Windsor Dental PC

Review: I was referred to Windsor Dental Center by my regular dentist Jose P[redacted] of [redacted]. I first arrived at Windsor Dental center in person to give them my insurance information, a copy of the x-rays that Jose P[redacted] took showing the work needed done, and schedule an appointment for a [redacted]. They then called me back a week later, telling me that they accepted my insurance, and so I scheduled an appointment.

On the day of the [redacted], 3/**/15, I was seated in the office. The dentist then arrived, having no idea of what tooth needed work. I told him that I gave the office a copy of the x-rays that I had taken. A few moments pass, and he returns to tell me that they cannot find the x-rays. He then takes more x-rays, which I later discovered he charged my insurance company for, despite their own error in losing the copy that I gave them.

After the work was completed, I was then directed to billing who had me pay a $170 co-pay. I did not know at the time that my insurance requires no co-pay, so I paid this. I was later told by my regular dentist and several co-workers who have the same insurance that there should not have been a co-pay.

A few days after the work, I receive a phone call from Windsor Dental, asking me how to process my insurance information. They told me also that my regular dentist was on vacation and could not be reached. I gave them all the information that was listed on the insurance card that I previously showed them. They then told me that I was out of their network, but it was all taken care of.

A few months pass and I receive a bill from Windsor Dental for $233.25. I then went to their office to explain the situation and only received explanations of “Your regular dentist gave us the wrong information.” despite the fact that my regular dentist was on vacation and could not be reached while they were trying to process my insurance.

I then contacted my insurance, who told me that Windsor Dental was out of network, but also told me that my insurance requires prior authorization for dental surgeries and that they were not contacted by Windsor Dental prior to the work, which would also have told Windsor Dental that they are out of network prior to the work being done. They also told me that Windsor Dental charged them for the x-rays, despite the fact that they should not have needed to be taken.

I then called Windsor Dental Center yet again, and I was told that I had provided them with the wrong insurance information, despite the fact that this is the same card that I gave to my regular dentist, the pharmacy who I picked up a prescription from, and used for an eye exam and glasses, none of whom had any issues collecting payment.

I have received no help from Windsor Dental Center in resolving this issue, all they have done is made accusations towards me and my regular dentist. I can't afford to pay over $400 for something that should have been 100% covered by my insurance, plus having my insurance pay for unnecessary x-rays, all due to their mistakes. I have been stressed and anxious over this issue for months now. Plus, I even received the bill while I was on vacation from work.Desired Settlement: I just want the $233.25 bill to be cancelled, and the $170 co-pay refunded to me.

Business

Response:

Patient called in to make an appt and supplied insurance information to be [redacted] through [redacted]. We participate with that insurance and for a [redacted] there is no co-insurance due from the patient. We have other patients who are employed by [redacted] and have [redacted] insurance so we are familiar with the insurance. We scheduled him for his [redacted]. When the patient checked in, our treatment coordinator immediately asked him for his insurance card, to which he responded, "I don't have it." He was then given paperwork to fill out and he filled in [redacted] for his dental insurance, not [redacted]. At that time he was told given the change in insurance information, there is going to be an out of pocket expense. We were in possession of his X-ray but it was not clear enough for our endodontist to evaluate the tooth, so another was taken. This is common for a treating dentist to take his own X-ray so he can offer the best a nd most accurate treatment to the patient. I won't even dignify his allegation that the endodontist couldn't find the X-ray but if required we can supply a copy of the referring doctor's X-ray. Given the new [redacted] insurance information, an estimated co-insurance was collected from [redacted] in the amount of $170. This is always an estimate as we won't know 100% until the insurance processes the claim and we receive payment. We received $0 from Aetna, with an explanation that the insurance coverage had termed - 24 months ago. That is when the patient was called by our office - to find out once and for all what dental insurance he had. That's when we were informed he had insurance through the 1199 - a benefit union fund - a lesser plan with [redacted], and one we don't participate with. Had the patient given us all the correct information from the beginning, we could have given him all the correct information regarding what he would be exp ected to pay. As a gesture of good faith, we offered to charge him the insurance fees only and not our regular full office fee. In addition, it should be noted, when he filled out his paperwork, he filled out his incorrect date of birth, so it made verifying any insurance virtually impossible. We can supply a copy of [redacted]'s paperwork also. Currently [redacted] owes $233.25 plus the $170 he paid for a total of $403.25. Windsor Dental did nothing wrong and made several attempts to gather the patient's insurance information. [redacted] is his medical insurance, not his dental insurance and HR departments at places of employment ([redacted]) explain the difference to their employees. [redacted] does offer a dental insurance but [redacted] no longer has it.