MG Dentistry & Rejuvenation Center

Complaint: ***
I am rejecting this response because: the allegation that the insurance company misinformed you is quite hard to believeAs far as placing the blame on me as a patient is also difficult to understand given your proposal that includes full coverageI'm unsure how you can claim no liability and that you did right by your patient by providing a treatment plan that is not confirmed. What you are stating is that you do not sit on the same side of the table as your patients You propose a treatment plan and are not incentivized to perform proper due diligence because in your eyes, you get paid either way The insurance company claims they do not cover it because that is written in the policy and you claim no liability because you aren't required to check if the crown you are proposing is covered, despite having shown it as fully coveredThe party who loses is the patient by no fault of his own.I am willing to pay the out of network charge portion of this ~$as I did in fact agree to the out of network coverage after Dr***, the one who started the process, left the practice However, I am not willing to pay for the difference between the porcelain and metal downgrade amountI am willing to pay the out of network amount if provided with the amount.
Sincerely,
*** ***

I would like to bring to your attention that there has been absolutely no neglect on behalf of MG Dentistry at doing the best we can with the information your insurance is willing to give usIf anything, you did not do your due diligence by confirming your own coverage with your insurance company
We estimate and submit for you and follow up with them if needed as a courtesy and convenience for our patientsMG Dentistry is a third party; the contractual obligation with the insurance is between you and themWhen presenting treatment to you it was stated that our provider was considered out of network (non-contracted provider)We obtain a benefit breakdown for our patients as a courtesy and do our best to be as accurate as possibleInsurances don’t disclose to us that crowns will be downgraded or given the alternative benefitAlso, ALL of our proposed treatment plans state “I understand this is an estimate and insurance portion is not guaranteed” which you have signedAs far as providing you with options for the crown, we ONLY do porcelain crowns in the office and cannot present you with an option we do not offerTo address your points; 1.) You were given the most cost effective porcelain crown, there are more expensive and aesthetic but in the posterior teeth not necessaryIn addition this office has not made a metal crown in over years except for gold which are cost prohibitive to most people due to the high cost of gold at which the lab charges2.) MGD sent a proposal estimate the issue is not between MGD and the insurance because we do not participateThe contract is between you and your insurance3.) We did not neglect due diligence that is how we got estimateYour insurance failed you by not giving us accurate information4.) You were presented the most cost effective posterior restoration that is made in this office; the other options would have been more expensive and not an appropriate choice for posterior teeth due to wear, strength and durabilityIn addition MGD does not have liability in this matter as the contract of coverage is between you and your insuranceWe rendered a service that you were fully aware of that the doctor was out of networkYou should actually be having this discussion with your insurance company as to why, in today’s world they are still only covering the metal crowns