Kool Smiles

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.
This response by mr. [redacted] is factually not true. Nothing was ever said that my deposit was to purchase supplies. NOTHING.
Regards,
[redacted]

Review: I was assured that Kool Smiles accepted my specific health insurance (dental) policy and were in-network providers. I was told I could NOT choose which physician in the practice would actually do my examination. After having my dental examination, my health insurance was billed Out-of-network rates as apparently the physician who saw me was not a participating provider in my health insurance plan. My health plan paid properly, but out of my health fund (my money, counting towards my deductible). Kool Smiles is refusing to refund the difference unless the request comes from insurance carrier, who paid it as billed and cannot request the refund as they followed procedures properly.

If they say they accept insurance (and they had my insurance information weeks before the encounter and again the day of), then that is agreement to contracted rates. They misled me to believe I would be receiving care from someone that accepted my insurance and now they will not honor that. At Kool Smiles Insurance Verification team, my wife has now spoken with [redacted] (who never called us back), [redacted] (who called back but wouldn't do anything for us), [redacted]'s supervisor [redacted] (who also refuses refund and says that "the way we do things here is that you cannot choose a physician, and yes the one that saw you was not participating")

To put in perspective, my wife had the same routine care and xrays at the same facility the following day and had the same hygienist. Kool Smiles billed her for In-network ($176), half the cost of my encounter ($333).

I feel caught in the middle, taken advantage of, and hope that others do not end up in this unfortunate situation. Kool Smiles had poor online reviews but we were forced to go to them as they were the only providers who (apparently) accepted our insurance within an hour's drive of where we reside.Desired Settlement: Kool Smiles owes me (via [redacted], my insurance company) $157 for billing me at out-of-network rates when they assured me they were in-network.

Business

Response:

I responded to this complaint via email earler this morning. If you did not receive the response, please let me know. Last week was chatic here in Atlanta with the unprecedented show and traffice situation. Some key peole in the decision-making process were not available.

We have fully complied with Ms. [redacted] request to reimburse [redacted] on his befalf.

Sincerely,

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.

Regards,

Review: Regarding a notice of collection: UCS account # [redacted]

First of all, this issue had tried to be resolved months ago... @ Kool Smiles I was hung up multiple times after requesting to speak to a supervisor. I dispute the charge you are saying I owe. However, after 7-8 months of not hearing anything from I received a bill about 1-2 weeks ago. I assumed you ignored my dispute from the prior months. I believe that bill showed $57 owed. I went ahead and sent a payment of $17 through bill pay on 1/23/2014, which leaves a balance of $40. Now I am getting a bill for $60. I will make payment for the $40 because I don't want this to go against my husband's credit, [redacted]. (which is funny you put the collection in his name??? he has never signed any forms and agree to pay anything to you) I, [redacted] have handled my son's [redacted]ald's dental care. So, I wouldn't recommend you placing any collection against him. Secondly, I will make the payment of $40 to pay this account in full and will pursue other avenue to file the dispute. I think you all handled yourself very poorly considering you never once called me or notified me it was going to be sent to collection. Once again, showing poor customer service considering my account should indicate my calls disputing this fee. After speaking with a representative, I was notified for the first time I owe more money!!! (2/8) Here is info sent on email: On the bill from 9/14 - I had never heard about this balance owed. Before they would even do the procedure with my son they ran my insurance and required me to pay the unpaid amount from the insurance. (according to that ledger was $63) Also, why was there a balance? You all received the payment directly on this procedure from the insurance. (at this time you all were considered in-network?) why should I have to pay the difference I don't feel this amount I owe.

Now, no one is returning my calls or emails.Desired Settlement: I don't actually want a refund. I want my account balance $0. I don't feel I owe you all anything.. I feel for the past two weeks I have jumped through hoops trying to resolve the issue and haven't received anything from you all since 2/6. Enough is enough. The bill you all are now saying I owe is funny after I seen the document from you all... your staff required me to make a payment for the visit for what the insurance wouldn't pay ( my deductible) but yet you all say I owe more when you absolutely refused treatment in the patients room until I gave you a credit card and your ran the amount owed and had me sign the receipt. I want this issue resolved with a $0 balance

Business

Response:

In researcing this complaint, our policy is that all patients are to be informed befiore they pay anything for their service, such as a copay, that the amount requested is an estimate obtained from their insurance company.

While it is confusing that the estmate may not cover the actual fee for service, there are rare occasions in which the estimate is not accurate. In this case, the estimate was less than the actual correct fee, leaving the $100 balance.

However, given the confusion and the patient's understanding that all that needed to be paid was actually paid on the date of service, as a courtesy, we agree to write off the $100 amount due.

Hopefully, this will resolve the complaint.

Sincerely,

[redacted], Vice President of Quality, Kool Smiles

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.

Regards,