Complaints

• Initial Complaint

  03/21/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On February 17, 2023 I had an emergency service for a molar crown. The dentistry told me that they participated with my dental insurance and was told that my portion of the bill was $858.50 and I had to pay it before services were rendered.Last week I received the Explanation of Benefits from the insurance company, Delta Dental, stating that the Patient Responsibility was $420.20.I talked to the dentist office in two separate occasions and was told that I had agreed to the terms. I have two main issues.1. I was not told about the not covered charges and,2. It is my understanding that if health provider is in-network with an insurance company, they agree to accept the agreed upon reimbursement fees.

  Business response

  04/10/2023

  Our office is obligated to honor contracted fees based on an insured specific insurance plan. Our standard practice is to review a patient's contracted plan fees and obtain a signed approval for the treatment before any treatment is started. The patient was provided a written "financial estimate" based on her insurance plan's contracted rates prior to proceeding with any treatment. Additionally, the fees associated with the treatment were fully documented on the financial estimate and reviewed with the patient prior to treatment. The patient electronically signed the financial arrangement with the contracted fees and that arrangement states:

  "I HAVE READ THIS DOCUMENT AND AGREE TO THE COST(S) AND TERMS AS NOTED INCLUDING:
  I have been presented choices/options and fees in regard to my treatment alternatives, including covered benefits(s), where applicable.
  I have chosen to go outside the coverage of my Insurance/Plan and proceed with the accepted/planned treatment at the estimated fees listed above.
  By choosing the accepted/planned treatment listed above, I understand that I have an additional expense than if I choose the covered benefit under my Insurance/Plan.
  I understand that this treatment will be considered optional/alternate/not covered/cosmetic by my Insurance/Plan.
  I have chosen to go outside the covered benefit(s) of my Insurance/Plan and proceed with the accepted/planned treatment at the fees listed above.
  I HAVE READ, fully understand and AUTHORIZE the treatment LISTED ABOVE. I AGREE I AM FINANCIALLY RESPONSIBLE FOR ALL TREATMENT STARTED.
  I UNDERSTAND my Insurance/Plan coverage, including that my Insurance/Plan may not pay the estimated amount(s) listed above.
  I agree to be FULLY RESPONSIBLE IF MY INSURANCE/PLAN DOES NOT PAY these estimates for ANY REASON and understand that this may increase my expense.
  Any change in my treatment plan, either by my choice or by necessity, will change the fees quoted. I understand that whenever possible, I will be informed of any changes in advance.
  I understand that the office's contracted fee with my Insurance/Plan may not be the same as the Estimated Fee noted above. Once my Insurance/Plan adjudicates my claim, if my patient share was overestimated or underestimated, I will be refunded or charged the difference.
  I understand that my Insurance/Plan requires that for billing services are identified by a pre-defined numeric codes. My Insurance/Plan may apply benefits based solely on the pre-defined numeric codes not the treatment actually provided"

  Based on this information, we feel the patient was fully informed of the treatment plan and financial arrangement prior to any treatment being completed. Therefore, no refund will be issued to the patient. 
   
  

  
  

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