Michael K. Ban, D.M.D.

March 9, 2016 Physician's StatementI initially examined the patient on November 25, 2016 with a chief complaint of fractured retained roots of the mandibular lower left third molar. There are typically 3 roots with this tooth. It is the last molar in the arch and her roots were broken off below...

the gingiva. I explained to the patient that to remove the roots of the tooth I would need to section the remains of the tooth and take the roots out individually and most likely need to make an incision of the tissue to gain access.I gave her the option to havethe procedure performed under local anesthesia or sedation.  After discussing her options, she elected to have the procedure performed under sedation. This was thoroughly explained and the patient was given exact instructions if we performed sedation. These were third molar roots - multiple rooted tooth, not a single root. Also we could have waited for a predetermination but the patient was symptomatic and wanted the procedure performed sooner. We work with insurance companies every day and we appealed to her insurance carrier in an attempt to help her.Physician: Michael K. B**, DMDOffice Manager StatementIn our office benefits for this particular insurance are looked up on the insurance website and we are given a summary of benefits. In the patient's case we looked specifically into the dental oral surgery benefits for her root extraction which covered at 50%; and also looked into anesthesia, which stated that it was covered at 100%. They do not show under the anesthesia that anesthesia is not covered if the patient has a root removed. Typically, In the past this insurance did not pay for anesthesia if the extraction was routine, which means there is no cutting or removal of bone to get the tooth out.Unfortunately, only recently has there been an issue with this insurance company not covering anesthesia if a root removal is involved and there was no way for us to know this ahead of time. We did our best to help the patient out by appealing that decision, but the insurance company did not see it that way. They don't cover for anesthesia period if a root is involved. Insurance is becoming increasingly complex in deciding what they will cover and will not cover. It is not always possible for us to know this ahead of time. We were just as surprised as the patient was when they did riot cover the anesthesia for that reason. The patient was not given a bill for our full anesthesia charge, the service was provided for her and we deserve to be paid for services rendered*Office Manager: Laurie F[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
Unfortunately, this has turned into a he-said, she-said scenario. As much as I like Dr. B**, his memory of my exam is incorrect. I was not given the choice between local and full anesthesia with pros and cons of both explained to me. If I had been given the option of local anesthesia I would have definitely accepted that option due to being able to drive myself home that day and knowing that the price would be less. He very clearly told me that he'd be completely putting me under, and I'd need to make sure I had someone with me to drive me home.  In addition, in all of my discussions with his office's business manager, that version of the story was not mentioned until the very last conversation. You'd think an important detail like that would have been something that was brought up immediately, months ago.
If the business is going to stand behind this untruthful version of the events- that I chose full anesthesia with all knowledge of the pros and cons- future customers of Dr. B**'s need to know that that is a lie so that they know to ask for options in their care.
In regards to my insurance company changing their coverage between the dates of the estimate and the procedure, [redacted] Insurance has stated that that is also a lie. Full anesthesia for a root removal is never covered unless it is proven medically necessary and hasn't been for as long as the representative could remember.
Dr. B** and his staff can continue to stand behind the legality of what they did. Yes, I did sign that what they told me was an estimate and that I was responsible for the remainder. However, that does not excuse the morality of their actions.  At best, they were negligent in providing me options and negligent in reviewing my insurance accurately to provide a realistic estimate. However, due to the lies they continue to state, it seems like this was not negligence but a purposeful deceitful act. Future customers do need to be made aware.
Regards,
[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.Unfortunately, this has turned into a he-said, she-said scenario. As much as I like Dr. B**, his memory of my exam is incorrect. I was not given the choice between local and full anesthesia with pros and cons of both explained to me. If I had been given the option of local anesthesia I would have definitely accepted that option due to being able to drive myself home that day and knowing that the price would be less. He very clearly told me that he'd be completely putting me under, and I'd need to make sure I had someone with me to drive me home.  In addition, in all of my discussions with his office's business manager, that version of the story was not mentioned until the very last conversation. You'd think an important detail like that would have been something that was brought up immediately, months ago. If the business is going to stand behind this untruthful version of the events- that I chose full anesthesia with all knowledge of the pros and cons- future customers of Dr. B**'s need to know that that is a lie so that they know to ask for options in their care. In regards to my insurance company changing their coverage between the dates of the estimate and the procedure, [redacted] Insurance has stated that that is also a lie. Full anesthesia for a root removal is never covered unless it is proven medically necessary and hasn't been for as long as the representative could remember. Dr. B** and his staff can continue to stand behind the legality of what they did. Yes, I did sign that what they told me was an estimate and that I was responsible for the remainder. However, that does not excuse the morality of their actions.  At best, they were negligent in providing me options and negligent in reviewing my insurance accurately to provide a realistic estimate. However, due to the lies they continue to state, it seems like this was not negligence but a purposeful deceitful act. Future customers do need to be made aware.
Regards,
[redacted]

March 9, 2016 
Physician's StatementI initially examined the patient on November 25, 2016 with a chief complaint of fractured retained roots of the mandibular lower left third molar. There are typically 3 roots with this tooth. It is the last molar in the arch and her roots were...

broken off below the gingiva. I explained to the patient that to remove the roots of the tooth I would need to section the remains of the tooth and take the roots out individually and most likely need to make an incision of the tissue to gain access.I gave her the option to havethe procedure performed under local anesthesia or sedation.  After discussing her options, she elected to have the procedure performed under sedation. This was thoroughly explained and the patient was given exact instructions if we performed sedation. These were third molar roots - multiple rooted tooth, not a single root. Also we could have waited for a predetermination but the patient was symptomatic and wanted the procedure performed sooner. We work with insurance companies every day and we appealed to her insurance carrier in an attempt to help her.Physician: Michael K. B**, DMDOffice Manager StatementIn our office benefits for this particular insurance are looked up on the insurance website and we are given a summary of benefits. In the patient's case we looked specifically into the dental oral surgery benefits for her root extraction which covered at 50%; and also looked into anesthesia, which stated that it was covered at 100%. They do not show under the anesthesia that anesthesia is not covered if the patient has a root removed. Typically, In the past this insurance did not pay for anesthesia if the extraction was routine, which means there is no cutting or removal of bone to get the tooth out.Unfortunately, only recently has there been an issue with this insurance company not covering anesthesia if a root removal is involved and there was no way for us to know this ahead of time. We did our best to help the patient out by appealing that decision, but the insurance company did not see it that way. They don't cover for anesthesia period if a root is involved. Insurance is becoming increasingly complex in deciding what they will cover and will not cover. It is not always possible for us to know this ahead of time. We were just as surprised as the patient was when they did riot cover the anesthesia for that reason. The patient was not given a bill for our full anesthesia charge, the service was provided for her and we deserve to be paid for services rendered*Office Manager: Laurie F[redacted]

Review: In December 2015, I was referred to Dr. Ban for a root removal. After he examined me, he told me that when he removed it I'd be under anesthesia, so I'd need to bring someone with me to wait with me and drive me home. His staff then reviewed my insurance and gave me an estimate of $96, which I paid right then. A couple days later I went back and had the procedure done. A couple weeks after that I received a bill in the mail for $200. I called to question the bill and was told that after the procedure when they ran my insurance, they found that the anesthesia wasn't covered anymore- it had changed from when they gave me the estimate to after the procedure. They told me they appealed to my insurance on my behalf and were denied and that they felt so badly that they gave me a discount and could charged me the full amount of over $300. Lastly, they told me that since the $96 was just an estimate, there was nothing I could do other than fight my insurance and that if I didn't pay them, they'd send my bill to collections.

I called my insurance company and was basically told that 1. for as long as the representative had worked there, they had never covered anesthesia for a root removal (only local anesthesia) unless it was absolutely medically necessary (which mine wasn't), 2. it was common practice among all insurance companies to only cover local anesthesia for a root removal, and 3. the surgeon had not given me a discount- due to an agreement they signed with the insurance company, they were only allowed to bill me $200 for anything that was not covered.

I called Dr. Ban's office back and was told that I had been given the choice of local or full anesthesia, and since I made my choice, I had to pay for it. I was not given a choice- nothing was discussed with me on the pros and cons of the anesthesia choice. I was also basically told that everything my insurance company had told me was a lie.Desired Settlement: More and more it is sounding like I was unfairly and maliciously charged this $200, and so I would like the charge removed from my account.

Business

Response:

March 9, 2016 Physician's StatementI initially examined the patient on November 25, 2016 with a chief complaint of fractured retained roots of the mandibular lower left third molar. There are typically 3 roots with this tooth. It is the last molar in the arch and her roots were broken off below the gingiva. I explained to the patient that to remove the roots of the tooth I would need to section the remains of the tooth and take the roots out individually and most likely need to make an incision of the tissue to gain access.I gave her the option to havethe procedure performed under local anesthesia or sedation. After discussing her options, she elected to have the procedure performed under sedation. This was thoroughly explained and the patient was given exact instructions if we performed sedation. These were third molar roots - multiple rooted tooth, not a single root. Also we could have waited for a predetermination but the patient was symptomatic and wanted the procedure performed sooner. We work with insurance companies every day and we appealed to her insurance carrier in an attempt to help her.Physician: Michael K. B**, DMDOffice Manager StatementIn our office benefits for this particular insurance are looked up on the insurance website and we are given a summary of benefits. In the patient's case we looked specifically into the dental oral surgery benefits for her root extraction which covered at 50%; and also looked into anesthesia, which stated that it was covered at 100%. They do not show under the anesthesia that anesthesia is not covered if the patient has a root removed. Typically, In the past this insurance did not pay for anesthesia if the extraction was routine, which means there is no cutting or removal of bone to get the tooth out.Unfortunately, only recently has there been an issue with this insurance company not covering anesthesia if a root removal is involved and there was no way for us to know this ahead of time. We did our best to help the patient out by appealing that decision, but the insurance company did not see it that way. They don't cover for anesthesia period if a root is involved. Insurance is becoming increasingly complex in deciding what they will cover and will not cover. It is not always possible for us to know this ahead of time. We were just as surprised as the patient was when they did riot cover the anesthesia for that reason. The patient was not given a bill for our full anesthesia charge, the service was provided for her and we deserve to be paid for services rendered*Office Manager: Laurie F[redacted]