ComplaintsforSoltani Periodontics & Implant Dentistry

• Initial Complaint

  05/27/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I was referred to Soltani Periodontics for a teeth scaling procedure, they performed a exam and charged $200 , without using correct codes for insurance company they were supposed to go over what insurance would cover before doing procedure they called on day before procedure saying insurance would cover nothing. ***************** says they used wrong codes again , called there office again secretary informed they would resubmit and contact me , they never did I called Soltani Periodontics after they charged me $200 for unneeded exam for procedure they never performed, due to there errors and mishandling of insurance claim. Very poor customer experience.

  Business response

  06/07/2022

  *********************************** had his first visit with our office on February 17, 2022. We are a specialist office who specializes in Periodontal and Implant Dentistry. *********************************** was referred to us by his general dentist for periodontal concerns. We are not participating providers with his current dental insurance therefore are not a party to that contract. We submitted ADA **** D0160 to his dental insurance on his behalf as a courtesy for his first visit with us. That **** was correct and valid, attached is an explanation of the **** that was submitted. His insurance plan has stated it is not a covered benefit under his plan. Again, that is between him and his insurance. We also recommended treatment and called to obtain benefits on his behalf for ADA **** D4341 and the explanation of that **** is also attached. Per his dental insurance they are not covering that procedure as he has had some similar treatment done within 2 years and that **** carries a frequency limitation which is out of our control.He can appeal the benefit determination with his insurance if he feels that is not accurate, he is the member and he has a contract with them. We have submitted all the correct coding to his insurance and have not made any errors.We kindly ask that you dismiss the consumer complaint made on behalf of ********************************** against our practice as it is inaccurate. Thank you for your help.

  Customer response

  06/08/2022

   
  Complaint: 17283526
  
  I am rejecting this response because 

  I should of been notified before service was performed that it wasnt going to be **vered by insurance the pre diagnosis procedure should not have been done until they had approval from insurance ***  **mplete waste of time and money 

  Insurance ** stated to me that I would of been **vered but this office used in**rrect **des. 
  
  Sincerely,
  
  *******************************

  
  

  Business response

  06/13/2022

  As I stated previously, we are not a party to the contract between ******************** and his *********** ******** We are not participating providers and do not have a usual and customary fee schedule to know what is usually covered by his insurance. Upon scheduling a new patient to our office we are vey clear and let them know we can submit claims on their behalf as a courtesy and are not in network with their insurance. Whatever their insurance does not cover it is their responsibility. If we had billed an incorrect ADA **** his insurance would've contacted us and that is definitely not the case as we have billed correctly. It is unfortunate that ******************** feels like it was a waste of his time and money but he did receive the proper exam and diagnosis from our specialist periodontal doctor. Thank you.

  Customer response

  06/16/2022

   
  Complaint: 17283526
  
  I am rejecting this response because:the handling of the procedure, insurance ** stated there are other **des that

  periodontists can use, but that if they feel they used **rrect **de there is nothing they can do because out of network

  Procedure Name EXTENSIVE ORAL EVALUATION 
  Procedure Code D0160, this procedure was no different than any other dentist has already done , therefore was unneeded. Especially when they did not even **operate with insurance **.

  to get them forms and documentation for scaling to be **vered. Wasnt notified until last day before appointment that nothing for scaling was **vered. All do to the fact that there office did not follow up with me or insurance **. No call no nothing.

  Sincerely, 
  
  *******************************

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