Scottsdale Dentistry & Cosmetic Dentistry By Dr. Foreman

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.As the business indicated, I was referred by another co-worker with the same insurance as myself, so the business should have known upfront that my insurance would not cover 80%/20% as they indicated she is billed the same (60/40) when I called to discuss it at a later date. I had a verbal discussion of the estimates based on the 80/20, but was never given anything in written, and after the first visit I noticed the balanced being charge was more than was I was originally told, but because I was so groggy and in pain I didn't think to question it. I was not informed of the fact my insurance would only cover 60/40, I was told they are arguing with the business and she will keep me posted. The first and second appointments I had friends drive me to them both, as I have only ever had nitrous at all previous dentist offices, and I knew I would be foggy after and unable to drive well. During both appointments, I was informed it took them the entire tank of nitrous to keep me sedated as well. The third appointment in October is when I couldn't find anyone to take me so i went alone. I had a panic attack in the chair because I have a major phobia of needles, which is listed in ALL my medical records, and was told they couldn't continue the appointment. I then indicated I have been prescribed Xanax before by previous doctors before procedures, so Dr. [redacted] indicated he would prescribe it for me and reschedule the appointment. The 3rd appointment I took a Xanax before the appointment, started having a panic attack part of the way through the appointment and Dr. [redacted] suggested to take another one, they would turn the nitrous back up and let me settle down again. Then they collected the 3rd payment. When I had my treatment discussion appointment with Dr. [redacted] I was verbally told the treatment plan and was never given anything in writing. Months later when I requested a copy of my medical record, the page with dates about the May appointments is not even included. When I asked later why the office did not forward the treatment plan to my insurance to CONFIRM the 80/20, I was told by Gwen that it was not their responsibility to confirm my coverage and that I should have looked into that myself before allowing the treatment to be done.

WE have no further response to this complaint.  Everything is clearly documented in the chart and does not coincide with Miss [redacted]'s accounting of the situation.

[redacted] was referred to us by another co-worker who has the same insurance.  She presented to us with [redacted] card.  Dr. [redacted] is a preferred provider for [redacted] Radius, so I called ins and got percentages for treatment.  No one identified the insurance as [redacted] Core, nor did they say...

that we were considered out of network on this plan even though Dr. [redacted] is a preferred provider for [redacted].

I estimated [redacted]’s responsibility based on the percentages I was given, and divided that amount over the 3 appointments she would need.  These arrangements were made with [redacted] well before the time of her first appointment.  Her Consultation was 4-17-14.  None of these financial arrangements were made while under the influence of any medication that we knew of.

At her first appointment (5-9-12) she used Nitrous which is totally reversed at the end of the appointment and I collected the agreed upon amount.  On 5-23-12 I received the payment from insurance company.  I called them and complained about the wrong amount being paid.  I was then informed that a [redacted] Radius Dentist was considered out of network and restorations would be paid at 60% not 80 %.  I informed [redacted] of this and suggested she contact her HR rep at the company she worked for, to complain because it was not right.

At her appointment scheduled on 5-22-12 she admitted that she had taken Xanec for previous appointment but had not told us.  She couldn’t find any for this appointment and had to reschedule

She scheduled her next appointment on 5-29-12 and again I collected the pre-agreed upon payment and told her I would bill her for the difference after insurance paid because it would give her some added time to budget for the larger amount.

She then scheduled her last appointment on 11-6-12 when she again paid the remaining 3rd payment.

I am very surprised that [redacted] feels she should be reimbursed for anything.  She needed the treatment, the treatment was done and she was happy with Dr. [redacted].

Our new patients are given a treatment agreement to read and sign at their first appointment with us that explains in detail that we are not responsible for what their insurance company does or does not pay.  We bill them as a convenience to the patient.  [redacted] received this agreement and signed it.

In Summary, this is an issue of insurance coverage and a patient not taking the responsibility to find out about her coverage plus inaccurate information given to us by her insurance company.  [redacted] was fully aware by her second appointment that her insurance would be paying at a different percentage than I first estimated, and still proceeded with treatment. There will be no refund made.