ComplaintsforAdvanced Dental Care

• Initial Complaint

  07/07/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  My first dental visit to Advanced Dental Care on 04/25/23 became a nightmare!! I made an appointment to get my teeth cleaned. I confirmed with the office to make sure the services would be 100% covered before my visit. On the day of my appointment, they said they needed to do an X-ray. I remembered that there was an X-ray that was 100% covered by my insurance when I looked at my policy. Still, I told them I would do the X-ray only if my insurance covers it 100%, and they confirmed, so I proceeded with the X-ray. However, now they’re billing me for the X-ray, because my insurance didn’t pay for it. I contacted my insurance company, they stated only bitewing X-ray would be covered instead of the comprehensive full mouth X-ray. They also stated that the full mouth X-ray is only required every 3 to 5 years. I just had a full mouth X-ray done at another dentist, and they could have used that instead of doing it again. I did everything I could to make sure the services would be 100% covered by my insurance, so I contacted the office about the charge. The office manager was very rude and unprofessional. We could not reach a resolution. I felt like it’s unethical for them to perform a different X-ray option from what the insurance stated and charge me for the more expensive option. This bill is not acceptable.

  Business response

  07/11/2023

  H**** *** called our office on January 4th to schedule an appointment for an exam, x-rays and a cleaning. At that time she let us know she was concerned about having cavities. We took her insurance information over the phone and scheduled her for January 18th 2023. M** ***** called back on January 5th to reschedule her appointment. The appointment was rescheduled to April 24th at her request. We always inform our patients of what services they are being scheduled for. We verify the patients dental insurance before their scheduled appointment, however due to the amount of exclusions and limitations insurance plans have we never guarantee payment. We will always file the claim but ultimately the patient is responsible for all services rendered. It is the patients responsibility to know how their benefits work and what coverage they have. We submitted the patients claim to Cigna Dental on April 24th for a total charge of $203.00 which is our contracted rate with Cigna. The insurance company processed the claim and paid a total of $118.00. According to the explanation of benefits the patient had a six month waiting period for certain services. The full mouth set of x-rays (procedure code D0210) we took on April 24th was denied due to that 6 month waiting period. It is necessary for our doctors to have a current full mouth set of x-rays in order to complete a thorough exam and give our patients the best standard of care. We would not be able to complete a full exam and address the patients concern for cavities if we had only taken bitewing x-rays like M** ***** suggested in her complaint. When M** ***** called the office to go over her bill we went over in detail as to why an Fmx was necessary verses bite-wings. We also informed her the insurance company NEVER guarantees payment for any service. We try our best to give the patient an estimate of their out of pocket cost. The patient has signed a consent form acknowledging financial responsibility. The patient acknowledged we cannot render services on the assumption all charges will be paid for by the insurance company. Our number one priority is our patients health. We strive to provide them with as much information as possible. Unfortunately we can not and will not ever guarantee a patients insurance will pay for services rendered. We went over this information with M** ***** when she called to discuss her bill. We gave M** ***** a 20% discount as a courtesy for the unexpected charge. I have attached a copy of the consent for services and financial policy electronically signed by the patient. I have also attached a copy of the explanation of benefits from the insurance company showing the patients responsibility and the reason for denial. Please let me know if there is anything else you need from me. Thank you. 

  Customer response

  08/03/2023

  Please also note this appointment was scheduled ahead of time. ADC should have checked my benefits prior to my appointment. Therefore, when they told me the X-ray was covered, I took their word and assumed they meant bitewing X-ray.

  Business response

  08/07/2023

  This will be my last response in regards to this issue. We have explained multiple times as to why a full mouth set of x-rays is necessary on a patients first comprehensive exam visit. There was obviously a misunderstanding as to what was communicated at the time the appointment was scheduled. One of the patient reviews M** ***** attached does not belong to our office location. We have countless of outstanding reviews online. We are one of the highest rated dental offices in our area and have been voted best dentist in Valdosta 14 years in a row. Our number one priority is our patients health. Unfortunately not everyone will find us to be the dentist for them. We pride ourselves on the outstanding service we provide and will continue to provide. Ultimately it is the patients responsibility to know the ends and out of their benefits. We try our best to simplify insurance and help the patient understand how their specific plan works, however it is impossible to go over every exclusion or limitation their specific policy has. It is standard routine to have a full mouth set of x-rays taken when coming in for your first comprehensive exam, not bitewings as M** ***** suggested. It is standard routine for us to inform our patients what they are being scheduled for. Ms. H**** *** is responsible for any unpaid balance on her account. 

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩