ProCare Dental Group PC-Wheaton

Initial Business Response / [redacted] (1000, 5, 2015/07/21) */ Mr [redacted] received a perio maintenance and irrigation on 7/15/for which he was charged and paid $Mr [redacted] 's plan stated his copay should have been $(plus $irrigation)Mr [redacted] sees a periodontic Specialist for alternating perio maintenance visits and has seen that specialist earlier this yearThe plan overlooked or was not advised that there is a limitation on the perio maintenance code (***) of "one"Mr [redacted] has previously received his maximum allowable benefit for the code, and charges for services 7/15/are correct Mr [redacted] 's dental plan is a [redacted] or pre-paid planNon-covered services or services beyond the scope of the plan are billable to the patient at the office fee, thus the statement that the $would also have been charged to a non-insured patient is correct per the dental plan rules It is unfortunate that Mr [redacted] is misunderstood on the benefits provided by his plan, and even more unfortunate that after contact with his plan, he did not receive correct information as to his benefits and related limitationsProCare apologizes for any part it [redacted] have had in that circle of miscommunication Initial Consumer Rebuttal / [redacted] (3000, 7, 2015/07/21) */ (The consumer indicated he/she DID NOT accept the response from the business.) I absolutely do not agree with the response because I should have been given a price estimate of the cleaning before treatment, especially since I had commented to Dr [redacted] when I sat down in the chair that I usually receive my cleanings from my periodontist, Dr [redacted] and that it was recommended by Dr[redacted] that since my insurance covered cleanings I might save money by alternating my cleanings between both offices since I always pay out of pocket for all of my cleanings with Dr [redacted] Little did I know that I would wind up paying almost twice as much the same cleaning that I receive at Dr [redacted] 's officeIn addition,patients should have written and billing/pricing information accessible to themIn addition, Dr [redacted] and the office manager know full well that I have been seen by Dr [redacted] for at least as long I have been coming to their officeIn reality, I have been treated by Dr [redacted] for the past yearsMedical records/x-rays/referrals have been sent both ways.There is a paper trail that would confirm thisFor them to charge me the same price for a cleaning as someone without any insurance is asinine to say the leastWhy would anyone bother to purchase medical insurance if businesses were going to charge a patient as if he/she had no insurance at allThis of course has nothing to with Ms [redacted] 's (office manager)rude behavior towards the rep from [redacted] and myselfI have been coming to this office for about ten years and have always been a patient that have payed my co-pays without failI resent being treated as if I were completely new to this office with them not having any history what so ever as to my previous treatment Final Business Response / [redacted] (4000, 9, 2015/07/31) */ The statement from the treating dentist as to the estimate of costs PRIOR to treatment is that Mr [redacted] verbally acknowledged that services would not be covered and he would be responsible for the costs of treatment that dayThere was opportunity to obtain further details of those costs at that time Mr [redacted] 's dental plan, even though it is an HMO type, has certain rules and restrictionsThe plan contracts with Specialists like Dr [redacted] to pay for services on a claims basisFor these same services by the General Dentist, no claims are submitted, nor are they accepted by [redacted] ( [redacted] )If Dr [redacted] chooses to accept copays and the plan continues to reimburse him in the face of an obvious plan limitation, that would be their ( [redacted] and DNOA) businessThe General Dentist would have no knowledge of that transaction Further, prior to July 17, 2015, there appears to be no "paper trail" between Dr [redacted] and the general dentist's office, although there may have been a discussion between Dr [redacted] and Mr [redacted] regarding his alternating visits In previous years, Mr [redacted] had coverage thru a different insurance provider, also a ***The limitations and restrictions on frequency of periodontal folltreatment were completely different in that planThe last periodontal cleaning at this office prior to June was August Final Consumer Response / [redacted] (2000, 11, 2015/08/03) */ (The consumer indicated he/she ACCEPTED the response from the business.)

Initial Business Response /* (1000, 5, 2015/07/21) */
Mr. [redacted] received a perio maintenance and irrigation on 7/15/2015 for which he was charged and paid $192. Mr. [redacted]'s plan stated his copay should have been $45 (plus $39 irrigation). Mr. [redacted] sees a periodontic Specialist for...

alternating perio maintenance visits and has seen that specialist earlier this year. The plan overlooked or was not advised that there is a limitation on the perio maintenance code ([redacted]) of "one". Mr. [redacted] has previously received his maximum allowable benefit for the code, and charges for services 7/15/15 are correct.
Mr. [redacted]'s dental plan is a [redacted] or pre-paid plan. Non-covered services or services beyond the scope of the plan are billable to the patient at the normal office fee, thus the statement that the $192 would also have been charged to a non-insured patient is correct per the dental plan rules.
It is unfortunate that Mr. [redacted] is misunderstood on the benefits provided by his plan, and even more unfortunate that after contact with his plan, he did not receive correct information as to his benefits and related limitations. ProCare apologizes for any part it [redacted] have had in that circle of miscommunication.
Initial Consumer Rebuttal /* (3000, 7, 2015/07/21) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I absolutely do not agree with the response because I should have been given a price estimate of the cleaning before treatment, especially since I had commented to Dr. [redacted] when I sat down in the chair that I usually receive my cleanings from my periodontist, Dr. [redacted] and that it was recommended by Dr.[redacted] that since my insurance covered cleanings I might save money by alternating my cleanings between both offices since I always pay out of pocket for all of my cleanings with Dr. [redacted]. Little did I know that I would wind up paying almost twice as much the same cleaning that I receive at Dr. [redacted]'s office. In addition,patients should have written and billing/pricing information accessible to them. In addition, Dr. [redacted] and the office manager know full well that I have been seen by Dr. [redacted] for at least as long I have been coming to their office. In reality, I have been treated by Dr. [redacted] for the past 20 years. Medical records/x-rays/referrals have been sent both ways.There is a paper trail that would confirm this. For them to charge me the same price for a cleaning as someone without any insurance is asinine to say the least. Why would anyone bother to purchase medical insurance if businesses were going to charge a patient as if he/she had no insurance at all. This of course has nothing to with Ms. [redacted]'s (office manager)rude behavior towards the rep from [redacted] and myself. I have been coming to this office for about ten years and have always been a patient that have payed my co-pays without fail. I resent being treated as if I were completely new to this office with them not having any history what so ever as to my previous treatment.
Final Business Response /* (4000, 9, 2015/07/31) */
The statement from the treating dentist as to the estimate of costs PRIOR to treatment is that Mr. [redacted] verbally acknowledged that services would not be covered and he would be responsible for the costs of treatment that day. There was opportunity to obtain further details of those costs at that time.
Mr. [redacted]'s dental plan, even though it is an HMO type, has certain rules and restrictions. The plan contracts with Specialists like Dr. [redacted] to pay for services on a claims basis. For these same services by the General Dentist, no claims are submitted, nor are they accepted by [redacted] ([redacted]). If Dr. [redacted] chooses to accept copays and the plan continues to reimburse him in the face of an obvious plan limitation, that would be their ([redacted] and DNOA) business. The General Dentist would have no knowledge of that transaction.
Further, prior to July 17, 2015, there appears to be no "paper trail" between Dr. [redacted] and the general dentist's office, although there may have been a discussion between Dr. [redacted] and Mr. [redacted] regarding his alternating visits.
In previous years, Mr. [redacted] had coverage thru a different insurance provider, also a [redacted]. The limitations and restrictions on frequency of periodontal follow-up treatment were completely different in that plan. The last periodontal cleaning at this office prior to June 2015 was August 2006.
Final Consumer Response /* (2000, 11, 2015/08/03) */
(The consumer indicated he/she ACCEPTED the response from the business.)