Complaints

• Initial Complaint

  08/21/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I had dental work done on December 16th 2022 by Sterling Smiles Dental. Before having the procedure, I was told by Sterling Smiles Dental that my insurance would cover the cost. However, upon discovering on August 21 2023, I only have pediatric dental within my insurance plan. Hence, Sterling Smiles Dental has a balance due for $415.00 for the care with no insurance coverage. I only agreed to have the dental work done due to being told by Sterling Smiles Dental that insurance would cover the cost. I am willing to pay the bill but only if its been adjusted to match the insurance cost. It is misleading to tell customers that they are covered when they actually are not and bill them the full amount.

  Business response

  08/28/2023

  When the patient arrived at our office on 12/16/2022 he gave us his insurance card. As a courtesy I checked his insurance which stated that he had an active policy through Anthem, with no evidence that his plan was a pediatric plan. Before any work was done the patient was presented with a treatment plan with an estimate of what insurance would cover. The estimate states that his insurance would cover $415.00. The patient signed the treatment plan/ Estimate. When submitting his claim to insurance it had gone months without being paid. I made several phone calls to insurance to see why they have not paid the claim. Insurance stated that they denied the claim because the member had a pediatric plan. At that point I sent Mr.Robinett a bill explaining that insurance would not cover the treatment because he had a pediatric plan through his insurance. 

  Business response

  08/28/2023

  Attached are the supporting documents, showing that when checking insurance as a courtesy to the patient, it does not show anywhere that this is a pediatric plan, only that he has active insurance policy. Also shows the treatment plan/estimate that was signed and shows that the patient is responsible for anything that insurance does not cover. And lastly the notes in his chart that state insurance denied the claim because it was a pediatric plan.

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