ComplaintsforPrestige Dental Kissimmee

• Initial Complaint

  07/24/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  On 07/18/2024, I received a phone call from the billing department at PRESTIGE DENTAL KISSIMMEE PA requesting that a balance of $543.90 payment be made and was due on 07/22/2024. After a lengthy discussion with the billing department, I asked why there was a balance due assuming that my wife's dental plan (****, FEP) covered for the treatment that was provided.Let me explain my background history about PRESTIGE DENTAL. I was a patient of the previous Dentist, **************** for 8+ years and he was an In-Network provider under the **** Dental Plan for all those years. Upon ******************* passing, Prestige Dental was acquired by DR **** and new staffing personnel were hired. I called the **** Dental claims department and inquired about the EOB's which I was able to download. It was during my conversation with **** that they informed me that the current owners of the dental office (***********) opted to change from an In-Network to an Out-of-Network provider status.When I continued going to Prestige Dental, the office staff did not even inform either my wife or me of them being either an In-Network or an Out-of-Network provider which makes a big difference for dental coverages. I felt mislead during the whole process and the Treatment Plan breakdown estimate did not even mention that it was either an In-Network or an Out-of-Network. No time during my dealings with the current office staff was the subject of an In or Out of-Network status was brought up. And here we are in July 2024 and PRESTIGE DENTAL wants to collect for services rendered, which in my opinion, some were not really required or necessary (X-rays).

  Business response

  08/05/2024

  To whom it may concern:
  

  We received a letter in the mail about the complaint against our business filed on 07/24/2024, complaint ID: ********. In response to the complaint, there are many protocols we follow at this office to prevent these situations from occurring. At our office we provide our patients with forms to fill out, that explains to them that everything we have regarding their insurance is an estimate and that the final balance is after the claims have been processed. It also explains that whatever difference is leftover it is solely their responsibility to take care of. We are a new practice that took over a previous dentists office only recently in November of last year. We had explained to patients our issues with credentialing insurances at the time as we were out of network with most major insurances and were in the process. The patients are also given another form that they as well sign off on showing them the fees for everything and the estimate the insurance has given us of what they would cover. At this office the previous dentist didn't have the full medical or updated x-rays for patients so everyone who has come in, per our doctors request, we've had to treat as a new patient to get a full comprehensive exam. All of this is a standard procedure with our staff as transitioning is kind of a tough process, especially when the previous staff were not making the right decisions for our patients' health. What procedure is necessary or not is determined by the doctor. The complaint letter indicates that the complainant does not believe that some X-rays were necessary. Unfortunately, the complainant is not a licensed dentist, and is not qualified to determine what is the standard of care for anyone. Without full mouth radiographs being updated per American Dental Association guidelines, proper exams cannot be done. In order for the patient to have proper examination, clinical decisions based on standard of care in ***************** were made. Not only did we explain to the patient how in and out of network status impacts the visit, but it is important to consider that it is the patients' responsibility to understand the terms of their insurance company and its plans. We can only guide the patients with the general protocol and expectations from the information that we gather from their insurance company. It is the patients themselves that have signed contractual relationships with the insurance company, and have fine details of terms of agreement pertaining to the usage of their purchased insurance plans. It is usual and customary for patients to be informed that all expected fees when involving insurance companies are only estimates. Legally, providers must follow the explanation of benefits, and waiving copayment is actually an illegal act according to the federal insurance rules and regulations. We understand that dentistry is expensive and insurance companies barely help with the cost of dental treatment. However, it is patients' responsibility to understand their own contract with insurance companies and the given policies. We expect the complaint to be resolved as the complaint was generated due to the lack of the complainant's understanding of his and her own insurance policies. Should you have any questions, please do not hesitate to contact us again. Thank you very much.

  
  

  Customer response

  08/12/2024

   
  Complaint: 22035123
  
  I am rejecting this response because:

  We, as patients, were not informed of in/out of network status as explained in reply from Prestige Dental. If we would have known that Prestige Dental had changed their status to Out of Network, we would have gone to a dental office that was In-Network to save on expenses for dental services.

  Secondly, it is not our fault that the dental history of the patient(s) was not readily available from previous staff and to consider me as a new patient after being a patient for 8 plus years, I found strange.

  The amounts payed by the ************** and my wife's credit card, I consider sufficient for services rendered.
  
  Sincerely,
  
  **** And *********************************

  Business response

  08/21/2024

  To whom it may concern:
  We received a letter in the mail about the rejection of our response against our business filed on 08/12/2024, complaint ID: ********. In response to the rejection, as I had previously stated there are many protocols we follow at this office to prevent these situations from occurring. At our office we provide our patients with forms to fill out, that explains to them that everything we have regarding their insurance is an estimate and that the final balance is after the claims have been processed. It also explains that whatever difference is leftover it is solely their responsibility to take care of. These papers are given to each patient and signed by the patient as approval to continue forward with the services that we are about to perform. 
  Although the practice location address is unchanged, the business is a totally different entity with a new EIN number. The transition happened only in November of last year, and as patients were very alarmed to abruptly have to meet the new doctor, it was actually an unavoidable communication that we had to establish in order to have patients move forward to establish patient-doctor relationship with the new doctor. We had explained to patients that insurance credentialing takes a long time, and that until we are fully credentialed, we would be an out of network provider until insurance fully updates the status as in-network. Moreover, the new doctor has never seen any of the returning patients mouth, so every single patient that the new doctor had to meet are considered new patients according to the rules and regulations of the healthcare field.
  As I previously stated, what procedure is necessary or not is determined by the doctor.. Without full mouth radiographs being updated per American Dental Association guidelines, proper exams cannot be done. In order for the patient to have proper examination, clinical decisions based on standard of care in ***************** were made. We understand that dentistry is expensive and insurance companies barely help with the cost of dental treatment, unfortunately. Like many other professional services, dental care involves a business model where costs are a necessary aspect of delivering high-quality care. Ensuring that these services are paid for is integral to sustain the dental industry and enable dental practices to serve the community in need. Dentists undergo extensive education and training, which involves significant expenses. The fees they charge directly relate to the extent of the cost of overhead of material of choice used for patients and the newest technology doctor elects to use in their treatments. Quality of the dental material and technology is directly related to the quality of treatment result. Should you have any questions, please do not hesitate to contact us again. Thank you very much.

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