Turlock Cosmetic Dentistry

On 1/28/our office received a call from *** *** requesting an appointment with our officeOn this date she spoke to myself and stated that she thinks she has cavities and would want to be sedated for her treatment. Ms *** provided her insurance information and a breakdown was
received. Based on the reason that Ms *** stated when she made her appointment, there would be no way to do a consultation. She is correct that a consultation is a meet and greet the dentist and that xrays and exams are required for any dentist to make a diagnosis on a patient. Ms *** states that she provided her insurance card to the office on her appointment date and that our office then went and got her breakdown of benefits which is completely false. Our office obtained her verbal breakdown form her insurance company on 2/19/when we spoke *** with ***. Ms *** was informed that her exam and xrays were estimated to be paid at 90%. Upon arrival at the office Ms *** was provided her required paperwork which included a payment policy that states on different sections that insurances are an estimate and not guarntees. It also states that if your insurance pays less than the estimate you will be supplementally billed. Ms *** had her xrays and exam done and was presented with the diagnosis of her needed treatment and cost. As for Ms ***'s statement that she has been trying to work out her bill with the office, this is false. We have sent Ms *** statements since 4/2/with no response. It was not until the patient was sent a collection warning letter that she contacted the office regarding her balance days later. She was informed that if she had questions regarding what her insurance paid that she would need to address those with her employer and/or insurance company as they are the ones who control her policyShe did state that if she knew she would owe a balance she would have went to a provider who her insurance would have paid more towardShe was advised that if she wanted to see an in network provider she would need to get that information from her employer and/or insurance as well and that the employees are usually provided a booklet from employer/insurance as to who is in their network. If Ms *** is aware of billing due to her employment she would also be aware of the fact that all fees are estimates and that the insurance company will process claims according to the way it has been set up with the employer. No co pays are legally allowed to be written off unless the office updates the insurance companies that they are doing so at which time the insurance company will reprocess the patient's claim and in most cases still have the patient's pay more. This is the policy that they set up with the employers when they do the insurance plans for the employers. Our office handled each step of the appointment with Ms *** appropriately and the balance is an issue between her insurance and employer and is not a write off by the providers.?

I am rejecting this response because: The fact both my fiance and I were verbally advised multiple times that I would not owe anything over the $which was my copay and paid the day of my visit and after specifically asking if that was all I would owe, is what I do not agree withWhy was I advised I would only owe a certain amount and not advised that I could possibly owe more depending on how my insurance processes my claim? Only now after the fact this was brought to my attention? I also contacted my insurance (***) and was advised because this office is out-of-network they usually do not provide quotes to out-of-network providers therefore my dispute would be with the office as they are the ones who provided me the quoteSo if the office really did contact *** the day of my visit as stated why was I not advised of the same information as *** advised me? And according to my insurance the remaining balance I owe was not applied to a copay, deductible, or coinsurance, it was over their allowed amount and applied as the amount not covered.Further more this office is not aware of my job function with my employer so for them to assume for me to already know this is wrong, but sense they are bringing up my employment I also know that when our EMT's/Paramedics provide our patients with a price quote at the time of service we only charge what the patient was quoted, even if the price exceeds the quoted amount, our biller's submit the claim to the insurance and if they do not pay in full any amount over the quoted amount is written off and patent's are only responsible for the remaining balance up to the quoted amount

Review: In Jan.-Feb. 2015 I contacted this office after hearing their advertisement on the radio for a free consultation & free sedation. The first time I called to schedule an appointment for a consolation the person I spoke to conformed my consultation appointment was scheduled, however a few days later I had to call back to reschedule for 2/23/15. That time I spoke to someone different & assumed she was able to see my original appointment was for a consolation, that time I was asked what my main concern was, & again thinking this appointment was still a consolation I said I believe I have a few cavities. Upon my visit I was called back into the ex-ray room accompanied by my fiance, where I filled out paper work & was about to receive services. Before I started receiving services I asked if this was a part of the consultation, at that point the person I spoke with the second time came in the room & very assertivly said I didn't say I wanted a consultation that I thought I had cavities & I wasn't going to find this out from a consolation, I apologised for the mix up & told her I thought she know from my original call, again I was told very firmly that a consult. was only a meet & greet with the Dr. After that I specifically asked how much will I end up owing if I do go through with this? My ins card was tasked & she came back saying $26. I specifically said if that is all I'll owe than ok. My fiance also told the person performing the service that we need to make sure because if it was any more then we could not afford it. Now 5 months later I'm getting a bill for $93.99?? I tried resolving this issue on my own with them but the same person that said all I'd owe is $26 is now saying they can't control how the ins. decides to pay & also accused me saying I should already know this because of the company I work for handles medical billing which is true however, I also know if we give our patients a price quote at the time of service we honor that quote, if it goes over the quote we writeoff the excess.Desired Settlement: Because I feel I was assertivly talked into receiving service I did not originally ask for, the fact I specifically asked if $26 was all I would end up owing (& already paid), & the fact that I was never told I could end up owing more (regardless of my job function-has nothing to do with this) I feel their statement of only owing $26 needs to be honored.

Business

Response:

On 1/28/15 our office received a call from [redacted] requesting an appointment with our office. On this date she spoke to myself and stated that she thinks she has cavities and would want to be sedated for her treatment. Ms [redacted] provided her insurance information and a breakdown was received. Based on the reason that Ms [redacted] stated when she made her appointment, there would be no way to do a consultation. She is correct that a consultation is a meet and greet the dentist and that xrays and exams are required for any dentist to make a diagnosis on a patient. Ms [redacted] states that she provided her insurance card to the office on her appointment date and that our office then went and got her breakdown of benefits which is completely false. Our office obtained her verbal breakdown form her insurance company on 2/19/15 when we spoke [redacted] with [redacted]. Ms [redacted] was informed that her exam and xrays were estimated to be paid at 90%. Upon arrival at the office Ms [redacted] was provided her required paperwork which included a payment policy that states on 2 different sections that insurances are an estimate and not guarntees. It also states that if your insurance pays less than the estimate you will be supplementally billed. Ms [redacted] had her xrays and exam done and was presented with the diagnosis of her needed treatment and cost. As for Ms [redacted]'s statement that she has been trying to work out her bill with the office, this is false. We have sent Ms [redacted] statements since 4/2/15 with no response. It was not until the patient was sent a collection warning letter that she contacted the office regarding her balance 3 days later. She was informed that if she had questions regarding what her insurance paid that she would need to address those with her employer and/or insurance company as they are the ones who control her policy. She did state that if she knew she would owe a balance she would have went to a provider who her insurance would have paid more toward. She was advised that if she wanted to see an in network provider she would need to get that information from her employer and/or insurance as well and that the employees are usually provided a booklet from employer/insurance as to who is in their network. If Ms [redacted] is aware of billing due to her employment she would also be aware of the fact that all fees are estimates and that the insurance company will process claims according to the way it has been set up with the employer. No co pays are legally allowed to be written off unless the office updates the insurance companies that they are doing so at which time the insurance company will reprocess the patient's claim and in most cases still have the patient's pay more. This is the policy that they set up with the employers when they do the insurance plans for the employers. Our office handled each step of the appointment with Ms [redacted] appropriately and the balance is an issue between her insurance and employer and is not a write off by the providers.?

Consumer

Response:

I am rejecting this response because: The fact both my fiance and I were verbally advised multiple times that I would not owe anything over the $22.00 which was my copay and paid the day of my visit and after specifically asking if that was all I would owe, is what I do not agree with. Why was I advised I would only owe a certain amount and not advised that I could possibly owe more depending on how my insurance processes my claim? Only now after the fact this was brought to my attention? I also contacted my insurance ([redacted]) and was advised because this office is out-of-network they usually do not provide quotes to out-of-network providers therefore my dispute would be with the office as they are the ones who provided me the quote. So if the office really did contact [redacted] the day of my visit as stated why was I not advised of the same information as [redacted] advised me? And according to my insurance the remaining balance I owe was not applied to a copay, deductible, or coinsurance, it was over their allowed amount and applied as the amount not covered.Further more this office is not aware of my job function with my employer so for them to assume for me to already know this is wrong, but sense they are bringing up my employment I also know that when our EMT's/Paramedics provide our patients with a price quote at the time of service we only charge what the patient was quoted, even if the price exceeds the quoted amount, our biller's submit the claim to the insurance and if they do not pay in full any amount over the quoted amount is written off and patent's are only responsible for the remaining balance up to the quoted amount.