Oral & Facial Surgeons Of Arizona

Review: I underwent a dental proceedure I was advised in advance, was covered by insurance at 100%. I was later billed by this dental provider for the services I was told were covered by insurance and were not. The insurance company representative states that a request by the dental office for pre-authorization of covered services would have stated actual costs covered. A pre-authorization for covered services was not requested by the dental office.Desired Settlement: The dental office states, having been told incorrect coverage information falls outside of their responsibility and becomes an issue between the patient and the insurance company. A pre-authorization would have avoided the coverage dispute. I feel the dental office should ethically stand behind mis-leading information offered and waive costs they stated were covered by insurance and were not.

Business

Response:

We were aware that [redacted] was disappointed that he has a balance. When [redacted] came into our office we had him fill out a health history form at his initial visit and he signed the section 'fees and payments stating' " We make every effort to keep down the cost of our oral surgical care. You can help by paying upon completion of each visit. Other arrangements can med made with our office manager depending upon special circumstances. An estimate of the charge for any procedure of surgery you may require will be given to you upon request. If you have any dental and/or medical insurance we will be glad to fill out the proper forms, but please complete the identifying information on this form. Please remember that insurance is considered a method of reimbursing the patient for fees paid to the doctor and is not a substitute for payment. Some companies pay fixed allowances for certain procedures and others pay a percentage of the charge. It is your responsibility to pay any deductible amount, co-insurance and any other balance not paid for by your insurance company. You will be responsible for all collection costs, attorneys fees, and court costs." At this same visit based on the insurance we were able to obtain via phone and via fax from his dental insurance company he was presented with an 'estimated' treatment plan. [redacted] claims that no one asked him if he would like a predetermination and while that is not usually the practice of our treatment coordinator he did sign the estimate where in part it was written "If you would like our office to submit a pre-determination to your insurance company prior to services please inform our treatment coordinator". We have since recognized that due to frequency a pano x-ray was not covered by his insurance so as a professional courtesy we wrote off the x-ray; a charge of $115.00. Also, as a professional courtesy we wrote off a bone graft which was a charge of $375.00. [redacted] now has a balance of $375.00. We feel that we have met him more than half way. Dr [redacted] contacted the patient personally to let him know that we stand by what is his current balance is. I have enclosed records relating to this matter.

Please let me know if you need me to provide you with anything else. It is unfortunate that when patients have dental and / or medical treatment done; and insurance does not take care of what is estimated that the grievance ends up towards our facility and not the patient's insurance. Regardless of this outcome patient was provided superior treatment by a very qualified doctor who is deserving of payment for services rendered.

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.

I was advised by multiple representatives of this office before and after treatment that the proceedure would be covered by insurance in full. I was also advised of costs I would incur outside of covered insurance for the planned implant surgery. I made the decision to proceed with treatment that day based on assurances, offered multiple times, the proceedure was covered by insurance at 100%.

The staff is very friendly, the environment inviting. The larger question is an ethical one. Is a business representative responsible to stand behind their word with fingers crossed behind their back?

Regards,

Business

Response:

Because oral surgery is such a personalized service, a good rapport between oral surgeon and patient is of vital importance.

Our relationship seems to be missing the important elements of communication, trust and mutual understanding. We have written off the balance of $375.00 as an act of good faith. However, for this reason, we believe it is in [redacted]' best interest to seek care from another oral surgeon.

Our office will continue to be available to him for emergency care for 45 days while he seeks another oral surgeon. We would be happy to forward his records with his permission to a new oral surgeon.

Thank you.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I will wait until for the business to perform this action and, if it does, will consider this complaint resolved.

Regards,

Review: I was referred to Dr. [redacted]' business to remove my wisdom teeth. Once my appointment came around I went in to fill out all the things they needed from me before they could do the procedure. They told me that the rate my insurance was willing to pay was 80 percent. They then showed me a break down in prices on a treatment plan contract stating the numbers given to them by my insurance. I sign the contract to get on with the procedure and a couple of months later I get a call from Oral & Facial surgeons stating that my insurance was denied and that I had to pay for the rest of the amount. I asked them how was I told that I was insured then all of the sudden I am not. I explained to them that there is no way I could take on an extra 800 dollar bill. I am a full time student, a full time worker and I have two kids and I just bought an engagement ring for my girl friend and I was going to take extra hours from work to pay for it. I also pay bills in the house I live in and have to provide for my family and schooling. I am stretched to my limit and can't afford to pay a bill for years and years. I called both the insurance and doctors office and I kept getting stiff armed between them saying they weren't responsible. After hours of arguing, it is understood that the insurance information they thought was for me was actually for my father. I then find out that I wasn't even insured for a whole year and a half before they procedure even happened. I talked to [redacted] at Oral & Facial Surgeons and she explained to me that they didn't catch the difference in the DOB and that was a mistake on their end. She then went on to state that because I wasn't aware if I had insurance that I had to pay the fee.Desired Settlement: I feel like I should only pay to what the insurance rate would have been. There is a price of 200 dollars (plus or minus 3 dollars) that I was under the impression that I would have to pay.

Business

Response:

While we are very sorry that [redacted]'s expectations of our office were not reached; it is clear in reviewing his account that what he is mostly upset about is that he has an account balance. Upon [redacted]'s first visit he provided our office with his father's insurance information; not his insurance information which ironically they have the same name. Insurance asks us to provide them with an insurance identification number which we were able to provide based on the information [redacted] gave us. Unfortunately, it was not the correct information and the insurance that [redacted] did have with his father at one time had termed. Our office when given insurance information will submit a claim to their insurance company on their behalf. Any co-pays, co-insurance, deductibles, non-covered procedures or amounts over the maximum allowable benefits are due a the time of service. Verification of insurance benefits is completed as a courtesy to our patients based on the information they provide us; if the information is incorrect then we can only verify to the best of our ability. Insurance policies are a contract between the patient and their insurance company, and therefore we are not able to guarantee benefits or payments that will be made on patient's behalf. We make every effort to let the patient know prior to services what their out of pocket expenses will be. Patients are responsible to all amounts that insurance companies do not reimburse our office for including but not limited to services they deem not medically necessary, services that are over the insurance companies customary fee schedule or payments received that are less than estimated. More importantly, if coverage is not in effect at the time of service the Oral and Facial Surgeons of Arizona fee will be charged. Prior to service the above was explained to patient; he signed a contract which I have attached. I have also included our contact notes that we have had with patient.

If you have any further questions and/or concerns please do not hesitate to contact me.

Thank you.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I will wait until for the business to perform this action and, if it does, will consider this complaint resolved. I agree to pay the balance

Regards,