Los Osos Valley Family & Cosmetic Dentistry

Complaint: I am rejecting this response because:DrK [redacted] and his staff should know if they are an in-network provider or not and if they do not know, they should say soI repeat: I called before I made an appointment to enquire if they accepted HumanaThey said they didThey made no distinction between a federal plan and a “regular” one, nor has any other dentist or medical officeAgain, my insurance card clearly says: Federal Advantage Dental A##6; Group Name: Federal Advantage; Group ID: FE###M; Plan Code: AV##aIt also carries an emblem encased by the profile of a bald eagle that reads FE##IP I am not suggesting that DrK [redacted] ’s office is responsible for each patient’s insurance plan, but I am saying that they are responsible for knowing if they are in-networkThey are responsible; when they say they take an insurance plan and later find out, they are out-of-networkThey provided information, when they said they accepted Humana and did not say except for federal employees I do not have a problem with their estimate of the cost of the services providedI do have a problem with having to pay these costs, when I expected my insurance to pay for themIf there had been any question of coverage, I would have gone to another dentist BTW, on September 12, 2016, I paid a co-payment of $138.00, which is not included in DrK [redacted] ’s idea of a fair resolution, half of the $he claims I owe him That brings the total I have paid to $484, while DrK [redacted] absorbs only $ This entire incident was created, because DrK [redacted] and his staff said they accepted an insurance plan that they do notThis is an error made by DrK [redacted] and his staff that I should not have to pay for this is not fair, and it is not ethical Regards, [redacted] H***

MsH*** received treatment on 9/1/and 9/12/ On her first visit (9/1/16) she gave us a Blue Shield insurance card and a Humana insurance card After both visits, we attempted to send her dental claims to Blue Shield The claims were denied coverage as we are not in network
providers for the Blue Shield Federal Program We then send the claims to Humana Again the claims were denied because we are not an in-network provider for the Humana Federal Program After many phone calls were made to the insurance companies regarding MsH***'s claims, we were informed by the insurance company that we are an in-network provider for Humana PPO plans, but not for Federal Plans These many submitted claims and phone calls explain the amount of time between the date of service and MsH***'s receipt of a bill.MsH*** claims that we should have known our status with the Humana Federal Plan We have filed insurance claims with different insurance companies for our current patients It is unreasonable for our office to be responsible for every patient's insurance plan Rather, each patient is responsible for her own insurance plan As such, MsH*** should have researched to determine if we were an in-network provider for her insurance plan When treatment was presented to MsH***, she initialed a treatment plan paper that clearly states that all of our insurance estimates are just that: estimates The paper clearly states, "Insurance coverage is only an estimation Guarantor is responsible for all treatment fees not covered by insuranceEstimated patient portion is due on date of service." Because there was a misunderstanding regarding MsH***'s insurance plan, I thought it fair to reduce the amount owed by MsH*** by half (from $to $346) This way we could meet in the middle MsH*** has now paid her portion, and I seek no further collection action

Complaint: 11933271
I am rejecting this response because: When a medical/dentist office says they accept your insurance and then turns around and demands that you pay them, because they later discover they are out-of-network, it is flat out wrong and unethical. Asking me to pay for their mistakes is wrong! As I said before, I called them before making an appointment, because I wanted to make sure they accepted my insurance. They lied to me. Another word to describe what they did is entrapment. I would not deliberately go to a dentist who is out-of-network. I want my money back. I acted in good faith. They did not.  
Regards,
[redacted] H[redacted]

We believe we have made a fair offer to Ms. H[redacted].  Ms. H[redacted]'s insurance policy is a contract between her and her insurance company.  If the insurance company decides not to pay for treatment, then a grievance should be made towards the insurance carrier.  We attempted to resolve this problem numerous times with her insurance carrier, but our appeals were denied. Ms. H[redacted] may have more luck in appealing the insurance company's decision that we had.   We are sorry that there was a misunderstanding, but we stand by our offer.  Legally we are within our rights to try to collect the full amount, but thought it was fair to reduce that number by half.  We appreciate Ms. H[redacted]'s payment of her half and consider the account closed.

Complaint: 11933271 I am rejecting this response because:Dr. K[redacted] and his staff should know if they are an in-network provider or not and if they do not know, they should say so. I repeat: I called before I made an appointment to enquire if they accepted Humana. They said they did. They made no distinction between a federal plan and a “regular” one, nor has any other dentist or medical office. Again, my insurance card clearly says: Federal Advantage Dental A##6; Group Name: Federal Advantage; Group ID: FE###M; Plan Code: AV##a. It also carries an emblem encased by the profile of a bald eagle that reads FE##IP.   I am not suggesting that Dr. K[redacted]’s office is responsible for each patient’s insurance plan, but I am saying that they are responsible for knowing if they are in-network. They are responsible; when they say they take an insurance plan and later find out, they are out-of-network. They provided false information, when they said they accepted Humana and did not say except for federal employees.   I do not have a problem with their estimate of the cost of the services provided. I do have a problem with having to pay these costs, when I expected my insurance to pay for them. If there had been any question of coverage, I would have gone to another dentist.   BTW, on September 12, 2016, I paid a co-payment of $138.00, which is not included in Dr. K[redacted]’s idea of a fair resolution, half of the $692 he claims I owe him.  That brings the total I have paid to $484, while Dr. K[redacted] absorbs only $346.   This entire incident was created, because Dr. K[redacted] and his staff said they accepted an insurance plan that they do not. This is an error made by Dr. K[redacted] and his staff that I should not have to pay for…this is not fair, and it is not ethical.   Regards, [redacted]