ComplaintsforHarmony Dental Associates: Marietta Dentist | Cosm

• Initial Complaint

  04/17/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I am writing to dispute the cost of **rays with the service I received at Harmony Dental Associates on March 27th. I visited Harmony clinic for a dental cleaning and was surprised to find that an excessive number of **rays were taken, which is in violation of my insurance policy. As a result, my insurance company has refused to cover the cost of these **rays, stating that Dentist exceed the plan limit for this service. I am now being asked to pay out of pocket for these expenses, totaling $81. I think this cost should be borne by Harmony Dental Associates for the following reasons:1. I have dental insurance for over 20 years, all my in-network dentists have adhered to the insurance regulations of permissible **rays. This is why I always use in-network dentist and this is also the first time I have encountered a in-network dentist violating insurance regulations. It is totally unbelievable.2. Harmony Dental associates did not notice me before taking those **rays that exceeded my insurance coverage. I never agree to take those extra **rays. 3. I have communicated with my insurance company and they have confirmed that Harmony should be fully aware of the **ray policy. They have stated that Harmony shouldn't take so many **rays during one service.4. Based on the above three points, the dentist deliberately took extra **rays, knowing the insurance policy regulations and without notifying the patient, which led to the insurance denial. The dentist is fully responsible for this incident and they should bear this cost themselves.

  Business response

  04/25/2024

  Patient came to our office as  new patient on 03.04.2024. All diagnostic x-rays were completed for ****************** to perform appropriate treatment. Treatment was submitted and insurance Explanation of Benefits did not cover ************ x-rays as they stated he had exceeded his allotted amount. They also downgraded the procedures. The x-rays not covered were billed out to patient. The patient is upset that the insurance didn't cover the services. After speaking with the patient at length he confessed that he had already visited another dentist, who performed services. I explained that every time he visited a new office the dentist cannot treat the patient without diagnostics. He asked that we resend the claim to Metlife. We did and they denied the x-rays a second time. Please see attached supporting documents. The $81 is the patients responsibility.

  Customer response

  05/03/2024

   
  Complaint: 21588456
  
  I am rejecting this response because:  1.My last teeth cleaning date is Aug21,2023 by my previous dentist who has moved out from my insurance network from 2024.  This was Harmony said I had already visited another dentist who performed service?  *********** of seven months ago?   And Harmony knew all my dental record and insurance information after I finished online new patient form in January2024.  It was the duty of Harmony to know what  kind of Xray was did on Aug21,2023 and what kind of Xray was allowed by insurance on March4,2024.  If not, why I choose in network dentist?  2. I never heard any dentist need all diagnostic x-rays to perform treatment. And Harmony did not told me all diagnostic Xray until I asked them to explain the bill.  My teeth problem is deep bag and Harmony measured it by tool not Xray.  If Harmony think their own policy is greater than insurance policy, they should notice patient and insurance company before treatment.  3. It was the insurance representative said Harmony should call them and resubmit the bill according to the policy. I told Harmony to communicate with the insurance first, then submit the bill again. I did not know whether Harmony had communicated with the insurance. 4. Harmony did not give me any good suggestion about my teeth bag problem except repeating deep cleaning on March4,2024, so I visited a Periodontist and would do some treatment. I told Harmony about this when I asked the Xray cost. There is no any relationship between the periodontal treatment and  the Xray fee of Harmony.  

  
  Sincerely,
  
  ********

  Business response

  05/08/2024

  Per Complainants submission and documentation, the insurance company clearly states what is owed by the patient. We, Harmony Dental Associates have not added any additional fees. We have billed, as contracted with the patients insurance, per the complainants documents, $81.00 due.

  Customer response

  05/14/2024

   
  Complaint: 21588456
  
  I am rejecting this response because:  I have asked MetLife to review my case including downgrade the procedures mentioned by Harmony.  I request MetLife reimburse the standard X-ray fee according to my plan, and state clearly who is responsible for the extra X-ray fee which were taken by Harmony without my consent.
  
  Sincerely,
  
  ********

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