Shady Springs Dental Care

Revdex.com: 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 No this is not acceptable I expect nothing less from the unprofessional business I had hoped the Revdex.com would be able to do something This business refuses to see what this complaint is really about They want to make it about the care I received and my fear of dentist Bottom line, this complaint is about the fact that fees were NEVER discussed with me I gave them checks for the amount requested only to find out that in the end they would want almost the same amount of money again At no time was I given any indication that there may be such a large some of money requested AGAIN Regards, [redacted] ***

This patient came to our office mistakenly thinking she had broken a tooth It turned out that she had heavy calculus (tartar buildup) that had chipped on the back of her lower front teeth It felt like a broken tooth to her which happens fairly often She expressed a desire, due to her fear, to have this one issue addressed and nothing elseDue to her fear of dental treatment, she desired oral sedation for the treatment needed to address her initial concern The treatment was planned in two appointments with oral sedation for each visit She referenced our website saying that the website states that "most issues can be completed in one or two visits"Completing dental care in 1-visits is often true for many patients but certainly not 100% of the time This patient requested we only address her initial concern and due to the complexity of that issue, it was necessary to accomplish this in two separate appointments It appears from the patient's complaint that she doesn't have any objection to the treatment that we suggested and accomplished for her It seems her complaint is with the out of pocket expense (what her insurance doesn't pay) she is going to incur as a result of the treatment provided.The patient makes a statement that she has excellent dental insurance From years of experience of dealing with dental insurance companies, I would characterize her insurance as "typical dental insurance coverage" What I mean by that is that dental insurance is rarely a benefit that pays for all of someone's dental treatment The insurance company will normally pay a portion of the treatment costs and the balance is the patient's responsibility I could bill the exact same services that I provided to this patient to different insurance companies and I am 100% confident that the amount paid would be different from each of the companies despite them claiming an amount that would be the usual, customary and reasonable fee (UCR) and that amount would be different for all companies as well The truth is that an insurance company pays a claim according to the benefits package that an employer or subscriber has paid for in premium dollars Some insurance plans do pay better than others For the many years I have been practicing (30+), I have always tried to treat every patient that walks through our doors the same We strive to be fair in our feesThis patient was charged exactly the same for her sedation procedure and the other procedures she had done as any other patient in our practice Some of those other patients have no insurance and must pay 100% of the fee out of pocketSome patient's insurance companies reimburse at a higher level than others I am guessing that this patient is upset that her dental insurance company reimbursed at a low percentage on what was paid on her treatment she had done and now wants our office to adjust off the difference I have no agreement with her insurance company (nor any other insurance company) that our office will accept what the insurance company pays as final payment As a courtesy, we will bill the patient's dental insurance for the treatment that was done and whatever the insurance company doesn't pay.......the balance is the patient's responsibility.To further illustrate that the fees that this patient was charged are not "exorbitant" as she characterized them I did a quick check of the fees that she was charged in our office and compared them in software provided by the National Dental Advisory Service edition that gives average fees based on the specific zip code where my office is located These fees are given in a range from the 40% percentile to the 95% percentile One of the fees that she questioned is for periodontal scaling and root planing and the fee she was charged was $per quadrant The fee range in the software for this procedure was from $228-$ Similarly, the fee she was charged for non-intravenous moderate (conscious) sedation was $and the fee range in the software was $270-$ Both of the fees that she was changed in our office was well within the range of what other dentists are charging for the exact same procedure I have already sent this patient a page letter a few days ago attempting to address her concerns It didn't seem to help the situation as she characterized my letter as "demeaning, harsh and unnecessary" Both the patient and I have provided you a copy of this letter where I did my best to attempt to address her concernsI am really confused by this entire situation I have also attached an initial online survey that this patient completed after her initial visit to our office reporting complete satisfaction with her treatment she received in our office on her initial appointment It seems like her dissatisfaction occurred after her insurance company didn't reimburse for her treatment as much as she would have expected or liked for them to do soNaturally, I am not a party to the contract between her and her dental insurance company It would seem that her complaint should not be with me but rather her insurance carrier Our office is planning on collecting the balance she owes on her account after her insurance company remits the amount that they are going to pay on her treatmentI appreciate the opportunity to respond to this complaint

I don't see this situation coming to a positive resolution since the patient and our office has a significant disagreement about her financial obligation. I have no further comments except to state again that our office did what we said we were going to do at the normal fee that is always charged to other patients (for these same services) and the patient has an obligation to pay the balance that her insurance does not pay.  Since I don't expect a positive resolution, I am not interested in continuing this "back and forth" discussion any longer. I stand by my previous comments that have been provided as sufficient rebuttal to this complaint.

This patient came to our office mistakenly thinking she had broken a tooth.  It turned out that she had heavy calculus (tartar buildup) that had chipped on the back of her lower front teeth.   It felt like a broken tooth to her which happens fairly often.  She expressed a desire, due...

to her fear, to have this one issue addressed and nothing else. Due to her fear of dental treatment, she desired oral sedation for the treatment needed to address her initial concern.  The treatment was planned in two appointments with oral sedation for each visit.   She referenced our website saying that the website states that "most issues can be completed in one or two visits". Completing dental care in 1-2 visits is often true for many patients but certainly not 100% of the time.  This patient requested we only address her initial concern and due to the complexity of that issue, it was necessary to accomplish this in two separate appointments.  It appears from the patient's complaint that she doesn't have any objection to the treatment that we suggested and accomplished for her.  It seems her complaint is with the out of pocket expense (what her insurance doesn't pay) she is going to incur as a result of the treatment provided.The patient makes a statement that she has excellent dental insurance.  From 30 years of experience of dealing with dental insurance companies, I would characterize her insurance as "typical dental insurance coverage".   What I mean by that is that dental insurance is rarely a benefit that pays for all of someone's dental treatment.  The insurance company will normally pay a portion of the treatment costs and the balance is the patient's responsibility.    I could bill the exact same services that I provided to this patient to 10 different insurance companies and I am 100% confident that the amount paid would be different from each of the 10 companies despite them claiming an amount that would be the usual, customary and reasonable fee (UCR) and that amount would be different for all 10 companies as well.  The truth is that an insurance company pays a claim according to the benefits package that an employer or subscriber has paid for in premium dollars.   Some insurance plans do pay better than others.  For the many years I have been practicing (30+), I have always tried to treat every patient that walks through our doors the same.  We strive to be fair in our fees. This patient was charged exactly the same for her sedation procedure and the other procedures she had done as any other patient in our practice.    Some of those other patients have no insurance and must pay 100% of the fee out of pocket. Some patient's insurance companies reimburse at a higher level than others.  I am guessing that this patient is upset that her dental insurance company reimbursed at a low percentage on what was paid on her treatment she had done and now wants our office to adjust off the difference.  I have no agreement with her insurance company (nor any other insurance company) that our office will accept what the insurance company pays as final payment.  As a courtesy, we will bill the patient's dental insurance for the treatment that was done and whatever the insurance company doesn't pay.......the balance is the patient's responsibility.To further illustrate that the fees that this patient was charged are not "exorbitant" as she characterized them.  I did a quick check of the fees that she was charged in our office and compared them in software provided by the National Dental Advisory Service 2015 edition that gives average fees based on the specific zip code where my office is located.  These fees are given in a range from the 40% percentile to the 95% percentile.   One of the fees that she questioned is for periodontal scaling and root planing and the fee she was charged was $271 per quadrant.  The fee range in the software for this procedure was from $228-$315.   Similarly, the fee she was charged for non-intravenous moderate (conscious) sedation was $322 and the fee range in the software was $270-$368.  Both of the fees that she was changed in our office was well within the range of what other dentists are charging for the exact same procedure.   I have already sent this patient a 3 page letter a few days ago attempting to address her concerns.  It didn't seem to help the situation as she characterized my letter as "demeaning, harsh and unnecessary".   Both the patient and I have provided you a copy of this letter where I did my best to attempt to address her concerns. I am really confused by this entire situation.   I have also attached an initial online survey that this patient completed after her initial visit to our office reporting complete satisfaction with her treatment she received in our office on her initial appointment.  It seems like her dissatisfaction occurred after her insurance company didn't reimburse for her treatment as much as she would have expected or liked for them to do so. Naturally, I am not a party to the contract between her and her dental insurance company.  It would seem that her complaint should not be with me but rather her insurance carrier.  Our office is planning on collecting the balance she owes on her account after her insurance company remits the amount that they are going to pay on her treatment. I appreciate the opportunity to respond to this complaint.

Revdex.com:
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.
No this is not acceptable.  I expect nothing less from the unprofessional business.  I had hoped the Revdex.com would be able to do something.   This business refuses to see what this complaint is really about.  They want to make it about the care I received and my fear of dentist.  Bottom line, this complaint is about the fact that fees were NEVER discussed with me.  I gave them checks for the amount requested only to find out that in the end they would want almost the same amount of money again.  At no time was I given any indication that there may be such a large some of money requested AGAIN.   
Regards,
[redacted]