ComplaintsforApex Dental, PA

• Initial Complaint

  06/28/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Apex Dental filed a false insurance claim with my insurance company stating that they perform a root canal. My root canal was performed by a specialist Dr **********************

  Business response

  07/08/2024

  patient came to the office with an acute abscess on tooth #**.  We attempted to start the endo but because of the Exudate we were unable to dry the canal to finish.  Scheduled to have the patient to come back to complete.  Patient came back on 4/4/2024, 4/9/2024 and 4/23/2024 but we were unable to complete due to Exudate in the canal still.  patient was given a referral to the Endodontist and told to see her ************ due to persistent infection.  After patient saw the Endodontist we starting proceedings to return the money to the insurance on 6/17/2024.  We have sent a corrected claim to the insurance on 6/19/2024, since she is finishing the root canal with the specialist, and it is still in process.  As explained to the patient, it takes time to return money and process the code that was actually performed.  

• Initial Complaint

  10/10/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  I went to see **************** at Apex H333835**343236363939H in 1/2022 after visiting Mystic H333835**343236363939H and was told by the dentist there that there was decay under Tooth #4 and Tooth #**. I wanted a 2nd opinion. Since Mystic H333835**343236363939H already took a full mouth x-rays, I forwarded the x-ray images from Mystic to Apex H333835**343236363939H. **************** also took a couple x-rays. I told him that my insurance would not cover them. He said he would not charge me for them. **************** confirmed that he also saw decay under both #4 and #**. I went with **************** to replace my crowns. After the procedure, I paid my share of 50%. My insurance should cover 50%. In 4/2023, I started receiving a bill for $472 from ******************** office. I thought it was a mistake since my insurance was supposed to pay for it. When I received the bill dated 5/31/23 with the due date of 6/10/23 for $472, it says "to avoid placement with our collection agency, you must pay your account within 10 days of the date shown above." I called Apex H333835**343236363939H on 6/8 to resolve this matter and spoke with *****, the ops manager. She told me that my insurance denied the claim on #**. I called Guardian and learned they approved claim on #4 but denied claim on #** because their 2 internal dentists deemed procedure to be unnecessary. I told the rep that my dentist told me there was decay under the crowns on both #4 and #**. The rep said to ask my dentist to request a Peer to Peer Review with their dentist to explain why it was necessary. I called ***** back, gave her the info. I also asked her to not send my account to collection since this needed to be resolved with my insurance. She said she would message Accounting to hold off. However a few days later, I still got a letter from their collection agency. In 6/2023, I got another denial letter from Guardian. They said Apex H333835**343236363939H did not request Peer Review. They just asked for a normal appeal. I went to Apex and paid $20 to show good faith trying to resolve this on 7/6 as recommended by the office.

• Initial Complaint

  04/11/2022

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Resolved

  More info

  My wife had received dental services at this office 9/2021 and we have paid our out of pocket portion; the remaining was supposed to be billed to our dental insurance. We later received a bill from the office to pay also the insurance coverage portion. We called the office and they informed us to disregard the bill as they are in an appeal process with the insurance. We kept receiving mail and message bills for the same amount and each time I would call the office and they would inform me that they are still in the appeal process. I made clear over the phone that we have no intention to default on any payments and they assured us that we did not and we will be informed of the result of the appeal. My wife received a call on April 7th from a collector demanding instant payment of the amount. Unsure if it was a legitimate collector or a phishing scheme; we called the office and they told us they were still processing the claim. We called the insurance company and they said the appeal was denied as of March 14th and the reason for denial was that the dental office did not provide the appropriate imaging and narrative that would justify the coverage. I gave our narrative of the services provided and the insurance representative took it on herself to call the dental office back and specify what would allow them to cover the appealed claim. I called back the dental office billing to follow up and they said they admitted receiving the call from the insurance and that they were "on it" and that the collections company was "ours" and not to worry about it, that no inquiry will be made, but they had to "clear their books". On April 10th we received in the mail a collections bill with additional charged interest. Today 4/11/22 I had called the insurance company and they are still awaiting the dental office to provide the requested information. I demand they retract the billing from collections, submit requested info to insurance and directly communicate with me to settle

  Business response

  04/27/2022

  Business Response /* (1000, 6, 2022/04/12) */ After reviewing the patient's complaint and account, our central billing office will be taking the following action on this account today. 1.Remove this account from soft collections. 2. Following up with the insurance company to reprocess the appeal with the accurate information. 3.Call patient to communicate these actions taken. We apologize for the inconvenience this has caused this patient. Nothing adverse will be or has been reported to any credit bureau. Consumer Response /* (2000, 8, 2022/04/24) */ (The consumer indicated he/she ACCEPTED the response from the business.) I did receive a call from the billing central administrator who acknowledged their Wesley Chapel office billing personnel shortcomings as they have "dropped the ball twice" with not following with the insurance company appropriately and sending the file to collections inappropriately. She did explain their planned corrective measures as explained in their reply. I am satisfied with the eventual results and accept their apology for the inconvenience.

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