ComplaintsforGinger Creek Dental, LLC

• Initial Complaint

  01/12/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  ************************* and ***** are both in the MetLife Dental Plan. On November 17, 2022 ***** went to Ginger Creek Dental to have a dental implant. Instead, all ***** could have done was a bone graft, which got infected, with implant to follow later. On Nov. 30, 2022, ************************* had a dental implant also. ****** implant post literally fell out 3 weeks later. On May 25, 2023, ***** had her implant placed and on June 1, 2023, ***** had his implant placed again.By May 2023, all of ****** EOBs from MetLife had been received, resulting in a credit balance for ***** since the office had us pay up front.On July 5, ****** implant had exploratory surgery, resulting in removal. On July 12, ***** had final x-ray and asked to speak to Dr. **** (**********) to find out what happened. His assistant said Dr. **** said the implant had to be removed and ***** would have to get a three-tooth bridge. Dr. **** said there would be no charge for the failed implant and that the dental claims would have to be corrected So the $1736.86 received from MetLife for the failed implant would have to be returned so that those funds would be available for the three-tooth bridge. On August 15, ***** emailed ****** (the office manager) asking what the status of her and ****** accounts were and she replied that it was under review in the finance department. Further emails from ***** to ****** had no response. ***** had to pay out-of-pocket for the three-tooth bridge since most of the annual allotted money from MetLife had been used for the failed implant.On Sept 5, 2023 ***** called MetLife and got on a 3-way call with Ginger Creek. The front desk read the surprising notes that were on ****** account that no corrected claim would be filed since ************** work had to be compensated. On Sept 14, ***** filed a dental grievance with MetLife against Ginger Creek Dental. MetLife did their reconciliation of both accounts. The letters and spreadsheets from ******* are uploaded below.

  

  Business response

  01/31/2024

  Both accounts in question have been reviewed.  All treatment and services completed were billed to the insurance company.  In review of Glenns account, EOBs from the insurance company stated that benefits were ***ed and an alternate benefit was applied to a procedure code,per the insurance company. An adjustment was made as a courtesy to the patient instead of charging the insurance contracted *** allowable fee for services rendered.  Patient paid for services and adjusted difference from the credit adjustment applied; leaving no refund on this account to be made. In review of Karens account and EOBs, a credit of $838.56 was transferred to another location in association with Ginger Creek Dental, per the patients request, for a 3 unit bridge to be completed.  Bridge was completed and remaining balance was adjusted off the account instead of billing the patient. 
  

  Customer response

  02/02/2024

  Complaint: 21137186
  
  I am rejecting this response because:  Ginger Creeks response to ****** account is not correct. I have attached the documentation on what happened that resulted in a $659 credit on ****** account.  Please note that MetLife, the dental insurance company has also documented that a patient refund is due of $659.  In Ginger Creeks treatment plan for *****, they have code D6104 for his bone graft.  When MetLife first processed the claim, they changed it to D7953 which has a higher negotiated fee and it was incorrect to do that. I was told by the Ginger Creek office to submit an appeal to MetLife to get the code changed to Ginger Creeks original code of D6104 so that Ginger Creek could process my refund.  Ginger Creek said they have to go by the *** from MetLife.   MetLife corrected the *** which I sent on May 16, 2023 to ******, the Ginger Creek office manager.  ****** actually called me in early June 2023 to tell me that she and another person in the office had stayed late to reconcile ("rec'd" as she called it)  ****** account and she herself told me she verified that ***** is due the $659 refund.  The last communication from ****** was August 15, 2023, saying ****** account was still in review.  For ******* account, we have received no refund, no compensation nor has the money been transferred to Litchfield Dental Professionals.

  Customer response

  02/06/2024

  In explanation of my credit balance Ginger Creek sent to Litchfield Dental Professionals:  On 11-17-2022, I had the tooth extracted with bone graft and membrane placement all at the same time.  Ginger Creek had me pay $1017 for that but after MetLife payment, I owed only $161 so that generated a credit of $1017 -$161 = $856.  That credit balance was still there on May 25, 2023 when the implant was placed.  The implant failed and had to be removed on July 5, 2023.  On July 12, I came back for final x-rays and asked to speak to Dr. **** because I still did not know what happened or why the implant failed. I was told this happened less than 5% of the time and that Dr. **** said there would be no charge for the implant and the $1736.86 would be sent back to MetLife so that it would be available for my 3-tooth bridge. My annual dental limit is just $2000.   Instead, Ginger Creek kept the $1736.86 from MetLife and also $18.40 of my credit balance still sitting there and just sent $856 -$18.40 = $837.86 of my credit balance to the ***************** leaving me with $1081 to pay out-of-pocket for the 3-tooth bridge I had to have because of the failed implant.
  Before this,I had never had a medical or dental professional promise me something and then renege on that promise.  I would really like to know what happened to cause them to reverse their promise to me.  Did the ************* refuse to comply?  Also, I would like to see their reconciliation spreadsheets on both of our accounts.  I have provided a lot of data to back up what I am telling you.  Where is theirs?
  Also, I noticed on your BBB website that Ginger Creek had charged full price for 3 other people and they all had a hard time getting Ginger Creek to pay them their credit balance after dental insurance payment.

  Customer response

  03/18/2024

  Additional letter received today March 18, 2024 from MetLife stating they have been unable to get our money back from *********************************** of Ginger Creek Dental.

  

  Business response

  07/16/2024

  I have attached our response regarding ***************************** account. Please advise if you need any additional information. We are happy to provide you with MetLife's explanation of benefits pertaining to the dates of service listed below, given we can obtain ******* written consent to release those documents.

  
  

  Important items to note:

  • MetLife's allowed amount for the upper flipper is $990. We extended a discount to ***** of $590 making his total for the flipper $400.
  • MetLife downgraded the bone graft on #** and applied an alternate benefit.
  • ***** reached his plan's annual maximum, making him responsible for the balance left unpaid by his insurance.

  Please let me know if you have any questions. I greatly appreciate your help with this!

   

  Sincerely,

  *******************************

  Director of Operations

  La Cross Dental Administration

  Ph. ************

   

  Customer response

  07/17/2024

  7/1/2024 PE Spoke with the consumer, *****. The dental ****** has ceased communicating with her. MetLife and the dentist's accounting ****** has agreed that they owe her $659.00 for the work on her husband, *****. ***** has provided the documentation. Provided ***** with a link to the ***** for a complaint to be filed there. Will reach out to the doctor's ****** via email to see if they will make good on the refund.

  
  

  

  Business response

  07/18/2024

  7/8/2024 PE Left detailed message for *******; reminded her that an email was sent to her last week requesting refund of ******* dental work. Asked for a return call. Provided my direct dial number.

  
  

  

  Business response

  07/18/2024

  7/1/2024 PE  email sent to *****************************, Office manager, informing her of the move to mediation of the complaint.  Consumer is requesting refund.

  

  Business response

  07/18/2024

  7/8/2024 PE Left detailed message for *******; reminded her that an email was sent to her last week requesting refund of ******* dental work. Asked for a return call. Provided my direct dial number.

  
  

  

  Business response

  07/18/2024

  7/12/2024 PE Spoke with ******** at length. She will be providing supporting documentation on why they have already compensated the Fajardos through discounts. These are to come on Monday, July 15.

  
  

  

  Business response

  07/18/2024

  7/16/2024 PE On 7/15 the dental office sent a response and supporting documentation. These patients have received a discount which adequately compensates them for the work that was done.  Documentation is in the library. Email stated, "I have attached our response regarding ***************************** account.  Please advise if you need any additional information.  We are happy to provide you with MetLife's explanation of benefits pertaining to the dates of service listed below, given we can obtain ******* written consent to release those documents.  Important items to note:  -MetLife's Allowed amount for the upper flipper is $990.  We extended a discount to ***** of $590 making his total for the flipper $400.  -MetLife downgraded the bone graft on #** and applied an alternate benefit.  - ***** reached his plan's annual maximum, making him responsible for the balance left unpaid by his insurance.  Please let me know if you have any Questionquestions.  I greatly Appreciate your help with this!

  
  

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