Reston Dental Arts Center

Review: New dental patient. Checked online to confirm coverage with my insurance. Online information indicated some dentists at this location accepted my coverage.

1. Made appointment and asked for a dentist that took my insurance. Was offered a dentist and date/time.

2. On appointment day (7/3/2013), again asked receptionist if I was covered. She said she would check and then said, Yes.

3. During appointment, I continually mentioned coverage and indicated that I was on a budget. The hygienist suggested additional x-rays. I said that I wasn't sure whether I was covered. She left to check; returned and said, Yes, you are covered.

4. At the end of the appointment, I was given a sheet that clearly indicated the coverage I had "[redacted]" and it includes estimates for future needed dental work.

5. Later (around 7/15/2013), I received notification from my insurance, [redacted], that I was not covered for anything becuase Fusion Dental (new name) does not accept [redacted].

6. I immediately called [redacted] to ask for an explanation but was given conflicting information. One lady said that [redacted] is not accepted at all; another lady said that some of their dentists accept [redacted] but only the specialists.

7. Since that time, I have called approximately 6 more times and was referred to several individuals including: [redacted], and [redacted]. To the best of my knowledge, no call was returned. I also registered a complaint on their website but did not hear back.

The result is that I now owe $372.00 and will have to find another dentist and re-do the examination. I did everything in my power to ensure that I would be covered for this treatment. Fusion Dental provided wrong information through the [redacted] website, the initial appointment call, the appointment receptionist, and the hygienist. This should not happen. As they have not responded to my calls regarding what can be done about the bill, I advised the person I spoke with last week that I would be making a complaint to Revdex.com. As the referring person ([redacted] -- who I have been told would return my call three times) did not call back, I am now making the complaint.Desired Settlement: 1. I want the extra x-ray charged deleted. That information was clearly wrong. When I am standing in the x-ray room while the hygienist checks with the desk to see if I am covered, there is nothing else I could have done.

2. I want the records made available to me so that I can pass them along to the new dentist.

3. I want Fusion Dental to make any needed changes to the [redacted] website to ensure that the coverage information is accurate, particuarly if what one caller told me is true: We don't accept [redacted].

4. I want Fusion Dental to re-educate its staff so that there is clarity about which plans are covered and which are not so that patients/potential patients are not given incorrect information.

5. I want Fusion Dental to re-consider its call-back policy. If a patient is told, "someone will get in touch with you" that should indeed happen.

Business

Response:

October 10, 2013

To Whom It May Concern:,

I actually met with **. [redacted] personally to review what happened. I am not aware of three attempts to speak with me nor did I have multiple messages in my voicemail. When I spoke with her, I did apologize for the confusion and asked to see her card. The insurance card simply says [redacted] PPO. Nowhere on the card does it specify any restrictions, Our office is [redacted] Premiere which 99% of [redacted] PPO patients can utilize. They simply pay at a different rate, I had never seen the type of program that showed up when we sat together and pulled up the website. Nor did that letter category appear anywhere on her [redacted] card to alert us the program was different than our normal PPO patients. Our staff had no way of knowing this is a unique plan. When the front desk staff called she was told the patient was covered, As **- [redacted]'s letter clearly states, even the [redacted] representatives were confused and answered differently!! It also states she looked on the web page and it showed which doctors were PPO providers and which were only Premiere. While it is unfortunate that this happened, I do not see this as an error on the part of my office nor my staff members. We see a huge amount of [redacted] PPO and [redacted] Premiere patients and have never had this happen. We also have absolutely no control of the [redacted] website nor how they list their providers.

That being said, I have no problem doing an adjustment on the exam aspect of the visit since she will need to have that done again. I already sent her all x-rays via email so she will not need to have those taken again. Please advise on what you feel is fair and equitable. Our office takes a great deal of pride in how we handle our patients and their dental care. I appreciate your input.

Sincerely,