Maricela M Simmons DDS

Revdex.com: I have reviewed the response 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 The information Dr [redacted] stated is incorrect I chose to not have the crowns done with her because I did not trust her billing practicesI visited her office on occasions, and on of those occasions, procedures were performed on me which were not covered by insurance, but I was given an estimate each time that stated some part of the procedure was covered by insurance If they are creating these estimates based off of what my insurance provides, then they should be able to tell what is and is not covered In fact, they provided me with documentation on my first visit which stated what is and isn't covered, with one of the procedures that she performed pre-marked to indicate that it was not coveredI also have documents in which they state they are waiting for payment from my insurance for a procedure that I already found out was not covered and deniedThey stated that my "insurance funds" ran out but that is not the case, as they simply were submitting a claim for something (that they most likely knew) was not covered by my insuranceI find it suspicious that they submitted the claim for the procedure almost a month after they submitted the claim for the other work that was done on the same day If the cannot even base their estimates off of what they provide me with about my insurance, I cannot trust that they are going to provide me with accurate information regarding my dental health, and are instead merely interested in making as much money as possible off of me I am by no means trying to get free work done by them, as I have paid them over $out of pocket to date for the work they actually did complete All of that was paid on time Not a single estimate they provided me was accurate or even close to what was the actual cost turned out to be I will be contacting the ADA and California Dental board to look into this further Regards, [redacted]

March 10, 2014
Revdex.com
RE: [redacted] Complaint
           [redacted]
           Cardiff, Ca.  92007
    ID # [redacted]
On several occasions we have attempted to contact Mr. [redacted] and have...

him return for the completion and delivery of 2 crowns which were started November of 2013. We are unable to submit billing for these crowns to his insurance company until the crowns are delivered and completed. Therefore the entire balance remains the patients’ responsibility.  Should Mr. [redacted] choose not to return the ADA states “A dentist may bill for materials and lab costs when the patient fails to return for the permanent crowns.” 
Mr. [redacted] has accused the practice of providing false information regarding his insurance. Mr. [redacted] was provided an accurate estimate based upon the information received from his insurance provider. This was only an estimate. It now appears the insurance provider is stating Mr. [redacted] has run out of benefits for the coverage period in question. This does not make the practice guilty of providing false information. Any charges which are not covered by insurance remain the responsibility of the insured. We have not and never practice fraudulent billing!
We have spent countless hours corresponding and trying to explain insurance billing and adjustments to Mr. [redacted]. Mr. [redacted] has received the care, and it appears he simply does not want to be responsible for payment. What he has done is wrong, in fact it is stealing. We prefer not to have this type of patient in the practice, and have sent him a copy of this letter. He will also be sent a final statement adjusted to reflect the cost of the two temporary crowns (which he is wearing), and a letter of dismissal as a patient which gives him 30 days to seek another dentist (during which time we will only provide him emergency care). 
We have spent more than enough time on someone who neither appreciates the quality of care provided, nor understands his responsibility for the repair and treatment needed in his mouth.

Revdex.com:
I have reviewed the response 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.
 
The information Dr. [redacted] stated is incorrect.  I chose to not have the crowns done with her because I did not trust her billing practices. I visited her office on 3 occasions, and on 2 of those occasions, procedures were performed on me which were not covered by insurance, but I was given an estimate each time that stated some part of the procedure was covered by insurance.  If they are creating these estimates based off of what my insurance provides, then they should be able to tell what is and is not covered.  In fact, they provided me with documentation on my first visit which stated what is and isn't covered, with one of the procedures that she performed pre-marked to indicate that it was not covered. I also have documents in which they state they are waiting for payment from my insurance for a procedure that I already found out was not covered and denied. They stated that my "insurance funds" ran out but that is not the case, as they simply were submitting a claim for something (that they most likely knew) was not covered by my insurance. I find it suspicious that they submitted the claim for the procedure almost a month after they submitted the claim for the other work that was done on the same day.   If the cannot even base their estimates off of what they provide me with about my insurance, I cannot trust that they are going to provide me with accurate information regarding my dental health, and are instead merely interested in making as much money as possible off of me.  I am by no means trying to get free work done by them, as I have paid them over $900 out of pocket to date for the work they actually did complete.  All of that was paid on time.  Not a single estimate they provided me was accurate or even close to what was the actual cost turned out to be.  I will be contacting the ADA and California Dental board to look into this further
Regards,
[redacted]

Review: I went to this dentist to have some work done. After having some concerns about their billing practices and how they communicated regarding my treatment and options, I decided to no longer have any work done with their office. They are now claiming I owe them for procedures that they did not perform. They have also provided me with false information regarding insurance coverage and may be engaging in overbilling. I have documentation showing misleading billing practices and that they performed procedures on me without informing my beforehand, and claimed that those procedures were covered by insurance when documents they provided me (and a denied insurance claim) show otherwise.Desired Settlement: I would like them to stop billing me for procedures that they did not perform and for them to provide, in writing that my balance with their office is $0 and I have paid for all work performed by them.

Business

Response:

March 10, 2014

Revdex.com

RE: [redacted] Complaint

[redacted]

Cardiff, Ca. 92007

ID # [redacted]

On several occasions we have attempted to contact Mr. [redacted] and have him return for the completion and delivery of 2 crowns which were started November of 2013. We are unable to submit billing for these crowns to his insurance company until the crowns are delivered and completed. Therefore the entire balance remains the patients’ responsibility. Should Mr. [redacted] choose not to return the ADA states “A dentist may bill for materials and lab costs when the patient fails to return for the permanent crowns.”

Mr. [redacted] has accused the practice of providing false information regarding his insurance. Mr. [redacted] was provided an accurate estimate based upon the information received from his insurance provider. This was only an estimate. It now appears the insurance provider is stating Mr. [redacted] has run out of benefits for the coverage period in question. This does not make the practice guilty of providing false information. Any charges which are not covered by insurance remain the responsibility of the insured. We have not and never practice fraudulent billing!

We have spent countless hours corresponding and trying to explain insurance billing and adjustments to Mr. [redacted]. Mr. [redacted] has received the care, and it appears he simply does not want to be responsible for payment. What he has done is wrong, in fact it is stealing. We prefer not to have this type of patient in the practice, and have sent him a copy of this letter. He will also be sent a final statement adjusted to reflect the cost of the two temporary crowns (which he is wearing), and a letter of dismissal as a patient which gives him 30 days to seek another dentist (during which time we will only provide him emergency care).

We have spent more than enough time on someone who neither appreciates the quality of care provided, nor understands his responsibility for the repair and treatment needed in his mouth.

Consumer

Response:

I have reviewed the response 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.

The information Dr. [redacted] stated is incorrect. I chose to not have the crowns done with her because I did not trust her billing practices. I visited her office on 3 occasions, and on 2 of those occasions, procedures were performed on me which were not covered by insurance, but I was given an estimate each time that stated some part of the procedure was covered by insurance. If they are creating these estimates based off of what my insurance provides, then they should be able to tell what is and is not covered. In fact, they provided me with documentation on my first visit which stated what is and isn't covered, with one of the procedures that she performed pre-marked to indicate that it was not covered. I also have documents in which they state they are waiting for payment from my insurance for a procedure that I already found out was not covered and denied. They stated that my "insurance funds" ran out but that is not the case, as they simply were submitting a claim for something (that they most likely knew) was not covered by my insurance. I find it suspicious that they submitted the claim for the procedure almost a month after they submitted the claim for the other work that was done on the same day. If the cannot even base their estimates off of what they provide me with about my insurance, I cannot trust that they are going to provide me with accurate information regarding my dental health, and are instead merely interested in making as much money as possible off of me. I am by no means trying to get free work done by them, as I have paid them over $900 out of pocket to date for the work they actually did complete. All of that was paid on time. Not a single estimate they provided me was accurate or even close to what was the actual cost turned out to be. I will be contacting the ADA and California Dental board to look into this further

Regards,