Smile Life

Complaint: [redacted] I am rejecting this response because: My top teeth are now separating because of no permanent retainer On my initial appointment with Smilelife new that I had two insurances and that the possibility of both paying maximum How does the Director of finance know how I was treated I had an agreement with Dr [redacted] who agreed to make any further insurance payments to me It is not my responsibility to inform them of what my insurance covers and once I was educated by my insurance compnay what was covered usual and customary I did inform them Orthodontia is a lifetime maximum I will not be able to any other orthodontist and use my insurance for a top retainer because it has already been charged by smilelife I want the remaining $due to me and I also want them to replace my upper retainer with no chargewhich is what they should have done when I called them the day the wire was poking the inside of my mouth before I went into surgery and again they had no regards for my time only their own I had no choice but to pull it out as I was going to be in the hospital for days I do not accept their response and how does the financial director know how his staff treats people Regards, [redacted] - [redacted]

In her complaint, [redacted] complains of matters:She claims to have been overcharged by $1,as a result of the fee limitations imposed by her insurancecompanyShe claims that SmileLife’s treatment of her was unprofessionalShe claims she was denied retainers.Claims of Overcharging and Insurance Limitations:At the initial exam and acceptance of treatment in June of 2014, [redacted] signed a contract withSmileLife and the parties agreed the charge for her orthodontic treatment would be $4,At the outset, [redacted] did not inform SmileLife that her insurance company had a maximum regional fee schedule and that shewanted SmileLife to reduce its charge to match that maximum feeThe original financing agreement executedby the parties had no provision that required SmileLife to accept anything less than the original charge theyagreed toOnly after most of the treatment was complete in December 2015, did [redacted] mention anythingabout an insurance coverage limitationThe original Financial Agreement clearly states “I understand that ifour insurance benefit is decreased or terminated, I am responsible for paying the amount not covered toSmileLife.” [redacted] placed her actual initials next to that statement in the Agreement indicating she read it andunderstood the provision.SmileLife was unaware of any maximum in-network fees designated by CignaFurther, SmileLife’streatment rates are low for the general rates in the community in which it practicesTypically SmileLife doesnot contract with insurance plans that require discounted servicesNevertheless, December 22, 2015, SmileLifeemailed [redacted] ’s insurance company (Cigna) to confirm the maximum reimbursement schedule as [redacted] proposedJanuary 13, SmileLife received an email from Cigna confirming in-network maximums andattached a regional fee scheduleCorpus Christi’s maximum fee was $3,for comprehensive orthodontictreatment, such as [redacted] was receivingThe difference was $752—not $1,as [redacted] suggests.At the end of her treatment, [redacted] ’s payment record was:Down Payment:Down Payment: $ 540.00Periodic Payments: $1,630.04Insurance: $1,899.48Total received by SmileLife: $4,069.52To accommodate [redacted] , SmileLife has assumed Cigna’s contracted maximum fee of $3,448, leaving abalance owing to her of $SmileLife’s calculated numbers were different from [redacted] ’s by $so tofully appease her, SmileLife agreed to reimburse her $($+ $40.12).Additionally, SmileLife agreed that any additional monies received from her insurance policy would berefunded to her (see attachment #1)On March 1, 2016, SmileLife received a check in the amount of $545.28from Cigna Insurance and on March 30, 2016, SmileLife paid those funds over to [redacted] with a check for$(See Attachment #2).As an aside: After the foregoing, [redacted] asked SmileLife to file two additional claims with herinsurance for records and retainersSmileLife does not typically file these separate claimsWe file acomprehensive orthodontic claim in which those fees are includedHowever, [redacted] claimed her insurancerepresentative informed her these were valid claims, so, again, as an accommodation to her we filed the claimson her behalfBoth claims were denied last week (due to the policy’s expiration and [redacted] already receivingthe maximum benefits under the policy)We emailed the rejection notice to [redacted] SmileLife does notanticipate receiving any future payments from [redacted] ’s insurance policy on this accountSmileLife’s recordsare SmileLife has adjusted [redacted] ’s account and refunded [redacted] in full what she was owed andmoreNote: [redacted] also received dental hygiene cleanings at no charge, (our office typically charges for thisservice).As a further aside: Because of these orthodontic fee limitations, SmileLife has terminated its in-networkstatus with Cigna.SmileLife’s Treatment of [redacted] was Unprofessional:SmileLife disputes [redacted] ’s statement that she was denied treatment after being mins lateSmileLife’sstandard office policy is to reschedule patients if they are more than minutes late [redacted] ’s appointmenthistory shows that she had appointments scheduled that she no-showed and appointments that she was morethan minutes latePatient’s contract states “$broken appointment fee after 3rd missed appointment andall subsequently missed appointments(A missed appointment means you did not keep the appointment or didnot call hours prior to the appointment to cancel”Not only was [redacted] never turned away for treatment butshe was never charged according to her contractEven when she came late—though against office policy,SmileLife worked her into the schedule to accommodate herOn of those occasions [redacted] left after havingwaited less than minutesOur records indicate only occasion in which she was here for more than an hourwithout treatment being provided, this hour was spent in the office discussing settlement of account with Dr[redacted] We do however show appointment where [redacted] waited mins to be seenSmileLife’s goal is toseat each patient for treatment within minutes of the patient’s sign in on arrivalHowever, as with any otherhealthcare provider, SmileLife occasionally gets behind due to emergencies or other extenuating circumstances[redacted] ’s statement of being treated unprofessional is unsubstantiatedAs with all patients, SmileLifehas continuously strived to treat [redacted] professionallyAttachment #reflects the level of communication thatSmileLife has tried to maintain with [redacted] Furthermore, this email reflects the latest communication prior to [redacted] ’s complaint of replacement retainers, discussed in following paragraphDenial of Retainers: [redacted] ’s claim of denying her retainers is wrongSmileLife did provide her with both upper and lowerretainersThe facts are: [redacted] was provided bonded (glued) upper and lower retainers as well as an Essix (clear plasticremoveable) upper retainer, see photos (attachment #3)Smilelife was in contact with [redacted] on March 24,She did not mention any problems with her retainers at that time, see email (attachment #4)On March28, 2016, [redacted] called the office and stated that her upper bonded (glued) retainer came loose from one of theteeth and that it was bothering her tongue so she took it upon herself to remove the entire applianceWhen shecalled that day, one of our staff members explained that there is a $fee for replacing the retainer but [redacted] told staff member that she would discuss the matter with Dr [redacted] [redacted] came into the office the followingday, March 29, 2016, and refused to pay for a new retainer, however receptionist mentioned to Dr [redacted] that [redacted] stated she might pay half of the retainer fee [redacted] requested to speak directly to the doctor but leftbefore the doctor could free herself from the scheduled patient she was treating at the timeAs an aside, [redacted] ’s appointment that day was scheduled for 3: [redacted] checked in at 3:26—minutes late and left 19minutes later, at 3:The next day [redacted] was sent a letter (see attachment #5).Conclusion:SmileLife has tried to accommodate [redacted] in every way possibleBut at the point that [redacted] ’s requests turnto attempts to take advantage by demanding services from us without paying for them, SmileLife draws a hardlineAs our letter stated (see attachment #5) SmileLife is willing to replace [redacted] ’s retainers for the same feethat we would charge to any other patientOr we will remove remaining adhesive from the bonded retainer thatshe removed at no chargePatient currently has the upper essix (plastic) retainer and the lower bonded retainerwhich is what we typically provide.We truly appreciate your time and willingness in resolving this caseWe look forward to [redacted] accepting our response and dismissing her complaint.Sincerely, [redacted] ***Director of Finance

Complaint: ***
I am rejecting this response because: My top teeth are now separating because of no permanent retainer On my initial appointment with Smilelife new that I had two insurances and that the possibility of both paying maximum How does the Director of finance know how I was treated I had an agreement with Dr*** who agreed to make any further insurance payments to me It is not my responsibility to inform them of what my insurance covers and once I was educated by my insurance compnay what was covered usual and customary I did inform them Orthodontia is a lifetime maximum I will not be able to any other orthodontist and use my insurance for a top retainer because it has already been charged by smilelife I want the remaining $due to me and I also want them to replace my upper retainer with no chargewhich is what they should have done when I called them the day the wire was poking the inside of my mouth before I went into surgery and again they had no regards for my time only their own I had no choice but to pull it out as I was going to be in the hospital for days
I do not accept their response and how does the financial director know how his staff treats people.
Regards,
*** ***-***

Complaint: [redacted]
I am rejecting this response because:  My top teeth are now separating because of no permanent retainer.  On my initial appointment with  Smilelife new that I had two insurances and that the possibility of both paying maximum.  How does the Director of finance know how I was treated.  I had an agreement with Dr. [redacted] who agreed to make any further insurance payments to me.  It is not my responsibility to inform them of what my insurance covers and once I was educated by my insurance compnay what was covered usual and customary I did inform them.  Orthodontia is a lifetime maximum.  I will not be able to any other orthodontist and use my insurance for a top retainer because it has already been charged by smilelife.  I want the remaining $600 due to me and I also want them to replace my upper retainer with no charge. which is what they should have done when I called them the day the wire was poking the inside of my mouth before I went into surgery and again they had no regards for my time only their own.  I had no choice but to pull it out as I was going to be in the hospital for 3 days.   I do not accept their response and how does the financial director know how his staff treats people. 
Regards,
[redacted]-[redacted]

In her complaint, [redacted] complains of 3 matters:1. She claims to have been overcharged by $1,630.00 as a result of the fee limitations imposed by her insurancecompany.2. She claims that SmileLife’s treatment of her was unprofessional.3. She claims she was denied retainers.Claims of Overcharging and...

Insurance Limitations:At the initial exam and acceptance of treatment in June of 2014, [redacted] signed a contract withSmileLife and the parties agreed the charge for her orthodontic treatment would be $4,200. At the outset,[redacted] did not inform SmileLife that her insurance company had a maximum regional fee schedule and that shewanted SmileLife to reduce its charge to match that maximum fee. The original financing agreement executedby the parties had no provision that required SmileLife to accept anything less than the original charge theyagreed to. Only after most of the treatment was complete in December 2015, did [redacted] mention anythingabout an insurance coverage limitation. The original Financial Agreement clearly states “I understand that ifour insurance benefit is decreased or terminated, I am responsible for paying the amount not covered toSmileLife.” [redacted] placed her actual initials next to that statement in the Agreement indicating she read it andunderstood the provision.SmileLife was unaware of any maximum in-network fees designated by Cigna. Further, SmileLife’streatment rates are low for the general rates in the community in which it practices. Typically SmileLife doesnot contract with insurance plans that require discounted services. Nevertheless, December 22, 2015, SmileLifeemailed [redacted]’s insurance company (Cigna) to confirm the maximum reimbursement schedule as [redacted]proposed. January 13, 2016 SmileLife received an email from Cigna confirming in-network maximums andattached a regional fee schedule. Corpus Christi’s maximum fee was $3,448.00 for comprehensive orthodontictreatment, such as [redacted] was receiving. The difference was $752—not $1,630 as [redacted] suggests.At the end of her treatment, [redacted]’s payment record was:Down Payment:Down Payment: $ 540.00Periodic Payments: $1,630.04Insurance: $1,899.48Total received by SmileLife: $4,069.52To accommodate [redacted], SmileLife has assumed Cigna’s contracted maximum fee of $3,448, leaving abalance owing to her of $621.52. SmileLife’s calculated numbers were different from [redacted]’s by $40.12 so tofully appease her, SmileLife agreed to reimburse her $661.64 ($621.52 + $40.12).Additionally, SmileLife agreed that any additional monies received from her insurance policy would berefunded to her (see attachment #1). On March 1, 2016, SmileLife received a check in the amount of $545.28from Cigna Insurance and on March 30, 2016, SmileLife paid those funds over to [redacted] with a check for$545.28. (See Attachment #2).As an aside: After the foregoing, [redacted] asked SmileLife to file two additional claims with herinsurance for records and retainers. SmileLife does not typically file these separate claims. We file acomprehensive orthodontic claim in which those fees are included. However, [redacted] claimed her insurancerepresentative informed her these were valid claims, so, again, as an accommodation to her we filed the claimson her behalf. Both claims were denied last week (due to the policy’s expiration and [redacted] already receivingthe maximum benefits under the policy). We emailed the rejection notice to [redacted]. SmileLife does notanticipate receiving any future payments from [redacted]’s insurance policy on this account. SmileLife’s recordsare clear: SmileLife has adjusted [redacted]’s account and refunded [redacted] in full what she was owed andmore. Note: [redacted] also received 2 dental hygiene cleanings at no charge, (our office typically charges for thisservice).As a further aside: Because of these orthodontic fee limitations, SmileLife has terminated its in-networkstatus with Cigna.SmileLife’s Treatment of [redacted] was Unprofessional:SmileLife disputes [redacted]’s statement that she was denied treatment after being 5 mins late. SmileLife’sstandard office policy is to reschedule patients if they are more than 15 minutes late. [redacted]’s appointmenthistory shows that she had 8 appointments scheduled that she no-showed and 8 appointments that she was morethan 15 minutes late. Patient’s contract states “$25.00 broken appointment fee after 3rd missed appointment andall subsequently missed appointments. (A missed appointment means you did not keep the appointment or didnot call 24 hours prior to the appointment to cancel”. Not only was [redacted] never turned away for treatment butshe was never charged according to her contract. Even when she came late—though against office policy,SmileLife worked her into the schedule to accommodate her. On 2 of those occasions [redacted] left after havingwaited less than 20 minutes. Our records indicate only 1 occasion in which she was here for more than an hourwithout treatment being provided, this hour was spent in the office discussing settlement of account with Dr.[redacted]. We do however show 1 appointment where [redacted] waited 45 mins to be seen. SmileLife’s goal is toseat each patient for treatment within 10 minutes of the patient’s sign in on arrival. However, as with any otherhealthcare provider, SmileLife occasionally gets behind due to emergencies or other extenuating circumstances.[redacted]’s statement of being treated unprofessional is unsubstantiated. As with all patients, SmileLifehas continuously strived to treat [redacted] professionally. Attachment #4 reflects the level of communication thatSmileLife has tried to maintain with [redacted]. Furthermore, this email reflects the latest communication prior to[redacted]’s complaint of replacement retainers, discussed in following paragraph. Denial of Retainers:[redacted]’s claim of denying her retainers is wrong. SmileLife did provide her with both upper and lowerretainers. The facts are:[redacted] was provided bonded (glued) upper and lower retainers as well as an Essix (clear plasticremoveable) upper retainer, see photos (attachment #3). Smilelife was in contact with [redacted] on March 24,2016. She did not mention any problems with her retainers at that time, see email (attachment #4). On March28, 2016, [redacted] called the office and stated that her upper bonded (glued) retainer came loose from one of theteeth and that it was bothering her tongue so she took it upon herself to remove the entire appliance. When shecalled that day, one of our staff members explained that there is a $200 fee for replacing the retainer but [redacted]told staff member that she would discuss the matter with Dr. [redacted]. [redacted] came into the office the followingday, March 29, 2016, and refused to pay for a new retainer, however receptionist mentioned to Dr. [redacted] that[redacted] stated she might pay half of the retainer fee. [redacted] requested to speak directly to the doctor but leftbefore the doctor could free herself from the scheduled patient she was treating at the time. As an aside,[redacted]’s appointment that day was scheduled for 3:00. [redacted] checked in at 3:26—26 minutes late and left 19minutes later, at 3:45. The next day [redacted] was sent a letter (see attachment #5).Conclusion:SmileLife has tried to accommodate [redacted] in every way possible. But at the point that [redacted]’s requests turnto attempts to take advantage by demanding services from us without paying for them, SmileLife draws a hardline. As our letter stated (see attachment #5) SmileLife is willing to replace [redacted]’s retainers for the same feethat we would charge to any other patient. Or we will remove remaining adhesive from the bonded retainer thatshe removed at no charge. Patient currently has the upper essix (plastic) retainer and the lower bonded retainerwhich is what we typically provide.We truly appreciate your time and willingness in resolving this case. We look forward to [redacted] accepting our response and dismissing her complaint.Sincerely,[redacted]Director of Finance

Revdex.com Response by United Orthodontics, PC (“SmileLife”) to [redacted]’s Complaint ID [redacted] November 9, 2015 [redacted] 1)
normal;">      Ms. [redacted] was first seen in SmileLife’s Corpus Christi office October 17, 2014. a.       Her primary complaint was her crowded front teeth. b.      Occlusion was class I on right and Class II on left c.       Mild anterior crowding in upper and lower arches. d.      Space remaining in lower arch from missing first molar e.      Maxillary bridge from left first bicuspid to first molar. NOTE:  Patient had been for a consultation at another orthodontist’s office prior to her exam with Smilelife Orthodontics 2)      Treatment plan given by Dr. Smith: a.       Correct anterior crowding by aligning teeth b.      Close space from missing molar by moving 2nd molar forward c.       Accept class II occlusion on left due to bridge (bridge has replacement tooth that is ½ size of the normal tooth it is replacing) d.      Estimated treatment time 12 months  - Limited treatment fee: $3300.00 e.      Ms. [redacted] received a $330.00 discount.  Total fee charged was $2,970.00. (Patient made down payment and financed balance Interest free) [redacted] elected to start treatment with our office and braces were placed that same day. On August 28, 2015—after 10 months of treatment-- Ms. [redacted] walked into our office at 12:00 noon without a scheduled appointment and demanded to be seen immediately by the doctor to discuss her treatment.  The office was scheduled with other patients at the time so Ms. [redacted] was told a doctor would see her as soon as possible.  She was brought back for her consultation at 12:20, she complained about the wait and requested that we hurry up because she had somewhere she needed to be.   She was rude and abrasive from the moment she walked in the door.  In that meeting the following occurred: 1)      She was informed of Smilelife’s change of doctors at the Corpus Christi clinic as of August 12th, 2015 (Dr. [redacted] an owner and Dr. [redacted] a veteran practitioner of over 45 years).  Ms. [redacted] was introduced to them. 2)      She explained that she felt her treatment wasn’t progressing fast enough, she was due to get braces off in a few months and had spaces that were not closed. 3)      The doctor explained to the patient that this, being his first time seeing her case and, as with all patients, as a part of the transition for being the new treating doctor, SmileLife was  reviewing treatment plans with the patients and discussing treatment options going forward.    4)      Dr. [redacted] discussed with patient that, in his opinion, there were two treatment options. a.       Option One: continue treatment as planned, close the space and the approximate treatment time to complete would be 5 months.  b.      Option two: This option (which was beyond the scope of the limited treatment plan originally offered) would take significantly longer and would require sectioning the bridge (the size of the bridge being the cause of her class II malocclusion).  This treatment plan would include:                                         ...⇄ I.      Section maxillary bridge.                                         ...⇄ ii.      Close maxillary and mandibular space.                                         ...⇄ iii.      Patient would likely need to replace crowns after treatment was completed.  (SmileLife does not do crowns in the SmileLife offices.  It’s not among the services we provide.  But did get an estimate from dental office next door of $2,200.) [redacted] was told that she could get crowns replaced at the dental office of her choice.                                         ...⇄ iv.      Treatment time:  27 months total (including the 10 months [redacted] had already been in treatment)                                         ...⇄ v.      Note: This treatment option would be considered  comprehensive treatment and is typically charged $4,400.00 in our office Note:  Dr. [redacted] told Ms. [redacted] that this is the treatment he would do if she were his daughter or grand-daughter and that SmileLife would not charge anything extra to her if she chose to go with option #2. Ms. [redacted] asked to receive these options in writing, and was instructed that she could come by to pick up a revised treatment plan during the next day. On August 29, 2015, Ms. [redacted] came to the office accompanied by her mother to pick up her revised treatment plan and again demanded to be seen by the doctor without a scheduled appointment. The doctor again took the time away from scheduled patients to discuss these options with mother and patient.  At this time, the patient and mother told the doctor that he should be financially responsible for paying for her replacement of crowns. He told her that if she went to any other orthodontist they would most likely give her one or both of the same options for treatment.   And in the event that she received a legitimate second opinion from a licensed orthodontist that could correct the Class II malocclusion without affecting the bridge that he would refund her money. Tuesday, September 1, 2015, patient again came by the office without an appointment and demanded that we issue her a check for refund now without even providing the opinion from a licensed orthodontist.  She also asked to make an appointment to remove her braces before Friday September 4th because she was starting treatment with another orthodontist.   Ms. [redacted]’s treatment was financed through a third party, not SmileLife.  We told her that the finance company would have to work up her Bill of Service and if a refund was due, it would be through the finance company.  This usually takes about 2 weeks.  Ms. [redacted] scheduled appointment to have braces removed on Thursday, September 3rd at 3:30. At patient’s appointment on Thursday, September 3rd, we brought her into an exam room to discuss removing braces and requested refund.   Dr. [redacted] told patient that the owners of Smilelife said there would be no refund since SmileLife had provided the limited services that she initially contracted for and further that we would complete that limited treatment as originally planned.  Again, Ms. [redacted] never produced any documentation from another orthodontist stating a treatment plan that would fix her class II without sectioning her bridge.  In this meeting, Dr. [redacted] reiterated the 2 available options to complete treatment, and that the additional 15 months of treatment if she chose option 2, would be at no charge. [redacted] became instantly aggressive and began yelling at Dr. [redacted] and the assistants. She was asked to control herself and speak in a respectful manner, but refused to do so. Doctor [redacted] excused himself from the room because nothing short of a full refund would appease her. A short time later, the patient’s mother came to the office with the same boisterous attitude and demanded that we give her daughter’s money back. The patient also brought another person into the examination room and asked to speak with the doctor again. The doctor did return and they immediately began badgering him and making demands. It was at this time that we noticed the 3rd party was recording the conversations through her cell phone. Ms. [redacted] was asked several times while at this appointment if she would like us to remove the braces. She retorted, “No, I want you to give me my money back” “No, I do not want anyone in this office to touch me” and “No, I do not want to even look at that doctor.” Around 5:20p.m., Ms. [redacted] was told that we either needed to get her into a chair to remove her braces or she needed to leave because our office closing time was twenty minutes ago and at this point all conversations were purely confrontational on her part. She and mother demanded that they wanted something in writing from doctor stating that he would not refund Natalie’s money and they would not leave without it. By then the office was closed and we insisted that they leave.  They refused.  We called the police. All three parties stayed in our office until the police arrived around 7:30p.m. at which time they finally left. Since that day, we have attempted numerous times to discuss this matter with patient.  On September 17, 2015, Ms. [redacted] was sent a letter via certified mail instructing her to call us to make a future appointment for treatment or to remove the braces if she wished to discontinue or found another provider. We received no response or communication. We also have had our legal counsel attempt contact.  He called and left messages three different times beginning September 23rd.  He finally reached her on October 6, 2015.  He and she are finally in discussions to settle this matter.     She owes our practice $1,139.31 at this time.  She has been demanding a full refund of $1,584.