ComplaintsforA Plus Cosmetic Dentistry: Pirouz Shahbazian, DDS

• Initial Complaint

  10/03/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  At time of service, A+ Cosmetic Dentistry, I was verbally told I was paying 100% up front. Therefore, I paid $290 for each of the two services totaling $580. The office manager, N****, refused to contact my insurance, Delta Dental, ahead of time and only said that I would be reimbursed by Delta Dental for any overpayment. There was no bill given to me at the time. I was also never told that they are no longer a provider under Delta Dental. Months later, November, after not being reimbursed, I contacted Delta Dental and the original office manager (N****) and my dental hygienist (Sh****) are no longer working at A+. The bill sent to Delta Dental was now $920. From their inflated bill that was submitted, my insurance paid a total of $592 of the $920 amount. A+ has been harassing me for another $592 for about a year for a total of $1,172. I have told them that I had paid the original full price of the treatments ($290 + $290) at time of two the visits, totaling $580. They are threatening to sell my outstanding balance to collections. They have also billed Delta Dental for procedures that were not done on me e.g., dental exam by a DDS. Only the dental hygienist saw me. I paid 100% of the cost of each procedure, at each time of service. I have been yelled at and embarrassed inside their office and I have been harassed on the phone and by email for monies that are not owed. I do not owe this dental office any monies. I would like for the harassment to stop and for my outstanding balance, they say I have, to be adjusted to the amount agreed to at the time of service.

  Business response

  10/11/2022

  Patient had come in on DATE and was quoted for treatment for her diagnosis. Patient had Delta Dental insurance, and the treatment included procedures that would be 100% covered by her insurance ($536.00) and procedures that may not be covered at all by the insurance ($580.00). Patient was given a clinical and financial explanation for the treatment and had signed the agreement / contract. Only $580 was collected at the time for procedures that may not be covered by insurance. For procedures that would be covered by the insurance, the claims would be later submitted to the insurance for reimbursement.

   

  The dental practice had a ownership change in April of 2021, and it went through the process of enrolling with all the existing insurance providers, which can take 2-4 months. During this transition period, however, as a courtesy, the practice accepted insurance patients and provided cost of treatment that fully matched their insurance’s in-network fees. This resulted in no change of cost of treatment for the patients.

   

  With claims submitted by out-of-network providers, Delta Dental has a policy of sending the checks directly to their patients, and the dental practice has to collect from the patients. The claims were billed to the insurance for (2 different claims of $270.00) on October 27, 2021, and check(s) were mailed to the patient since the practice was considered out-of-network at the time.

   

  First attempt was made to inform and collect from the patient via Phone call on Nov 17, 2021. There was no response from the patient.

  Second attempt was made to inform and collect from the patient via Collection Letter on December 9, 2021, Patient call the office on December 20, 2021 regarding the bill. I explained to her that we were out of network with Delta Dental at the time of her service, but what the last employee (N****) collect from her $580 was for Irrigation and laser which they are not a covered benefit with her Insurance, She stated, she wanted us to sent out the claim for Irrigation and Laser so she can see the insurance wouldn’t cove them. My Biller sent out two claim for amount $290 for the right side and $290 for the left side. Code use for Irrigation D4921. After she said once she receives the claims she will give me a call back and take care of her bill. She never called our office again regarding the claims.

  Third attempt was made to inform and collect from the patient via Phone Call on January 19, 2022 there was no response from the patient

  Fourth attempt was made to inform and collect from the patient via Phone call on February 21, 2022 there was no response from the patient

  …

  Fifth attempt was made to inform and collect from the patient via Collection Letter on March16, 2022. The patient called back and she was provided with an explanation of the whole situation. Patient wanted the practice to try submitting a claim for $590 for procedures that would not be covered by the insurance. As expected, nothing was going to be reimbursed by the insurance, and patient was notified via Phone call on December 20, 2021.

  Sixth attempt was made to inform and collect from the patient via Phone Call on September 16, 2022. The practice received a letter from BBB regarding the patient’s complaint.

   

  Office manager, N****, has not been with the practice since July of 2021, and we cannot attest to the details of the verbal interaction the patient claims to have had. We have the financial agreement / contract at the patient’s disposal to further clarify and discuss if necessary. It is unfortunate that the patient had not been able to reach an agreement with us. The patient still has the opportunity to resolve this issue and come to an agreement with us if she is willing to accept communication with us.

   

  We hope this helps you reach an agreement on this issue,

  Please contact us if you need any additional information

   

  Thank you

  Customer response

  10/17/2022

  
  
  I am rejecting this response because:  Person writing this response was not at the dental office at time of procedure (May) and states that she does not know what N**** said.  There was no original bill made at the time of the procedures.  It was verbally told to me that I had to pay 100% of the bill upfront and would be reimbursed by Delta Dental, my insurance.  I was not advised that my dental insurance was no longer being accepted and I still, to this date, have not received that information.  I found out through speaking with a Delta Dental representative.  I contacted the dental office to create a bill, several months later, after not having one submitted to Delta Dental, because I wanted to be reimbursed.  Delta Dental reached out to have them send the bill.  The new bill, had inflated pricing, much more than agreed to verbally, at time of service.  Neither N****, the office staff, nor Sh****, the dental hygienist work for the dental office at the time the bill was created in November.  They have even double billed the insurance for items.  Delta Dental, says the price I would need to pay, out of pocket, for the increased billing from $ 580 to $920 would be only $328.00.  Yet, they have created another amount of $592.00. They keep increasing the amount I owe them, when the reality is, I do not owe them anything.  I need assistance with this, because they are fraudulently billing me and harassing me for an amount of money, that doesn't even make sense if you look at the bill that was created almost 6 months after service by a person who wasn't there to confirm that the bill was paid in full at time of service.  Delta Dental paid a portion of the amount, and I was to be reimbursed this portion by Delta Dental.
  
  Regards,
  
  D***** *****
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  

  Business response

  11/02/2022

  To start off, we are sorry to hear that the client is still unsatisfied with our explanation. The response and information we have provided in our previous letter are documented, objective
  information.
  

  We are sending copies of the financial agreement (FA) that was generated at the time between our patient and our staff at the time, via email and mail to the patient’s home address, which will have a written agreement on the total cost of treatment and the amount that was collected.
  

  - For procedures we did not have to collect for, FA will state “pt Insu covers 100% SRP.” We never had to and never did collect for that specific procedure.
  

  - For procedures we did have to collect for, FA will state ‘Total patient’s estimated portion,’ which collected in two visits $290 each: 05/03/21 and 05/12/21.
  

  - Of the total cost of treatment of $560 for the patient’s left side of the mouth, $290 was collected on May 12, 2021
  

  - Of the total cost of treatment of $560 for the patient’s right side of the mouth, $290 was collected on May 3, 2021
  

  When the checks were received from Delta Dental, the patient should have received an EOB (explanation of benefits) along with the checks, which would clearly state what the checks are paying for. Please share the EOB and I believe it will be the surest way to check facts and resolve the confusion / miscommunication / misunderstanding that occurred.
  

  - Again, when a provider is out-of-network, Delta Dental sends the provider’s checks to the patient/subscriber. The checks are meant to be collected from the patient.
  

  - Our office made sure that our patient never received any financial disadvantages or inconveniences while we were temporarily out-of-network, due to the ownership change and getting re-credentialed / re-certified to     be a provider for Delta Dental. We apologize if it caused the patient confusion. I think it would be in the best of both our interests to talk directly with the patient and negotiate so we can come to an agreeable             conclusion.
  

  I am the main dentist of the practice who have been reaching out and communicating. Also, as it was shown in our last letter, my staff had already attempted to call multiple times in an effort to help us connect but it never happened. Please give us a call at (805) 527 5772 at your earliest convenience.
  

  Thank you

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