay a different (inflated) rates for the services. If I summarize,
1. Patients are being treated as products, one doctor sells and the other one buys.
2. Dr. [redacted] sold her business and Dr. [redacted] bought it apparently that included her patients or products.
3. Without patients knowledge, they were quietly transferred to Dr. [redacted] and he "assumes" their care. Dr. [redacted] started billing them an inflated rate after providing services. I have no problems with his inflated rates as long as they were disclosed to the patients before the services. Patients would have a choice to go to a different doctor.
I have problem being treated as products. Nobody sell or buy me. Nobody changes my doctor, I do.