LeCann Family Dentistry

Failure to correctly follow up with insurance company as stated they would. Charged for services not authorized to provide. I have been a patient of LeCann Dentistry since February 2013. In March of 2013 I had fillings completed at the office and within less than a week one of them fell out. I called the office to report what happened and asked to make an appointment to have it fixed. The dental assistant, after questioning my reason for the visit, confirmed the filling did need to be replaced. I was informed "I was squeezed in, and "the wait time for service could be more than an hour". I was not able to wait an additional hour to have the filling repaired as I was under the impression I had an appointment and was going to be seen in a timely manner. I left with a hole in my tooth and had to wait almost two weeks to have it repaired. In September of 2013 my son and I returned to have our scheduled 6 month cleaning. While I was getting my teeth cleaned I was approached by the dental assistant working with my son. She asked if I wanted sealants for him. I told her I did not know if they had been done previously. She offered to call my insurance ([redacted]) and ask if they would be covered and if they had been done previously. (I have followed up with [redacted] and was informed a representative from LeCann Dentistry office called in September 2013 to request coverage but did not request a history of the sealants) I told her she could place them only if they were going to be covered as I did not know if they had been done, and I did not approve of the procedure if it didn't need to be done or wasn't covered. I received a statement for $156.00 issued October 4, 2013. I called the office as soon as I received this statement in attempts to resolve this issue. At this time I was informed by staff member she would speak with [redacted] to clarify the situation and would get back in touch with me.October 14, 2013 a second statement was issued for $181.00. I immediately called the office, for the second time. Again, I was told by the same office personnel she would speak to [redacted] to have this clarified. Again, I did not hear back.In March the office called to remind me of our next 6 month cleaning. We rescheduled the cleaning for April 9, 2014. At this time I spoke with the same office personnel, for the 3rd time, in regards to the billing statement. She repeated what I have heard before, she would speak to [redacted] and clarify the situation. April 8, 2014 at 6:00pm I received a voicemail from the office personnel stating $156.00 was due. She relayed the sealants were not covered by [redacted] because they had been done previously at another office. I called back within 5 minutes and left a message to inform her and the office this needed to be clarified prior to our appointment.I spoke with the office personnel on April 9, 2014 around 10:00am. I informed her of the situation and requested the name of the [redacted] representative spoken to in September 2013. I discussed with her my concerns: 1) The office offered to call [redacted] to find out if the sealants would be covered, provided the service with direction to perform if covered and not previously done, then I was sent a bill due to non-coverage2) The multiple times I have tried to clarify this situation over the past 6 months3) Finally receiving information after business hours the night before the next appointment4) The inability of the office to produce a name of the [redacted] representative spoken to in September 2013 [redacted]'s office failed to ask for the history of the sealants. After I sent a letter to [redacted] to review my concerns I was sent a bill statement. The statement listed a debt write off for $183.72 and a finance charge for $2.76. My poor assumption, due to lack of communication, was the issue had been resolved. I paid the $2.76. On June 2, 2014 I received a phone call from a collection agency informing me of a balance due to LeCann Dentistry. I find it unjust for this bill to be issued. Please review and respond. Thank you. Desired SettlementI am requesting the $183.72 to be cleared from my record with LeCann dentistry. Business Response July 12, 2014To whom it may concern:It appears that the patient has a complaint about two separate incidents; one involving her own treatment, and another involving the treatment of her son. We will address the two issues separately.The day that the patient came in for an evaluation appointment in the late morning to have her filling examined, it was noted that a small portion of the filling had debonded. In order to resolve the issue, we offered to provide same day treatment that afternoon; however we could not attend to the patient's needs that same hour because there was not enough time allotted to provide the type of service the it would require. The patient informed us that she was in no discomfort, and she told us she would like to reschedule to a different day because she did not want to come back in the afternoon of that same day.It is our goal to provide individualized, quality care for each patient. It is not our intention to keep a patient waiting for treatment; therefore we informed the patient of this and told her if she could not return to be treated that same day in the afternoon, then we could reschedule her within a day or two. As previously stated, the patient informed us that she was asymptomatic and opted to reschedule two weeks later. She was informed that there were available appointment times earlier than two weeks to provide treatment to address her concern. However, the patient opted to appoint two weeks out according to her scheduling needs. The second portion of the complaint is in regards to the insurance reimbursement for her son's treatment of four tooth sealants on September 23, 2013. The patient is claiming that we neglected to ask their insurance company, [redacted], for her son's sealant treatment history prior to treating him with sealants on four teeth. It is our standard procedure to call and ask insurance companies for history on preventative procedures (such as sealants, fluoride and radiographs) for all patients prior to treating them. When we verified the patient's son's insurance coverage with [redacted], the insurance company only provided history for radiographs for the patient's son, but not for the sealants and fluoride. We informed the patient that the insurance company informed us that sealants should be covered under her preventative coverage for her son. She gave us the consent to render treatment for the four sealants, and that treatment was rendered.It is unfortunate that the insurance company did not disclose that the patient's son had a prior history of sealants and x-rays, and therefore did not reimburse for the services. The estimated coverage we discussed with the patient was based on incomplete information from the insurance company. We have no way of knowing if an insurance company is not fully disclosing information about treatment history.Since the procedures were performed in good faith on our part, we feel justified in charging the assessed fee, because the patient is benefiting from the sealant procedure. Our Financial Policy, which this patient signed and agreed to as the parent/guardian of her son, states the following: "As a courtesy, we will assist you with filing your insurance. Insurance is an agreement between you, your employer, and your insurance company. We are not a party to the agreement. We believe that your insurance coverage should not dictate recommended treatment; however, we will be happy to assist you in maximizing your benefits. When we receive payment from your insurance company, we will reconcile the account at that time. If the insurance does not cover the remaining financial portion of the claim, the remaining balance is your responsibility and is due 10 days after receipt of your statement."In an ongoing effort to resolve this matter for the last six months, we have offered on several occasions a payment arrangement for installments to be made. The patient did not accept this as resolution and refused to pay the balance on her account. After six months of attempting to collect the remaining balance from the patient, the account was forwarded to a collection agency for the unpaid account balance. Recently on July 10, 2014 the patient opted to pay the remaining balance of $180.96, which included her son's sealant procedures that were performed on September 23, 2013. When she made payment she stated that she has appealed to her insurance company to review her son's claim for the sealants. The patient's account balance is current at this time. We informed the patient if her insurance company should make any payment to our office for the claim on the sealants, then we will forward the payment to her. Kind Regards,[redacted] D.D.S.