ComplaintsforQCA Endodontics, P.C.

• Initial Complaint

  10/10/2023

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Resolved

  More info

  On August 1, 2023, I had an infected tooth. My dentist referred me to QCA Endodontics. Upon arrival I was told I had to pay $165 for a Cone Beam CT. This was the first I heard about this. I used the remainder that was on my Wellness card. I received a statement saying I still owed a balance of $134.21 for more x-rays. I told the receptionist I'm 68 yrs old and on a pension. She told me the office sends out 3 statements then turned over to collections. She was rude and condescending, no compassion and did not offer a payment plan. Why x-rays charges when I had paid for a Cone Beam CT? Please help. V/r, *************************

  Business response

  10/17/2023

  Attached you will find *************************** Account Details,Explanation of Benefits from her insurance company, signed payment policy and signed estimated patient portion from the day of her visit.
  The $165 was the estimated patient portion from her day of service on August 1st, 2023, knowing that her insurance did not cover this portion of the visit. CBCT scans are taken on every patient as it provides 3D imaging and allows us to gather more information about the tooth and the anatomy surrounding the tooth to make a diagnosis. In addition, we must charge for our own Limited Exam and Periapical X-ray which is a 2D x-ray for an initial visit. Exams and periapical x-rays are considered diagnostic and typically insurance companies allow so many exams within a calendar year as well as diagnostic x-rays.
  United Concordia is a dental insurance company that we are not in-network with and therefore, if they say they pay 100% on exams and x-rays that is 100% of their fees (not ours). We do our best to give an estimate not knowing what they will cover up to their fees due to being out-of-network with United Concordia. After the claim processed, it shows on the explanation of benefits the amount paid from insurance was $45.79, leaving a remaining balance of $134.21.
  This remaining balance does not stem from additional x-rays,it stems from how much the insurance covered based off being out-of-network and paying our fees. For example, for the $144 limited exam the insurance paid $32.55 and for the periapical x-ray the insurance paid $13.24.
  Our payment policy that was signed on August 1st,2023 states that, We will gladly call your insurance company regarding your coverage, but please keep in mind that your co-payment is an ESTIMATE of what you owe. Some companies pay fixed allowances for certain procedures and others pay a percentage of the charge. While we do our best to estimate your insurance portion, it is your responsibility to pay any deductible amount, co-insurance,or any balance not paid for by your insurance company. It is possible that you may receive a bill for an amount still owed or you may receive a refund for overpayment. You will be responsible for all collections costs, attorney fees,and court costs incurred.
  Our estimated patient portion sheet that was signed on August 1st, 2023 states, Please note that this is an ESTIMATE OF BENEFITS AND NOT A GUARENTEE OF BENEFITS AND PAYMENT. One statement will be sent to the patient if a balance is due after insurance had paid on the dental claim. I understand this is NOT a guarantee of benefits or payment. I understand I am responsible for payment of services rendered and also responsible for paying any remaining balances on my account after insurance has paid on the dental claim. Also noted is that ****************** was marked as out-of-network which states, As an out of network provider, we do not have access to the detailed coverage of your policy and the allowable fees for the coverage may differ from our office fees.  
  We sincerely apologize for any rudeness during your phone conversation when you called our office to discuss your options. Unfortunately,we do not offer any type of payment plan other than Care Credit, which is an option you can apply for at home at www.carecredit.com.This option allows you to pay the balance off with Care Credit at a 0% interest for 6 months. 

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