Nova Dental

Complaint Information: Mr*** was seen initially on 5/8/at our [redacted] location for denture consultationA claim was sent to his [redacted] insurance plan for preauthorization (this is required for certain services) [redacted] was then seen on 7/19/with our Oral Surgeon for extraction of his remaining lower teethHe was advised initially he would have a healing period of a few months, prior to having his denture started, in order for optimum fit and by regulations dictated by his insurance policyWe accomodated the patient by having him seen in each of our locations at various appointments per his requestHe was seen on 9/3/for his initial impressions to start his denture plate, it was noted at that time he would need an additional procedure called alveoloplasty (which smooths down the boney areas, done for patients who will wear a prosthetic device)This procedure was done on 9/8/2014, he was informed he would need again some time for healing around weeks10/24/we started his preliminary impressions to fabricate his full lower denturePatient understood that several visits were necessary to fabricate this prosthesisAfter this appointment the patient had lost his dental insurance and was made inactive with [redacted] The patient was informed that he would have to fix the matter with his insurance, as they will not pay for services provided during an inactive period, regardless of any preauthorization done previouslyWe are not able to submit a claim for payment, as they require this to be sent on insertion datePatient was upset with us and had the State call usWe were advised to not continue during the inactive periodHe was advised if he could not get his insurance plan re-activated again he would be financially responsible for payment of the service if we continueWe understand the patient is upset, but this matter is between him and his insuranceWe would like to continue the treatment plan initially started, if we cannot finish we will not be financially compensated for services already provided thus far

Complaint Information:

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Mr. [redacted] was seen initially on 5/8/2014 at our [redacted] location for denture consultation. A claim was sent to his [redacted] insurance plan for preauthorization (this is required for certain services). [redacted] was then seen on 7/19/2014 with our Oral Surgeon for extraction of his remaining lower teeth. He was advised initially he would have a healing period of a few months, prior to having his denture started, in order for optimum fit and by regulations dictated by his insurance policy. We accomodated the patient by having him seen in each of our 3 locations at various appointments per his request. He was seen on 9/3/2014 for his initial impressions to start his denture plate, it was noted at that time he would need an additional procedure called alveoloplasty (which smooths down the boney areas, done for patients who will wear a prosthetic device). This procedure was done on 9/8/2014, he was informed he would need again some time for healing around 6 weeks. 10/24/2014 we started his preliminary impressions to fabricate his full lower denture. Patient understood that several visits were necessary to fabricate this prosthesis. After this appointment the patient had lost his dental insurance and was made inactive with [redacted]. The patient was informed that he would have to fix the matter with his insurance, as they will not pay for services provided during an inactive period, regardless of any preauthorization done previously. We are not able to submit a claim for payment, as they require this to be sent on insertion date. Patient was upset with us and had the State call us. We were advised to not continue during the inactive period. He was advised if he could not get his insurance plan re-activated again he would be financially responsible for payment of the service if we continue. We understand the patient is upset, but this matter is between him and his insurance. We would like to continue the treatment plan initially started, if we cannot finish we will not be financially compensated for services already provided thus far.

Review: Upon receiving terrible treatment for a "deep cavity" that I never realized existed, i.e. tooth was not bothering me at all, I subsequently developed an infection and needed a root canal performed by a different dentist. The following dentist was in agreement that my root canal was most likely related to the treatment by the dentist at Nova Dental. Regardless, my husband went for a routine well visit, in APRIL, by the way, 2 weeks or so after my well visit, before my filling was done. We just received a EOB from insurance today, NOVEMBER 12th, stating that the entire amount is not covered by insurance as Nova Dental FAILED to submit the claim in the time allotted by the insurance company which is 6 month or so, a generous amount of time. This visit is a well visit and should be covered 100% by insurance if Nova Dental had gotten their billing practices in order. I am horrified by the manner in which they conduct themselves.Desired Settlement: I will not expect to pay the 343 dollars that would have been covered by insurance for this well visit. It is Nova Dental's responsibility to submit claims in a timely manner.

Business

Response:

Office

notes for the above Review: 4/26/13 pt presents for restoration #20-DO and

#19-DO which pt advised may be deep Tx: Anes 1 carp 3% Mepivicaine IANB.

Excavated decay #19-deep, placed vitrebond and desensitizer, bond and placed

composite Adj occ N.V. pt wants to address yellow areas between #8 and #9

bonding, highly esthetic area. st [04/26/13] 6/5/13 follow up -patient

concerned with pain LL, in area where restoration had been done recently -large

DO restoration had been done, large amount of radiographic decay was evident

-area not very sens, however patient has never had large fillings and does not

know how teeth react to such fillings -discussed possible sensitivity following

large restoration -adj occ/polished #19 -patient slightly unhappy with ant

restorations, #8/9 -teeth appear quite good, slight M overhang #9

-smoothed/polished #8 and #9 to patient's satisfaction -patient insisted that

[redacted] had been very complementary of my attention to detail and had

suggested patient see me next -urged patient to call as needed regarding LL\ NV

-follow up? #19 Patient was explained that the decay was very deep as previous

notes regarding filling done by our office. Patient never returned after second

visit regarding this matter. Regarding the spouse of the complaint our office

did submit the claim to their insurance plan electronically after the visit,

however, as some insurance companies are, the claim was again resent a second

time. Our office has been trying to get payment for his services and no bill has

been sent to the patient regarding the denial of any payment from their

insurance plan. If you should have any further questions please feel free to

contact our office.

Sent on: 11/19/2013

12:45:59 PM

Consumer

Response:

Review: [redacted]

I am rejecting this response because: I do not feel that when I came back in June that the pain I was having was adequately assessed. The dentist felt that the filling was large and that it would take time to settle. However, the time I waited for it to "settle" potentially delayed proper treatment and ultimately led to an abcess in the tooth. Perhaps if an x-ray had been taken in June this issue might have been discovered and maybe something could have been done about it at that time. I never returned after that visit because I felt that a second opinion was warranted after continuing to suffer with pain the entire summer.