Luigi Di Cataldo

Attention: Revdex.com 6/21/Dear [redacted] , Thank you for taking the time to communicate to us why our services did not meet your expectationsWe have every desire to address your needs and provide the best solution available to resolve your issue as soon as possibleIt must have been very frustrating for you to feel that we are not helping resolve the issue at handWe are truly sorry for any misunderstanding you have experiencedWe will address each complaint individually in attempt to clarify any previous miscommunicationsFirstly, "At the beginning of our initial visit, I was pressured into scheduling a consultation with their orthodontic branch, Lone Star Pediatric Dental & Braces." I spoke with Lone Star Pediatric Dental in Lakeway, TX, who had seen Ms [redacted] 's daughter starting on November, 2013, to review the orthodontic referral chart notesBoth entries on June 12, and October 27, noted mom's ( [redacted] ) request to go see the orthodontist for examinationProof of documentation will be supplied upon requestSecondly, "I conceded to their recommendations Afterward I was presented with an outrageous estimate for their braces to which I could not affordI explained that I did not have the financial stability to bear the expense and that it would have to waitI was coaxed into reconsidering the braces for my daughter after they told me they would give me $1,discount for being a cosh customer." Based off of the Consumer Price Index for All Urban Consumers, in Austin, Texas, Comprehensive Orthodontic Treatment for an Adolescent on average was $6,(Higher rates documented in the 95th percentile was $8,071.17)Ms [redacted] was presented with a total case fee of $5,250.00, a $1,discount (as the patient was not a candidate of medical necessity in order for Medicaid to pay; therefore, we offered a complimentary 20% discount on our UCR fees), leaving her out of pocket expense totaling $4,This was broken down into a down payment and interest free monthly payments (which were also extended past the estimated treatment time for financial convenience) that Ms [redacted] agreed to by signing financial contracts on December 9, Proof of documentation will be supplied upon requestThirdly, "I was advised that my daughter would need the top and lower braces for approxmonths I waited for them to apply my daughter's braces and when they were finished, she came out to the waiting room with only her top braces onI was confused as the agreement with the initial down payment was for her to have the top and bottom doneI questioned them why her bottom braces weren't applied and they explained that her top teeth needed to be adjusted before she could receive her braces on the bottomI felt deceived They never mention this to me even though they were charging me for both." For this miscommunication, we do apologizeThe orthodontist reviewed at the initial exam the objectives in treatment she wished to address for the patientPer HIPPA privacy rights, we cannot release specific diagnosis in treatment/chart notes until we have received written consent of release from the legal guardian, [redacted] We are more than happy to review this again with Ms [redacted] : The treatment diagnosis was documented and reviewed with Ms [redacted] on December 9, at the initial records/braces appointment that it may take up to months before lower braces would be placedLower braces were not placed on the same date as top braces due to her daughters bite; the condition of her daughter's bite without initial treatment to the maxillary arch would have made her daughter's mandibular braces uncomfortable, and therefore not necessary yet in her treatment planProof of documentation will be supplied upon request and consent to release by [redacted] .Fourthly, "After the initial visit my daughter only attended two follappointments and each time I felt like steps were being missed and something wasn't rightMy daughter was in & out in minutes and she was never sore from the supposed adjustments to her bracesThey also never offered to brush her teeth when the wire was removed for replacement." Adjustment appointments are necessary because the elastic ties holding the wires in proper place stretch and weaken over timeWithout adjustments, the wires would be incapable of creating proper pressure to correct the dental issues requiring treatmentAlso, this gives the doctor opportunity to evaluate the movement of teeth and progress madeThis allows for the recommendation that may improve the treatment planIt takes a minimum of three weeks for tooth movement to occur, meaning that many adjustment appointments are requiredAgain, due to HIPPA privacy rights, once Ms [redacted] signs release consent forms, we will be happy to provide documentation from each visit which also noted the planned braces placement on the lower archBraces and wires do not prevent the ability to maintain proper oral hygiene, the patient must simply brush and floss differently around the appliancesOral Hygiene procedures and proper brushing habits were reviewed with the patient the day her upper braces were placedOral Hygiene is an important expectation to any patient in orthodontic treatmentProof of documentation will be supplied upon request and consent to release by [redacted] .The orthodontic treatment contract with the patient/responsible party was signed off in consent on December 9, A summarization in regards to the Ms [redacted] 's statement to her contractual agreements are as follows:"It is agreed that the Unpaid Balance will be paid in MONTHLY installments of $each due on the 26th day of each month and continuing until the account is paid in fullA reprocessing fee of $will be assessed to accounts that are delinquent more than daysWe wish to stress that the frequency of office visits has no bearing on the monthly payment and this; the monthly payment schedule does NOT correspond to the service received that monthThe payment schedule is mere a convenient way to meet your total financial obligationYour Orthodontic Treatment Fee includes all appliances, braces and office visits required to complete your planned treatment in our officeThe fee does not cover any work done at any other dental office outside this practice....I understand the following:· The account balance must be paid in full before removal of braces and appliances.· Active treatment will be halted if the account becomes two months past due.· In the event of transfer out of practice, the initial fee will not be refunded, regardless of number of braces placed.· The account balance will be pro-rated and settled accordingly.I, as the FINANCIALLY RESPONSIBLE PERSON for this account, certify that I have read this agreement and that all treatment decisions and alternatives have been explained to me."Proof of documentation will be supplied upon requestThe patient's first monthly payment, as agreed by Ms [redacted] , on January 19, was declinedPer the signed consent form for the automated billing that Lone Star Pediatric Dental and Braces uses, if a payment fails, the payment will attempt to be processed again two weeks following along with a $late feeIf this payment goes still uncollected, the office is then contacted to reach out to the patient to follow up on past due balanceFebruary 12, 2016, the orthodontic financial coordinator called and spoke with Ms [redacted] in regards to her account balanceMs [redacted] informed her that the patient's father was paying for the treatment, that she would call him in order to obtain payment for usThe financial coordinator reminded her that the February payment would also soon be dueMom understood and said she would call the office backMarch 8, 2016, our automated payment center called our office to speak with the financial coordinator (FC) to say mom had called them in regards to the accountMs [redacted] told them she cannot afford treatment, that the father is responsible, however father is not paying and unreachableMs [redacted] wanted to know what to doThe FC advised the automated payment center to tell her to continue to come into appointments but needs to figure out her financial situation with dad, as he did not sign the contract, he is not liable to Lone Star Pediatric Dental and Braces (LSPDB) to payThe FC said to tell mom if she continues to show for appointments without payment for services, per her contractual arrangement, the patient will move to maintenance checks, per the doctor's discretion, until we can collectMarch 9, 2016, patient was seen for her adjustmentAt the end of the appointment, Ms [redacted] declined to schedule the next appointment to put her daughter's lower braces on, that she prefer to call us back to scheduleMay 5, 2016, Helene from Cedar Park Smiles (CPS) called to request transfer information for Ms [redacted] s daughterThe FC called mom to review account balance and what transferring to a new orthodontist will entail, Ms [redacted] did not answer the phone, and therefore, voicemail was left for her to call us backMay 10, 2016, The FC sent transfer information (Completed PAO transfer forms along with initial photos from records taken on December 9th, 2015) to DrSmith's office (Cedar Park Smiles)Ms [redacted] has still not called back to review balances on accountMay 24, 2016, the patient was seen at Cedar Park Smiles for an exam to transferThe office called and spoke to the FC to let us know that until Ms [redacted] pays for her services rendered balance at LSPDB that DrSmith would not continue the treatment plan, even though he typically does not accept transfer casesThey requested to be sent proof of payment when the balance was paid, in order for them to continue treatmentMs [redacted] told CPS she was waiting on a court order for dad to pay the balance in order to pay, CPS understands, LSPDB understandsJune 2, 2016, Ms [redacted] called LSPDB in order to review account balanceA Treatment Coordinator (TC) was then able to review with her the services rendered to her account (per all documented notes from previous conversations and documents scanned to the account), the total balance due for services, what she had paid, and the balance remainingMs [redacted] did not understand why she still owed us moneyThe TC then attempted to review the contract signed, that her financial arrangement states if she transfers mid-treatment to another orthodontist, services rendered will be entered for the account balanceAs a courtesy, the patient's services rendered reflected the initial investment per the banding fee, and two treatment months for the patient's two adjustment appointmentsMs [redacted] at that point refused and requested to speak to the orthodontic manager (OM)The OM proceeded in conversation with Ms [redacted] to review the services rendered, that she is financially responsible for treatment providedMs [redacted] told the OM that she cannot afford braces or transportation to the office for treatmentMs [redacted] told the OM that she did not want LSPDB to continue communication to CPS any further and that she will not be going back to their officeThe OM tried to offer transportation service options to help the patient come in for her appointments, Ms [redacted] said none of those options were available to herMs [redacted] accused LSPDB of not caring about her daughter, who had been through a lot of painOur OM offered that if Ms [redacted] cannot pay for treatment, if transportation is also an issue, and if the braces were uncomfortable for the patient, that LSPDB would be willing to collect a portion of her services rendered of $in order to remove the patient's braces, and the remainder would be set up on a new billing arrangement at no interestMs [redacted] then threatened to call the Revdex.com since LSPDB was "denying treatment"The OM clarified that LSPDB was not denying treatment, but that Ms [redacted] has a financial obligation and if she cannot pay, then we would be happy to help by removing the braces from the patient, and/or seeing her at another office that may be closer to the patient's home addressThe OM also offered to remove the braces for the time being for $of her services rendered, set her up on a payment plan for the balance, freeze the remaining account balance, and when Ms [redacted] and her daughter were ready to continue treatment that we would not need to collect a new down payment, and resume the contractMs [redacted] ended the conversation without agreement to the options provided.In regards to Ms [redacted] 's account of the conversation that took place on June 2, 2016, "Essentially the proposed to repossess the braces with the included loss of any benefits from the money they were already compensated forNot to mention the fact that my daughter would have to endure the removal process just to have them put back on by another orthodontistThis seemed absolutely absurd and somewhat disturbingWhy not just propose a cash settlement?" Again, LSPDB does apologize that we were unable to clarify why we recommended removal of the bracesOur patients and their care is on the forefront of our mindsIf a patient cannot receive continued care to braces (regardless of financial or transportation obstacles), it is not recommended to leave braces; if not monitored/taken care of properly, the braces can be a hindrance to the patients oral healthA cash settlement was proposed multiple times for the services rendered, which Ms [redacted] deniedAlso, not all orthodontic practices utilize the same bracket and wire technologyIt is very common to have to remove braces on a transfer patient and place new brackets wires from the new treating orthodontistSince Ms [redacted] made it clear she cannot start treatment elsewhere and she did not wish to continue treatment with LSPDB, the OM was offering all options in order to assist the situation.Lastly, "Why did they want the braces from my daughter's mouth back? Do they plan on using them on another child or is it just to put my daughter though more pain and suffering?" When braces are removed, they are crimped off of the teethThis is not a painful process to the patientThe bracket technology is made to crimp off the teeth and are then destroyedPer OSHA Law & Regulations, brackets and wires are never shared among patientsAny unused/removed material is disposed per biohazard requirements.Lone Star Pediatric Dental and Braces, to say the least, is truly saddened we were unable to meet the needs of a much valued patient and familyOur office is more than happy to review and assist with the multiple options given to the patient if Ms [redacted] wishes to come to an agreementAgain, her daughter's health is very important to us, and we wish to ensure that she is taken care of.Sincerest Regards, Lone Star Pediatric Dental & Braces

Attention:...

Revdex.com                                   ...⇄ 6/21/2016 Dear [redacted], Thank you for taking the time to communicate to us why our services did not meet your expectations. We have every desire to address your needs and provide the best solution available to resolve your issue as soon as possible. It must have been very frustrating for you to feel that we are not helping resolve the issue at hand. We are truly sorry for any misunderstanding you have experienced. We will address each complaint individually in attempt to clarify any previous miscommunications. Firstly, "At the beginning of our initial visit, I was pressured into scheduling a consultation with their orthodontic branch, Lone Star Pediatric Dental & Braces." I spoke with Lone Star Pediatric Dental in Lakeway, TX, who had seen Ms. [redacted]'s daughter starting on November, 14 2013, to review the orthodontic referral chart notes. Both entries on June 12, 2014 and October 27, 2015 noted mom's ([redacted]) request to go see the orthodontist for examination. Proof of documentation will be supplied upon request. Secondly, "I conceded to their recommendations ... Afterward I was presented with an outrageous estimate for their braces to which I could not afford. I explained that I did not have the financial stability to bear the expense and that it would have to wait. I was coaxed into reconsidering the braces for my daughter after they told me they would give me $1,050.00 discount for being a cosh customer." Based off of the Consumer Price Index for All Urban Consumers, in Austin, Texas, Comprehensive Orthodontic Treatment for an Adolescent on average was $6,829.53 (Higher rates documented in the 95th percentile was $8,071.17). Ms. [redacted] was presented with a total case fee of $5,250.00, a $1,050.00 discount (as the patient was not a candidate of medical necessity in order for Medicaid to pay; therefore, we offered a complimentary 20% discount on our UCR fees), leaving her out of pocket expense totaling $4,200.00. This was broken down into a down payment and interest free monthly payments (which were also extended past the estimated treatment time for financial convenience) that Ms. [redacted] agreed to by signing financial contracts on December 9, 2015. Proof of documentation will be supplied upon request. Thirdly, "I was advised that my daughter would need the top and lower braces for approx. 16 months ... I waited for them to apply my daughter's braces and when they were finished, she came out to the waiting room with only her top braces on. I was confused as the agreement with the initial down payment was for her to have the top and bottom done. I questioned them why her bottom braces weren't applied and they explained that her top teeth needed to be adjusted before she could receive her braces on the bottom. I felt deceived ... They never mention this to me even though they were charging me for both." For this miscommunication, we do apologize. The orthodontist reviewed at the initial exam the objectives in treatment she wished to address for the patient. Per HIPPA privacy rights, we cannot release specific diagnosis in treatment/chart notes until we have received written consent of release from the legal guardian, [redacted]. We are more than happy to review this again with Ms. [redacted]: The treatment diagnosis was documented and reviewed with Ms. [redacted] on December 9, 2015 at the initial records/braces appointment that it may take up to 6 months before lower braces would be placed. Lower braces were not placed on the same date as top braces due to her daughters bite; the condition of her daughter's bite without initial treatment to the maxillary arch would have made her  daughter's mandibular braces uncomfortable, and therefore not necessary yet in her treatment plan. Proof of documentation will be supplied upon request and consent to release by [redacted].Fourthly, "After the initial visit my daughter only attended two follow-up appointments and each time I felt like steps were being missed and something wasn't right. My daughter was in & out in 15 minutes and she was never sore from the supposed adjustments to her braces. They also never offered to brush her teeth when the wire was removed for replacement." Adjustment appointments are necessary because the elastic ties holding the wires in proper place stretch and weaken over time. Without adjustments, the wires would be incapable of creating proper pressure to correct the dental issues requiring treatment. Also, this gives the doctor opportunity to evaluate the movement of teeth and progress made. This allows for the recommendation that may improve the treatment plan. It takes a minimum of three weeks for tooth movement to occur, meaning that many adjustment appointments are required. Again, due to HIPPA privacy rights, once Ms. [redacted] signs release consent forms, we will be happy to provide documentation from each visit which also noted the planned braces placement on the lower arch. Braces and wires do not prevent the ability to maintain proper oral hygiene, the patient must simply brush and floss differently around the appliances. Oral Hygiene procedures and proper brushing habits were reviewed with the patient the day her upper braces were placed. Oral Hygiene is an important expectation to any patient in orthodontic treatment. Proof of documentation will be supplied upon request and consent to release by [redacted].The orthodontic treatment contract with the patient/responsible party was signed off in consent on December 9, 2015. A summarization in regards to the Ms. [redacted]'s statement to her contractual agreements are as follows:"It is agreed that the Unpaid Balance will be paid in MONTHLY installments of $184.00 each due on the 26th day of each month and continuing until the account is paid in full. A reprocessing fee of $10.00 will be assessed to accounts that are delinquent more than 7 days. We wish to stress that the frequency of office visits has no bearing on the monthly payment and this; the monthly payment schedule does NOT correspond to the service received that month. The payment schedule is mere a convenient way to meet your total financial obligation. Your Orthodontic Treatment Fee includes all appliances, braces and office visits required to complete your planned treatment in our office.... The fee does not cover any work done at any other dental office outside this practice....I understand the following:·         The account balance must be paid in full before removal of braces and appliances.·         Active treatment will be halted if the account becomes two months past due.·         In the event of transfer out of practice, the initial fee will not be refunded, regardless of number of braces placed.·         The account balance will be pro-rated and settled accordingly.I, as the FINANCIALLY RESPONSIBLE PERSON for this account, certify that I have read this agreement and that all treatment decisions and alternatives have been explained to me."Proof of documentation will be supplied upon request. The patient's first monthly payment, as agreed by Ms. [redacted], on January 19, 2016 was declined. Per the signed consent form for the automated billing that Lone Star Pediatric Dental and Braces uses, if a payment fails, the payment will attempt to be processed again two weeks following along with a $20 late fee. If this payment goes still uncollected, the office is then contacted to reach out to the patient to follow up on past due balance. February 12, 2016, the orthodontic financial coordinator called and spoke with Ms. [redacted] in regards to her account balance. Ms. [redacted] informed her that the patient's father was paying for the treatment, that she would call him in order to obtain payment for us. The financial coordinator reminded her that the February payment would also soon be due. Mom understood and said she would call the office back. March 8, 2016, our automated payment center called our office to speak with the financial coordinator (FC) to say mom had called them in regards to the account. Ms. [redacted] told them she cannot afford treatment, that the father is responsible, however father is not paying and unreachable. Ms. [redacted] wanted to know what to do. The FC advised the automated payment center to tell her to continue to come into appointments but needs to figure out her financial situation with dad, as he did not sign the contract, he is not liable to Lone Star Pediatric Dental and Braces (LSPDB) to pay. The FC said to tell mom if she continues to show for appointments without payment for services, per her contractual arrangement, the patient will move to maintenance checks, per the doctor's discretion, until we can collect. March 9, 2016, patient was seen for her adjustment. At the end of the appointment, Ms. [redacted] declined to schedule the next appointment to put her daughter's lower braces on, that she prefer to call us back to schedule. May 5, 2016, Helene from Cedar Park Smiles (CPS) called to request transfer information for Ms. [redacted]s daughter. The FC called mom to review account balance and what transferring to a new orthodontist will entail, Ms. [redacted] did not answer the phone, and therefore, voicemail was left for her to call us back. May 10, 2016, The FC sent transfer information (Completed PAO transfer forms along with initial photos from records taken on December 9th, 2015) to Dr. Smith's office (Cedar Park Smiles). Ms. [redacted] has still not called back to review balances on account. May 24, 2016, the patient was seen at Cedar Park Smiles for an exam to transfer. The office called and spoke to the FC to let us know that until Ms. [redacted] pays for her services rendered balance at LSPDB that Dr. Smith would not continue the treatment plan, even though he typically does not accept transfer cases. They requested to be sent proof of payment when the balance was paid, in order for them to continue treatment. Ms. [redacted] told CPS she was waiting on a court order for dad to pay the balance in order to pay, CPS understands, LSPDB understands. June 2, 2016, Ms. [redacted] called LSPDB in order to review account balance. A Treatment Coordinator (TC) was then able to review with her the services rendered to her account (per all documented notes from previous conversations and documents scanned to the account), the total balance due for services, what she had paid, and the balance remaining. Ms. [redacted] did not understand why she still owed us money. The TC then attempted to review the contract signed, that her financial arrangement states if she transfers mid-treatment to another orthodontist, services rendered will be entered for the account  balance. As a courtesy, the patient's services rendered reflected the initial investment per the banding fee, and two treatment months for the patient's two adjustment appointments. Ms. [redacted] at that point refused and requested to speak to the orthodontic manager (OM). The OM proceeded in conversation with Ms. [redacted] to review the services rendered, that she is financially responsible for treatment provided. Ms. [redacted] told the OM that she cannot afford braces or transportation to the office for treatment. Ms. [redacted] told the OM that she did not want LSPDB to continue communication to CPS any further and that she will not be going back to their office. The OM tried to offer transportation service options to help the patient come in for her appointments, Ms. [redacted] said none of those options were available to her. Ms. [redacted] accused LSPDB of not caring about her daughter, who had been through a lot of pain. Our OM offered that if Ms. [redacted] cannot pay for treatment, if transportation is also an issue, and if the braces were uncomfortable for the patient, that LSPDB would be willing to collect a portion of her services rendered of $350 in order to remove the patient's braces, and the remainder would be set up on a new billing arrangement at no interest. Ms. [redacted] then threatened to call the Revdex.com since LSPDB was "denying treatment". The OM clarified that LSPDB was not denying treatment, but that Ms. [redacted] has a financial obligation and if she cannot pay, then we would be happy to help by removing the braces from the patient, and/or seeing her at another office that may be closer to the patient's home address. The OM also offered to remove the braces for the time being for $350 of her services rendered, set her up on a payment plan for the balance, freeze the remaining account balance, and when Ms. [redacted] and her daughter were ready to continue treatment that we would not need to collect a new down payment, and resume the contract. Ms. [redacted] ended the conversation without agreement to the options provided.In regards to Ms. [redacted]'s account of the conversation that took place on June 2, 2016, "Essentially the proposed to repossess the braces with the included loss of any benefits from the money they were already compensated for. Not to mention the fact that my daughter would have to endure the removal process just to have them put back on by another orthodontist. This seemed absolutely absurd and somewhat disturbing. Why not just propose a cash settlement?" Again, LSPDB does apologize that we were unable to clarify why we recommended removal of the braces. Our patients and their care is on the forefront of our minds. If a patient cannot receive continued care to braces (regardless of financial or transportation obstacles), it is not recommended to leave braces; if not monitored/taken care of properly, the braces can be a hindrance to the patients oral health. A cash settlement was proposed multiple times for the services rendered, which Ms. [redacted] denied. Also, not all orthodontic practices utilize the same bracket and wire technology. It is very common to have to remove braces on a transfer patient and place new brackets wires from the new treating orthodontist. Since Ms. [redacted] made it clear she cannot start treatment elsewhere and she did not wish to continue treatment with LSPDB, the OM was offering all options in order to assist the situation.Lastly, "Why did they want the braces from my daughter's mouth back? Do they plan on using them on another child or is it just to put my daughter though more pain and suffering?" When braces are removed, they are crimped off of the teeth. This is not a painful process to the patient. The bracket technology is made to crimp off the teeth and are then destroyed. Per OSHA Law & Regulations, brackets and wires are never shared among patients. Any unused/removed material is disposed per biohazard requirements.Lone Star Pediatric Dental and Braces, to say the least, is truly saddened we were unable to meet the needs of a much valued patient and family. Our office is more than happy to review and assist with the  multiple options given to the patient if Ms. [redacted] wishes to come to an agreement. Again, her daughter's health is very important to us, and we wish to ensure that she is taken care of.Sincerest Regards, Lone Star Pediatric Dental & Braces

Complaint: [redacted]
I am rejecting this response because:June 24, 2016Attention:Revdex.comResponse to Lone Star Pediatric DentalThank you for the response to my concerns about the business practices conducted by LoneStar Pediatric Dental. It pleases me to see that you have the desire to address my needs andprovide the best solution possible. I also want to thank you for clarifying that what I hadexperience were miscommunications and misunderstandings. I will attempt to respond to theclarifications you provided in the dissertation that was submitted.Firstly, “Thank you for taking the time to communicate to us why our services did notmeet your expectations. We have every desire to address your needs and provide thebest solution available to resolve your issue as soon as possible.” I attempted tocommunicate and find some resolve to this matter on multiple occasions. It was after theunprofessional and juvenile treatment I received by the orthodontic manager of Lone StarPediatric Dental that I decided to file a complaint with the Revdex.com. I alsoinformed her of my intentions to file the complaint and she indicated that she could care less.Secondly, “ both entries on June 12, 2014 and October 27, 2015 noted mom’s (HeidiConner) request to go see the orthodontist for examination”. The staff persistently advisedme that both of my children needed braces during each appointment we went to. I wouldn’texpect your staff would put notes in the file stating they pressured the client to attend aconsultation with the orthodontist so it’s not surprising they notated that it was at the client'srequest. I am assuming this will be clarified as a miscommunication considering I just receivedan email from Lone Star stating the pediatric dentist has referred my son to see the orthodontistfor a “complimentary evaluation” requesting me to schedule an appointment.Thirdly, “Based off of the Consumer Price Index for All Urban Consumers, in Austin,Texas”. I’m pleased to see that you are now able to provide a point of reference for the pricingof comprehensive orthodontic treatment. Even after I expressed my inability to pay and that Ireceive government assistance, the staff continued their persistence convincing me that thebraces were needed and they would work with me any way they could as it was important to mychild’s dental care. Regardless of what the price index states, $4200 for 16 brackets and a wireis ridiculous and outrageous and yes I signed the contract as I previously stated I was made tobelieve she needed them. You clearly indicate now that according to Medicaid, this was not amedical necessity. I appreciate you clarifying this miscommunication and now know that mydaughter did not need braces to begin with as indicated by Lone Star Pediatric Dental.Fourthly, “For this miscommunication, we do apologize. The orthodontist reviewed at theinitial exam the objectives in treatment she wished to address for the patient. Per HIPPAprivacy rights, we cannot release specific diagnosis in treatment/ chart notes until wehave received written consent of release from the legal guardian, [redacted] Conner.” I havenot signed any consent forms that would allow you to publish, speak about, or share medicalrecords, diagnosis, or notes regarding my children’s treatment or care. Lone Star PediatricDental and Braces is considered a “Covered Entity” under HIPAA regulations. I believe thatwhen you wrote about and published the condition of my daughter’s bite and the type oftreatment it requires, you violated our privacy rights as per HIPAA by disclosing more than theminimum amount of information necessary, which is prohibited act. I assume you will clarify asa miscommunication.I disclosed that I did not have the financial stability to afford the expense of orthodontictreatment for my daughter and that after continued pressure to move forward for my child’sdental health, was offered a discount of $1,050...to offset the outrageous estimate. Just toclarify “continued pressure”, I was made to believe the treatment was necessary, for both mychildren. As I stated earlier, I still receive emails telling me my son is being referred by thepediatric dentist for orthodontics treatment. All the while clearly knowing my financial situation.By using the terms outrageous estimate, offered a discount, and financial instability, was not aconsent to release for Lone Star Pediatric Dental and Braces to disclose and publish a detaileddescription of my billing information and history. This information is also protected under HIPAAprivacy rights.Finally, your orthodontic manager, who failed to provide me with her name, did not offer to havemy daughter’s braces removed for $350 so that she wouldn’t be uncomfortable. She said, if you can’t afford it then bring her back in so that we can remove them and we will only charge you$350 dollars. But the way I could tell she could care less about my daughter’s comfort level ordental health is because she laughed.To say the least, I find it difficult to believe that Lone Star Pediatric Dental and Braces was trulysaddened about their interactions with me. After the experience I had with their office managerand your patronizing response, I seriously doubt that we were valued as patient and family.
Regards,
[redacted]

Attention: Revdex.com                                   ...⇄ 6/21/2016 Dear [redacted], Thank you for taking the time to communicate to us why our services did not meet your expectations. We have every desire to address your needs and provide the best solution available to resolve your issue as soon as possible. It must have been very frustrating for you to feel that we are not helping resolve the issue at hand. We are truly sorry for any misunderstanding you have experienced. We will address each complaint individually in attempt to clarify any previous miscommunications. Firstly, "At the beginning of our initial visit, I was pressured into scheduling a consultation with their orthodontic branch, Lone Star Pediatric Dental & Braces." I spoke with Lone Star Pediatric Dental in Lakeway, TX, who had seen Ms. [redacted]'s daughter starting on November, 14 2013, to review the orthodontic referral chart notes. Both entries on June 12, 2014 and October 27, 2015 noted mom's ([redacted]) request to go see the orthodontist for examination. Proof of documentation will be supplied upon request. Secondly, "I conceded to their recommendations ... Afterward I was presented with an outrageous estimate for their braces to which I could not afford. I explained that I did not have the financial stability to bear the expense and that it would have to wait. I was coaxed into reconsidering the braces for my daughter after they told me they would give me $1,050.00 discount for being a cosh customer." Based off of the Consumer Price Index for All Urban Consumers, in Austin, Texas, Comprehensive Orthodontic Treatment for an Adolescent on average was $6,829.53 (Higher rates documented in the 95th percentile was $8,071.17). Ms. [redacted] was presented with a total case fee of $5,250.00, a $1,050.00 discount (as the patient was not a candidate of medical necessity in order for Medicaid to pay; therefore, we offered a complimentary 20% discount on our UCR fees), leaving her out of pocket expense totaling $4,200.00. This was broken down into a down payment and interest free monthly payments (which were also extended past the estimated treatment time for financial convenience) that Ms. [redacted] agreed to by signing financial contracts on December 9, 2015. Proof of documentation will be supplied upon request. Thirdly, "I was advised that my daughter would need the top and lower braces for approx. 16 months ... I waited for them to apply my daughter's braces and when they were finished, she came out to the waiting room with only her top braces on. I was confused as the agreement with the initial down payment was for her to have the top and bottom done. I questioned them why her bottom braces weren't applied and they explained that her top teeth needed to be adjusted before she could receive her braces on the bottom. I felt deceived ... They never mention this to me even though they were charging me for both." For this miscommunication, we do apologize. The orthodontist reviewed at the initial exam the objectives in treatment she wished to address for the patient. Per HIPPA privacy rights, we cannot release specific diagnosis in treatment/chart notes until we have received written consent of release from the legal guardian, [redacted]. We are more than happy to review this again with Ms. [redacted]: The treatment diagnosis was documented and reviewed with Ms. [redacted] on December 9, 2015 at the initial records/braces appointment that it may take up to 6 months before lower braces would be placed. Lower braces were not placed on the same date as top braces due to her daughters bite; the condition of her daughter's bite without initial treatment to the maxillary arch would have made her  daughter's mandibular braces uncomfortable, and therefore not necessary yet in her treatment plan. Proof of documentation will be supplied upon request and consent to release by [redacted].Fourthly, "After the initial visit my daughter only attended two follow-up appointments and each time I felt like steps were being missed and something wasn't right. My daughter was in & out in 15 minutes and she was never sore from the supposed adjustments to her braces. They also never offered to brush her teeth when the wire was removed for replacement." Adjustment appointments are necessary because the elastic ties holding the wires in proper place stretch and weaken over time. Without adjustments, the wires would be incapable of creating proper pressure to correct the dental issues requiring treatment. Also, this gives the doctor opportunity to evaluate the movement of teeth and progress made. This allows for the recommendation that may improve the treatment plan. It takes a minimum of three weeks for tooth movement to occur, meaning that many adjustment appointments are required. Again, due to HIPPA privacy rights, once Ms. [redacted] signs release consent forms, we will be happy to provide documentation from each visit which also noted the planned braces placement on the lower arch. Braces and wires do not prevent the ability to maintain proper oral hygiene, the patient must simply brush and floss differently around the appliances. Oral Hygiene procedures and proper brushing habits were reviewed with the patient the day her upper braces were placed. Oral Hygiene is an important expectation to any patient in orthodontic treatment. Proof of documentation will be supplied upon request and consent to release by [redacted].The orthodontic treatment contract with the patient/responsible party was signed off in consent on December 9, 2015. A summarization in regards to the Ms. [redacted]'s statement to her contractual agreements are as follows:"It is agreed that the Unpaid Balance will be paid in MONTHLY installments of $184.00 each due on the 26th day of each month and continuing until the account is paid in full. A reprocessing fee of $10.00 will be assessed to accounts that are delinquent more than 7 days. We wish to stress that the frequency of office visits has no bearing on the monthly payment and this; the monthly payment schedule does NOT correspond to the service received that month. The payment schedule is mere a convenient way to meet your total financial obligation. Your Orthodontic Treatment Fee includes all appliances, braces and office visits required to complete your planned treatment in our office.... The fee does not cover any work done at any other dental office outside this practice....I understand the following:·         The account balance must be paid in full before removal of braces and appliances.·         Active treatment will be halted if the account becomes two months past due.·         In the event of transfer out of practice, the initial fee will not be refunded, regardless of number of braces placed.·         The account balance will be pro-rated and settled accordingly.I, as the FINANCIALLY RESPONSIBLE PERSON for this account, certify that I have read this agreement and that all treatment decisions and alternatives have been explained to me."Proof of documentation will be supplied upon request.   The patient's first monthly payment, as agreed by Ms. [redacted], on January 19, 2016 was declined. Per the signed consent form for the automated billing that Lone Star Pediatric Dental and Braces uses, if a payment fails, the payment will attempt to be processed again two weeks following along with a $20 late fee. If this payment goes still uncollected, the office is then contacted to reach out to the patient to follow up on past due balance. February 12, 2016, the orthodontic financial coordinator called and spoke with Ms. [redacted] in regards to her account balance. Ms. [redacted] informed her that the patient's father was paying for the treatment, that she would call him in order to obtain payment for us. The financial coordinator reminded her that the February payment would also soon be due. Mom understood and said she would call the office back. March 8, 2016, our automated payment center called our office to speak with the financial coordinator (FC) to say mom had called them in regards to the account. Ms. [redacted] told them she cannot afford treatment, that the father is responsible, however father is not paying and unreachable. Ms. [redacted] wanted to know what to do. The FC advised the automated payment center to tell her to continue to come into appointments but needs to figure out her financial situation with dad, as he did not sign the contract, he is not liable to Lone Star Pediatric Dental and Braces (LSPDB) to pay. The FC said to tell mom if she continues to show for appointments without payment for services, per her contractual arrangement, the patient will move to maintenance checks, per the doctor's discretion, until we can collect. March 9, 2016, patient was seen for her adjustment. At the end of the appointment, Ms. [redacted] declined to schedule the next appointment to put her daughter's lower braces on, that she prefer to call us back to schedule. May 5, 2016, Helene from Cedar Park Smiles (CPS) called to request transfer information for Ms. [redacted]s daughter. The FC called mom to review account balance and what transferring to a new orthodontist will entail, Ms. [redacted] did not answer the phone, and therefore, voicemail was left for her to call us back. May 10, 2016, The FC sent transfer information (Completed PAO transfer forms along with initial photos from records taken on December 9th, 2015) to Dr. [redacted]'s office (Cedar Park Smiles). Ms. [redacted] has still not called back to review balances on account. May 24, 2016, the patient was seen at Cedar Park Smiles for an exam to transfer. The office called and spoke to the FC to let us know that until Ms. [redacted] pays for her services rendered balance at LSPDB that Dr. [redacted] would not continue the treatment plan, even though he typically does not accept transfer cases. They requested to be sent proof of payment when the balance was paid, in order for them to continue treatment. Ms. [redacted] told CPS she was waiting on a court order for dad to pay the balance in order to pay, CPS understands, LSPDB understands. June 2, 2016, Ms. [redacted] called LSPDB in order to review account balance. A Treatment Coordinator (TC) was then able to review with her the services rendered to her account (per all documented notes from previous conversations and documents scanned to the account), the total balance due for services, what she had paid, and the balance remaining. Ms. [redacted] did not understand why she still owed us money. The TC then attempted to review the contract signed, that her financial arrangement states if she transfers mid-treatment to another orthodontist, services rendered will be entered for the account  balance. As a courtesy, the patient's services rendered reflected the initial investment per the banding fee, and two treatment months for the patient's two adjustment appointments. Ms. [redacted] at that point refused and requested to speak to the orthodontic manager (OM). The OM proceeded in conversation with Ms. [redacted] to review the services rendered, that she is financially responsible for treatment provided. Ms. [redacted] told the OM that she cannot afford braces or transportation to the office for treatment. Ms. [redacted] told the OM that she did not want LSPDB to continue communication to CPS any further and that she will not be going back to their office. The OM tried to offer transportation service options to help the patient come in for her appointments, Ms. [redacted] said none of those options were available to her. Ms. [redacted] accused LSPDB of not caring about her daughter, who had been through a lot of pain. Our OM offered that if Ms. [redacted] cannot pay for treatment, if transportation is also an issue, and if the braces were uncomfortable for the patient, that LSPDB would be willing to collect a portion of her services rendered of $350 in order to remove the patient's braces, and the remainder would be set up on a new billing arrangement at no interest. Ms. [redacted] then threatened to call the Revdex.com since LSPDB was "denying treatment". The OM clarified that LSPDB was not denying treatment, but that Ms. [redacted] has a financial obligation and if she cannot pay, then we would be happy to help by removing the braces from the patient, and/or seeing her at another office that may be closer to the patient's home address. The OM also offered to remove the braces for the time being for $350 of her services rendered, set her up on a payment plan for the balance, freeze the remaining account balance, and when Ms. [redacted] and her daughter were ready to continue treatment that we would not need to collect a new down payment, and resume the contract. Ms. [redacted] ended the conversation without agreement to the options provided.In regards to Ms. [redacted]'s account of the conversation that took place on June 2, 2016, "Essentially the proposed to repossess the braces with the included loss of any benefits from the money they were already compensated for. Not to mention the fact that my daughter would have to endure the removal process just to have them put back on by another orthodontist. This seemed absolutely absurd and somewhat disturbing. Why not just propose a cash settlement?" Again, LSPDB does apologize that we were unable to clarify why we recommended removal of the braces. Our patients and their care is on the forefront of our minds. If a patient cannot receive continued care to braces (regardless of financial or transportation obstacles), it is not recommended to leave braces; if not monitored/taken care of properly, the braces can be a hindrance to the patients oral health. A cash settlement was proposed multiple times for the services rendered, which Ms. [redacted] denied. Also, not all orthodontic practices utilize the same bracket and wire technology. It is very common to have to remove braces on a transfer patient and place new brackets wires from the new treating orthodontist. Since Ms. [redacted] made it clear she cannot start treatment elsewhere and she did not wish to continue treatment with LSPDB, the OM was offering all options in order to assist the situation.Lastly, "Why did they want the braces from my daughter's mouth back? Do they plan on using them on another child or is it just to put my daughter though more pain and suffering?" When braces are removed, they are crimped off of the teeth. This is not a painful process to the patient. The bracket technology is made to crimp off the teeth and are then destroyed. Per OSHA Law & Regulations, brackets and wires are never shared among patients. Any unused/removed material is disposed per biohazard requirements.Lone Star Pediatric Dental and Braces, to say the least, is truly saddened we were unable to meet the needs of a much valued patient and family. Our office is more than happy to review and assist with the  multiple options given to the patient if Ms. [redacted] wishes to come to an agreement. Again, her daughter's health is very important to us, and we wish to ensure that she is taken care of.Sincerest Regards,   Lone Star Pediatric Dental & Braces