Smiles 4 Kids is sad to hear about [redacted]’s unfortunate experience. We strive to make every appointment a great experience. When we give estimates for our services we try to be as accurate as possible. We are sorry for any inconvenience this has caused, however we do want to emphasize that when a...
patient needs dental treatment we only give an ESTIMATE on what the patients portion will be. Our paperwork clearly states that “your insurance policy is an agreement you have with your insurance carrier. If you have questions regarding payments from your insurance company, we recommend that you call your insurance provider directly for the most accurate and speedy answer.” See attached paperwork signed and agreed to. As [redacted] said multiple times in his complaint that our estimate provided "was grossly erroneous" we do want to clarify that the definition of the word estimate is: an approximate calculation or judgment of the value, number, quantity, or extent of something. We can't give a 100% accurate amount owed at the time of service, we are not the insurance company, and we can't guarantee their payment. [redacted] stated that he feels “Smiles 4 Kids should write off these uncovered charges” that his insurance policy didn’t cover “due to Smiles 4 Kids negligence in obtaining and providing an accurate estimate.” We don’t see how we can provide a 100% accurate estimate, because an estimate is just that, an estimate and never will be 100% accurate. It is the policy holder’s responsibility, not ours, to know what their insurance policy covers. We honestly give anywhere from 5-10 estimates a day and we have never had an issue until now. When [redacted] states that Alexis told them at the time of service that they paid in full for their dental treatment, it is simply untrue. We always inform our patients when they pay at the time of service that it is only an estimate and as a courtesy we will bill out their insurance company for them. Once we hear back from the insurance company we will let the patient know if there is a balance owed. We also state that if the patient does over pay at the time of service all overpayments will be reimbursed back to the patient. We do apologize if that was misunderstood at the time of payment. Moving forward, [redacted] states in his complaint that “when insurance originally denied the space maintainer and root canals/pulpotomy Alexis again informed me it was included in the benefits.” Again this is simply untrue. Once the insurance company came back with payment and the explanation of the payment, we informed [redacted] at that time that his insurance policy doesn’t cover the procedures: space maintainer and root canals/pulpotomy. We would have never told [redacted] that his insurance is wrong and that these procedures are covered. They clearly are not; the insurance company told us that they were not a covered benefit. We actually sent [redacted] a copy of the explanation of the benefits that we received from his insurance company, even though the insurance company sends a copy to the patient as well, so he could see what his insurance company paid for. When [redacted] was asking us why his insurance policy didn’t cover those 2 procedures Alexis did respond in the manor of: “I have only known root canals/pulpotomys to be covered all the same, I have not seen on any dental plan where it covers a root canal but not a pulpotomy. This plan you have [redacted] on seems to be very adult oriented and there are several dental plans out there which are much more geared for children's care.” By her stating that, she never indicated that his insurance company should have paid on these procedures. All that it indicated was that in her personal experience in the dental field (which has been 15+ years); she has never seen a policy where it covers a root canal but not a pulpotomy. Every conversation with [redacted] has been very frustrating and we are not sure why there’s always a miscommunication and misunderstanding. We have tried to be very clear with him and it seems that he misunderstands what we communicate to him. What it boils down to is [redacted] is upset with us because his insurance policy didn’t cover as much as we estimated. When [redacted] discovered that he still owed Smiles 4 Kids a balance for the treatment his child received, he wanted to make up his own payment plan. He originally informed us that due to the holidays he didn’t have the money, but as soon as he caught up he would pay the money. He then came back and informed Smiles 4 Kids that he would pay us $10.00 every month until the amount was paid in full and he didn’t want any interest charged to him because our “estimate was grossly erroneous.” We informed [redacted] that he would need to pay more than $10 a month, because we couldn’t carry his account balance for 3.75 years until he got it paid off in full. We were willing to work with him and allow a 6 month payment plan, despite only typically allowing 3 months. That was still unsatisfactory to [redacted]. He is now upset because he is being charged interest fees. As you can see we have attached our paperwork that his wife signed and agreed to, “it is the parent’s/guardian’s responsibility to pay for any deductible or other balance not covered by the insurance. Regardless of insurance, I agree the balance will be paid in full within 60 days of treatment, unless previous arrangements have been made. Should my account exceed 90 days, one percent (1%) interest per month, twelve percent (12%) per year will be charged.” [redacted] is stating that he feels it is unfair that he is being charged an interest fee, when we have been upfront at the time of service that there will be interest fees charged out. We feel like we have been honest and we have been willing to work with [redacted]. All we have asked is that he be cooperative and reasonable regarding the financial arrangements we can provide.
Smiles 4 Kids is sad to hear about [redacted]’s unfortunate experience. We strive to make every appointment a great experience. When we give estimates for our services we try to be as accurate as possible. We are sorry for any inconvenience this has caused, however we do want to emphasize that when a...
patient needs dental treatment we only give an ESTIMATE on what the patients portion will be. Our paperwork clearly states that “your insurance policy is an agreement you have with your insurance carrier. If you have questions regarding payments from your insurance company, we recommend that you call your insurance provider directly for the most accurate and speedy answer.” See attached paperwork signed and agreed to. As [redacted] said multiple times in his complaint that our estimate provided "was grossly erroneous" we do want to clarify that the definition of the word estimate is: an approximate calculation or judgment of the value, number, quantity, or extent of something. We can't give a 100% accurate amount owed at the time of service, we are not the insurance company, and we can't guarantee their payment. [redacted] stated that he feels “Smiles 4 Kids should write off these uncovered charges” that his insurance policy didn’t cover “due to Smiles 4 Kids negligence in obtaining and providing an accurate estimate.” We don’t see how we can provide a 100% accurate estimate, because an estimate is just that, an estimate and never will be 100% accurate. It is the policy holder’s responsibility, not ours, to know what their insurance policy covers. We honestly give anywhere from 5-10 estimates a day and we have never had an issue until now. When [redacted] states that Alexis told them at the time of service that they paid in full for their dental treatment, it is simply untrue. We always inform our patients when they pay at the time of service that it is only an estimate and as a courtesy we will bill out their insurance company for them. Once we hear back from the insurance company we will let the patient know if there is a balance owed. We also state that if the patient does over pay at the time of service all overpayments will be reimbursed back to the patient. We do apologize if that was misunderstood at the time of payment. Moving forward, [redacted] states in his complaint that “when insurance originally denied the space maintainer and root canals/pulpotomy Alexis again informed me it was included in the benefits.” Again this is simply untrue. Once the insurance company came back with payment and the explanation of the payment, we informed [redacted] at that time that his insurance policy doesn’t cover the procedures: space maintainer and root canals/pulpotomy. We would have never told [redacted] that his insurance is wrong and that these procedures are covered. They clearly are not; the insurance company told us that they were not a covered benefit. We actually sent [redacted] a copy of the explanation of the benefits that we received from his insurance company, even though the insurance company sends a copy to the patient as well, so he could see what his insurance company paid for. When [redacted] was asking us why his insurance policy didn’t cover those 2 procedures Alexis did respond in the manor of: “I have only known root canals/pulpotomys to be covered all the same, I have not seen on any dental plan where it covers a root canal but not a pulpotomy. This plan you have [redacted] on seems to be very adult oriented and there are several dental plans out there which are much more geared for children's care.” By her stating that, she never indicated that his insurance company should have paid on these procedures. All that it indicated was that in her personal experience in the dental field (which has been 15+ years); she has never seen a policy where it covers a root canal but not a pulpotomy. Every conversation with [redacted] has been very frustrating and we are not sure why there’s always a miscommunication and misunderstanding. We have tried to be very clear with him and it seems that he misunderstands what we communicate to him. What it boils down to is [redacted] is upset with us because his insurance policy didn’t cover as much as we estimated. When [redacted] discovered that he still owed Smiles 4 Kids a balance for the treatment his child received, he wanted to make up his own payment plan. He originally informed us that due to the holidays he didn’t have the money, but as soon as he caught up he would pay the money. He then came back and informed Smiles 4 Kids that he would pay us $10.00 every month until the amount was paid in full and he didn’t want any interest charged to him because our “estimate was grossly erroneous.” We informed [redacted] that he would need to pay more than $10 a month, because we couldn’t carry his account balance for 3.75 years until he got it paid off in full. We were willing to work with him and allow a 6 month payment plan, despite only typically allowing 3 months. That was still unsatisfactory to [redacted]. He is now upset because he is being charged interest fees. As you can see we have attached our paperwork that his wife signed and agreed to, “it is the parent’s/guardian’s responsibility to pay for any deductible or other balance not covered by the insurance. Regardless of insurance, I agree the balance will be paid in full within 60 days of treatment, unless previous arrangements have been made. Should my account exceed 90 days, one percent (1%) interest per month, twelve percent (12%) per year will be charged.” [redacted] is stating that he feels it is unfair that he is being charged an interest fee, when we have been upfront at the time of service that there will be interest fees charged out. We feel like we have been honest and we have been willing to work with [redacted]. All we have asked is that he be cooperative and reasonable regarding the financial arrangements we can provide.