St. Mary's Dental

As stated before, we had notification stating we will go out
of network with [redacted] as of October 31, 2013. The notification went up in our
office in July of 2013, which was 4 months prior to going out of network. These
signs stayed up through January 2014; they were in our waiting room as well as
on the front desk where patients check out. 
We also have a signed document by the patient that states “your bill is
ultimately your responsibility”, which was attached to our prior response.  We make every effort to let patients know of
changes; however, ultimately it is the patient’s responsibility. Out of all of
our patients that come to us with [redacted] this is the only patient who has reported
not knowing.  We have many patients with
[redacted] that continue to come to our office even though we are out-of-network.
We called [redacted] and they stated that it is the patient’s responsibility to
check with [redacted] prior to each dental visit for coverage. Most dental offices
are fee for service which is different compared to medical offices which are
insurance based. Regardless of any of factors it is ultimately the patient’s responsibility which the patient consented to
by his signature of our financial policy page.

June 23, 2014
Dear **. [redacted],Thank you so much for alerting us of the complaint submitted to you by [redacted] on 6/9/14.I have been in practice for 27 years and this is the first complaint I have ever received. In the 27 years of business, we never participated...

with [redacted] Insurance (**. [redacted]'s PPO plan) except for the period from 05/24/2012 until 10/30/2013 (when we pulled out of the plan because it became to labor intensive for my staff to service). On or about June 2013 we posted a large sign in our reception area notifying all patients with [redacted] insurance that we would not be participating with [redacted] insurance effective 10/30/2013. Every single patient was notified verbally upon check out that in 4 months we would go back to being a non-participating [redacted] provider (as we did since 1994). **. [redacted] was in our office on 09/09/2013 and was notified at the completion of his visit that, effective October 2013, we would no longer be a [redacted] participating provider. The large sign in the reception room stayed posted until January 2014, It stayed posted for patients to see for over 7 months.In addition, we have almost 6,000 patients and it is the responsibility of the patients to know their insurance plan. Please find enclosed copies of **. [redacted]'s signed document where he acknowledges that his bill and his insurance coverage is HIS responsibility. At the patient's first visit with us, this is clearly explained verbally and in writing. Patients are also provided with a brochure called "Why doesn't my insurance pay for this" Please review. Please also find enclosed a copy of **. [redacted]'s Explanation of Benefits which details his insurance coverage for date of service 04/07/2014. At that visit he purchased an electric toothbrush in our office and his insurance/deductible was applied. We made every effort to notify the few [redacted] patients that we have via email as well. For whatever reason **. [redacted] was the ONLY [redacted] patient that did not get the message while the other 199 patients we have acknowledged that they knew we are a non-participating provider.Please find enclosed a copy of the letter we sent to [redacted] notifying them on July 30,2013 that we would return to a non-participating provider status effective in 90 days. In addition, we provide excellent over the top service to each of our valued patients without regard to their insurance coverage. We spent a great deal of quality time with **. [redacted] providing that excellent care. I encourage **. [redacted] to become acquainted with his insurance coverage since he is accustomed to receiving his medical/dental care in a military setting.If you would like to discuss this matter in greater detail, I would be happy to talk with you. My personal cell phone number is ###-###-####. It is unfortunate that **. [redacted] decided to go the route of the Revdex.com, but I am certain that you realize we did our due diligence of notifying him that we were a non-participating [redacted] provider. Perhaps he should consider that his insurance carrier did not properly notify him that St. Mary's Dental is a non-participating office and seek reimbursement from [redacted]?

Review: I feel that St. Mary's Dental did not properly inform me that my insurance was no longer covered by their office. They didn't inform me until after my cleaning when I was checking out, leaving me with a $168.80 bill on a visit to their office in April of 2014. They claim that they put a sign up somewhere in their facility, however failed to send any kind of notification via email, postal service, phone call, etc. The front desk informed me today that they pulled their sign down in January of 2014 and that I should have seen the sign in my previous visit in September of 2013, yet they made no mention of it to me on that November visit. They claimed that many of their patients choose not to use their primary care dentist and that they don't feel responsible for verifying each patients coverage prior to any procedure because it takes too much time. They assumed that I was like those patients instead of asking me. They also claimed that they frequently change insurance companies/coverages like this and that it's my responsibility to call their office before every visit to make sure my insurance is still covered. I feel like I've been wronged in this and left with a bill, while not a ridiculously high amount, is still an amount that I should not have had to pay. I pay for my dental insurance because it affords me two free cleanings a year and this office was one of the offices that accepted my insurance so I could get my teeth cleaned and checked regularly without receiving a bill. I can't for the life of me understand why they would think that I would pay for insurance just to come in to their office and still have a bill at the end of it. Their logic baffles me. To recap, had they provided proper notification to me that my insurance was no longer going to be accepted prior to the cleaning, I would not have accepted their services. I would have found a new dental office that did accept my insurance.Desired Settlement: I would like a refund of $168.80 for the services performed in April of 2014. They only reason I paid this bill is because I did not want it to go to collections and ruin my credit.

Business

Response:

June 23, 2014Dear **. [redacted],Thank you so much for alerting us of the complaint submitted to you by [redacted] on 6/9/14.I have been in practice for 27 years and this is the first complaint I have ever received. In the 27 years of business, we never participated with [redacted] Insurance (**. [redacted]'s PPO plan) except for the period from 05/24/2012 until 10/30/2013 (when we pulled out of the plan because it became to labor intensive for my staff to service). On or about June 2013 we posted a large sign in our reception area notifying all patients with [redacted] insurance that we would not be participating with [redacted] insurance effective 10/30/2013. Every single patient was notified verbally upon check out that in 4 months we would go back to being a non-participating [redacted] provider (as we did since 1994). **. [redacted] was in our office on 09/09/2013 and was notified at the completion of his visit that, effective October 2013, we would no longer be a [redacted] participating provider. The large sign in the reception room stayed posted until January 2014, It stayed posted for patients to see for over 7 months.In addition, we have almost 6,000 patients and it is the responsibility of the patients to know their insurance plan. Please find enclosed copies of **. [redacted]'s signed document where he acknowledges that his bill and his insurance coverage is HIS responsibility. At the patient's first visit with us, this is clearly explained verbally and in writing. Patients are also provided with a brochure called "Why doesn't my insurance pay for this" Please review. Please also find enclosed a copy of **. [redacted]'s Explanation of Benefits which details his insurance coverage for date of service 04/07/2014. At that visit he purchased an electric toothbrush in our office and his insurance/deductible was applied. We made every effort to notify the few [redacted] patients that we have via email as well. For whatever reason **. [redacted] was the ONLY [redacted] patient that did not get the message while the other 199 patients we have acknowledged that they knew we are a non-participating provider.Please find enclosed a copy of the letter we sent to [redacted] notifying them on July 30,2013 that we would return to a non-participating provider status effective in 90 days. In addition, we provide excellent over the top service to each of our valued patients without regard to their insurance coverage. We spent a great deal of quality time with **. [redacted] providing that excellent care. I encourage **. [redacted] to become acquainted with his insurance coverage since he is accustomed to receiving his medical/dental care in a military setting.If you would like to discuss this matter in greater detail, I would be happy to talk with you. My personal cell phone number is ###-###-####. It is unfortunate that **. [redacted] decided to go the route of the Revdex.com, but I am certain that you realize we did our due diligence of notifying him that we were a non-participating [redacted] provider. Perhaps he should consider that his insurance carrier did not properly notify him that St. Mary's Dental is a non-participating office and seek reimbursement from [redacted]?

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this because: Of all the different doctors and dentist offices I've been to, this is the first and only office that has not reviewed my insurance and notified me prior to going back to have any procedure or check up that something has changed. And this isn't just some minor change. This is a very big change. And it wasn't me who made a change nor was it my insurance company that changed. St. Mary's dental made a change. Therefore I feel it is their obligation to notify individuals that were affected by the change. They claim they informed me on my previous visit to their office that they were dropping [redacted] but that seems like something I would remember. Or even still, they already had a letter that they supposedly made available in their wait room that they could have simply printed out and sent home with all [redacted] patients on their most recent visit that they were still covered for. Like I said in my original complaint, I don't pay for my dental insurance so I can go to a dental office where my insurance is not accepted and have to pay the full amount. That would be absurd. I do however feel that it is more likely that a dental office, knowing that they will be losing one of their patients, would not notify one or some of their patients knowing that they will come to the office for a routine checkup and still make money off of them one last time before sending them on their way. The other possible explanation is that they just forgot to notify me. A simple mistake yes, but given that they had so many patients to notify, maybe one or some slipped through the cracks and we're failed to be notified. Even if none of that is the case, I sat in their waiting room for approximately 10-15 minutes waiting for my turn to go back. How long does it realistically take to hop into the computer system to verify if or what insurance company the patient is covered by? The last I checked, most if not all doctors offices do this already. Why would a dentists office be any different.

Regards,

Business

Response:

As stated before, we had notification stating we will go out

of network with [redacted] as of October 31, 2013. The notification went up in our

office in July of 2013, which was 4 months prior to going out of network. These

signs stayed up through January 2014; they were in our waiting room as well as

on the front desk where patients check out.

We also have a signed document by the patient that states “your bill is

ultimately your responsibility”, which was attached to our prior response. We make every effort to let patients know of

changes; however, ultimately it is the patient’s responsibility. Out of all of

our patients that come to us with [redacted] this is the only patient who has reported

not knowing. We have many patients with

[redacted] that continue to come to our office even though we are out-of-network.

We called [redacted] and they stated that it is the patient’s responsibility to

check with [redacted] prior to each dental visit for coverage. Most dental offices

are fee for service which is different compared to medical offices which are

insurance based. Regardless of any of factors it is ultimately the patient’s responsibility which the patient consented to

by his signature of our financial policy page.