ComplaintsforMidwest Dental Sleep Center

• Initial Complaint

  04/16/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I was diagnosed with Sleep apnea and tried using CPAP but unable to tolerate it. A friend suggested an oral appliance and my insurance gave me a name of a dentist that specialized in Dental Sleep. Saw the dentist, had maxillo-facial ** and had an impression done. Oral appliance was delivered, it was a technician who fitted it and instructions were given to me like how to make adjustments and a copy of the ** to be given to my regular dentist. On March, 2023, I had a sleep study done and the result showed it was not helping my sleep apnea, was told to go back to the office and this time a dentist checked the appliance and measured the fitting and was given instruction to do more adjustments that I followed. Another Sleep study was done on October 25, 2023 which showed that the oral appliance was not helping my sleep apnea. I called *****************************, the coordinator asking for a refund of what I paid but told me it is not possible. Why is it not possible, if you buy an equipment, electronics or anything and it is not working or you don't like it, you get a refund. It's not only the issue, they did not give the result of my ** which showed abnormality in my tooth #**, it took them 4 months when they delivered my oral appliance and handed me the result of the **. When I showed it to my regular dentist, I was told I had asymptomatic periodontitis with necrotic pulp and needed root canal and more endodontist expenses which probably could have been avoided had they given me the result in a timely manner. It's good I read the result and told my dentist, what could happened to me, get a systemic infection not knowing that I had that necrotic tooth and probably died? I am asking for a full refund of the money that I paid and refund the insurance company for what they paid. It would even be nice if they pay for what I paid the endodontist and the filling of my crown. My copay for the endodontist was $740 and the filling was $277.

  Business response

  04/26/2024

  Thank you for the opportunity to reply.

  The custom fabricated mandibular advancement device delivered to the patient on 12/15/2022 was custom fabricated for the patient specifically. The custom fabricated mandibular advancement device is custom durable medical equipment and is not equipment that *** be returned or re-stocked. 

  All patients are provided with a Financial Estimate prior to making an informed decision to proceed with fabrication of a custom fabricated mandibular advancement device. Please see the attached Financial Estimate dated 08.30.2022, which was signed by the patient. Per the Declaration section, it is noted that custom-fabricated equipment cannot be returned for a refund.

  Thank you. 

  Midwest Dental Sleep Center 

  Customer response

  04/26/2024

   
  Complaint: 21578954
  
  I am rejecting this response because:
  After multiple adjustments and Sleep Study twice that showed the oral appliance is not helping my sleep apnea, it would only be fair to get a refund of what I paid for.

  
  Sincerely,
  
  Proceda Roxas

  Business response

  04/29/2024

  Hello - As stated previously, custom durable medical equipment is made specifically for the patient and is not able to be re-stocked or returned. The patient may make an appointment with the practice to discuss possible treatment options to include combination therapy or hybrid therapy wherein the custom oral appliance is used in conjunction with another treatment modality. Thank You. 

  Customer response

  05/06/2024

   
  Complaint: 21578954
  
  I am rejecting this response because:
  I am rejecting the response from the business, I dont want to make anymore appointments and try anymore therapy and pay more money than I already have, I still ask for a refund of the money that I paid.
  Sincerely,
  
  Proceda Roxas

  Business response

  05/07/2024

  Thank you again for the opportunity to reply.

  As previously stated, the custom fabricated mandibular advancement device delivered to the patient on 12/15/2022 was custom fabricated for the patient specifically. The custom fabricated mandibular advancement device is custom durable medical equipment and is not equipment that *** be returned or re-stocked.  

  All patients are provided with a Financial Estimate prior to making an informed decision to proceed with fabrication of a custom fabricated mandibular advancement device. Please see previously attached Financial Estimate dated 08.30.2022, which was signed by the patient. Per the Declaration section, it is noted that custom-fabricated equipment cannot be returned for a refund. 

  Thank you. 
  Midwest Dental Sleep Center 

• Initial Complaint

  03/22/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Refiling because original complaint wasn't processed correctly/was missing explanation of issue - the full explanation is included in the attached file "MDSC_Complaint_BBB" because it exceeds 2000 characters (it's approx. 2200 characters). In short, the office is attempting to make me do their job/what should be done by a member of their staff regarding an issue between MDSC and ********** Blue Shield of Illinois of which I am not at fault for whatsoever, even though they have the proper resources and I don't/I am not being paid by MDSC. I explain the relevance of the two supplement attachments in the explanation. My desired resolution is that MDSC deal with their issue with ********** Blue Shield of Illinois themselves/stop sending me bills for the full service I received even though they know that I am not liable for it.

  Business response

  03/22/2024

  Hello - Thank you for the opportunity to resolve the matter.
  The individual's insurance has rejected the claim for eligibility, despite having authorization. The authorization, itself, specifically states it is only valid if the insurance is in effect at the time of service (see page 3 of the file titled "authorization"). The provider has filed multiple appeals to the individual's medical insurance (see reference numbers) without resolution. The provider cannot dispute eligibility, as eligibility is controlled by the member and the employer: the provider is not a party to that contract. The individual signed a Financial Policy indicating that all charges are the individual's responsibility if the insurance does not process the claim within 120 days of service. The provider has extended this timeline considerably while hoping the insurance would discover their error, but ultimately have not been able to resolve the balance with the insurance directly. 
  PreService:
  01.22.2022:  REF: xxxxxxx2372. Referral xxxxxx0650 from MD is authorized for CPT codes *****. *****, ***** and *****. It is valid 01.22.2022 through 09.03.2022 to MDSC/OB by ******** **************** at PO Box *********************************************
  04.27.2022: Eligibility with clearinghouse shows a $35 copay for services, 20% coinsurance for DME.
  
  Date of Service:
  04.28.2022: Patient presents for tele-visit CPT code *****. 
  
  Post Service:
  05.03.2022: Claim #xxxx6052 is submitted to ******** *************** (IHP) and rejected.
  06.21.2022: Claim is submitted to BCBS of ** and accepted.
  06.30.2022: Claim is updated from BCBS of ** as The claim/service has been transferred to the proper payer/processor for processing.
  09.28.2023: ******** *************** states they have never received the claim from BCBS of **. Phone REF# xxxx2773
  11.01.2023: ******** *************** states the policy is terminated and the claim is not payable. Phone REF# xxxx4670
  11.02.2023: Explanation Of Benefits received from ******** *************** with denial: Policy coverage is terminated. Statement sent to the patient.
  11.07.2023: Patient returned the statement to providers' office with a note about having switched to Aetna as of 07.01.2022.
  11.20.2023: Billing supervisor called the patient, LM to discuss account.
  **********: Phone call to BCBS of **. Plan states the member was still active with IHP group. Phone ref#xxxx5158
  11.28.2023: Phone call to ********** states there WAS an active Blue Advantage policy, but it was not with IHP. Phone ref#xxxx1991
  12.08.2023: statement sent to the patient.
  01.08.2024: statement sent to the patient.
  02.08.2024: statement sent to the patient.
  03.08.2024: patient is pending for collections.
  
  The claim went back and forth with IHP and BCBS of ** and was never paid. The medical group indicates the individual's eligibility with the group was terminated in September of 2019. BCBS of ** says it was not. The claim was filed timely, was accepted by the payer and rejected for eligibility. Eligibility issues are the responsibility of the member and insurer: the provider cannot appeal or resolve them. 

  Not clear about "brake light" comment. 

  Thank you for the opportunity to respond and work to resolve this balance due. 

  Customer response

  03/25/2024

   
  Complaint: 21471349
  
  I am rejecting this response because: Their response isn't consistent with what they've told me/made me aware that they know. I was covered by a BCBS HMO plan at the time of the service, which can be verified, and when I spoke to their billing department representative, she said that they found out that a BCBS representative erroneously claimed that I was not covered by BCBS past a date in 2019. I was covered until June 30th, 2022. The date of the service was April 28th, 2022. I didn't receive a statement from MDSC until November of 2023. I called BCBS (the business kept providing me with wrong numbers; I was able to find a commercial line online) and they let me know that MDSC submitted the claim incorrectly because my plan was employer-provided. What the representative at BCBS said was inconsistent with what the representative at MDSC claimed, and they were very easy to get a hold of - the representative, who kept trying to make me deal with the issue even though it is between BCBS and MDSC and way above my pay-grade seeing as I wouldn't be paid to do what is their job at all, told me that BCBS was "giving them the run around," and kept providing me with flagrantly wrong contact numbers. I had no issues when I spoke to BCBS, they were able to determine that the business has incorrectly sent them the claim with ease, and let me know that they'd send the claim over to the correct party - I can't imagine that a phone call between MDSC and BCBS would go any differently under the circumstances. I absolutely should not be charged the full service charge, I am not responsible for it, and MDSC knows this. Their response makes no sense, and based on the other complaint against them on BBB's website, I'm starting to wonder if they're attempting to pull a fast one and get double their money's worth, especially considering the number of public complaints against their billing department and a lack of transparency/incorrect estimates. Nothing that they have said has been consistent. Frankly, I'm disgusted by their lack of professionalism and sensitivity as a health care facility. I reached out multiple times letting them know what their representative had told me, and that I am dealing with health issues myself and that this issue, that isn't even my responsibility, had been a burden.
  
  Sincerely,
  
  ***** Officer

  Business response

  03/26/2024

  Hello - We remain available to work with the individual, if they would like to include us in a conference call to ****** Services with **************** we would be willing to help resolve the matter. We recently reached out to ****************, who confirms that the individual had an active policy at the time of service but did NOT have an active group listed for the policy. The reference number for that call is *********. Theyve asked for 30 business days to review whether there is anything they can do on behalf of the individual, since this is an eligibility issue, not a provider or contract issue. Again, we encourage the individual to contact our office directly to coordinate a day/time to conduct a conference call with **************** ****** Services. The appropriate person to contact with our practice is *******. Her contact details are provided below.   
  
  ****************
  Billing Supervisor, CPB

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

  ***************** 

  Customer response

  03/29/2024

   
  Complaint: 21471349
  
  I am rejecting this response because: Based on the business' responses,
  **** made it clear to be that they knew that ******** *************** were truly liable for the service, and that a mistake on IHP's end had purportedly been made. ****'s representative also made me aware that they had sent the claim to the wrong party (BCBS instead of IHP), but they never resent the claim to the correct party (as I just found out, having called IHP). I called BCBS via their commercial line (which was not the number the **** representative provided me with) and the call proceeded with ease - BCBS forwarded the claim to IHP, the call ended without issue. **** claim that they contacted BCBS and IHP, and that they weren't getting anywhere. I don't see why my experience would be any different. I just spoke to a representative with IHP, and the claim is being processed. Again, I don't see why I wouldn't have any issue with BCBS or IHP if **** supposedly were. Eligibility disputes may be between the employer and the member, but it was made clear to me that **** had been made aware that they submitted the claim to the wrong party and they didn't take action. The representative with **** made it clear to me that they were aware that an error had been made with regards to eligibility, and they knew what party was truly liable for the service, yet they didn't submit a claim with them - IHP's records support that I was eligible at the **** and they likely could have processed the claim sooner. Yes, a claim unprocessed by insurance within 120 days becomes the patient's responsibility, but the mistake, based on what I found out from IHP's representative, appears to be ****'s. **** did not contact me within those 120 days letting me know that there was an issue; in fact, I didn't receive a statement until over a year had passed since the date of service. I've never had an issue with the processing of an insurance claim before. Considering the incorrect claim submission on ****'s part, I would appreciate it if they would consider waving co-pay after the claim is processed by the insurance as a courtesy.
  Sincerely,
  
  ***** Officer

• Initial Complaint

  12/27/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Summary: I purchased a mouth guard from MWD for sleep apnea. I agreed to pay $2243.60 for services and appliances. I was a cash pay. ***y incorrectly sent to insurance and charged us both. I paying them a total of $2519.22 and now they are asking for an additional $479.20 over a year later. ***** also paid them $335.29 which should have been returned to Cigna. I was told they could not correct their online invoices and they continue to bill me.Payments made by me:$2243.60 (device $1469.50 ******* = $774.10 xrays and services) on March 22, 2022.Paid a total of $2,519.22 ($2243.60 + $40 (the miss with the insurance that should have been applied) and the $235.60 for the virtual appointment with the doctor) *** services I received are as follows:1.On 1/24/2022 online evaluation with the Midwest doctor who gave me the quote of $2243.60 for the appliance and x-rays/fitting. 2.On 2/1/2022 in-office visit for x-rays 3.On 3/22/2022 I picked up the device at the office. no additional services used MWD sent the following bills:1.Sent a bill for $7995 the invoice shows they received $2243.60 from me and $335.29 from Cigna. ***y tried to collect an additional $5911.11. I called and was told it was an error and to ignore. 3.Sent bill for $235.62 for the initial virtual appointment with the doctor. I was under the impression that this was part of the service I paid for (part of the additional $774.10?) but I was told no that was for the xray and fitting of the mouth guard. I paid the $235.62 on 7/13/2022. 4.Dec 7, 2023 sent bill for $609. I called the billing department she claimed that this was a balance kicked back by the insurance company. Again I said I paid in full as a 'cash pay' in march of 2022 5.I was told they would correct the $609 only they just applied the office visits I paid for and are now saying they should have billed $479.20. requesting adjustment to paid in full or a refund for the overpayment of $275.62 ($2243.60 - $2519.22)

  Business response

  01/03/2024

  The practice has reviewed the summary provided and would like to thank the individual for sharing their concerns. The practice considers the matter resolved and there is no balance due as of today, 01/03/24. The account has a $0.00 balance due to the practice for all dates of service, i.e., 01/24/22, 02/01/22, 03/22/22.  

  Professional services rendered on both 01/24/22 (New Patient Tele-Visit) and 02/01/22 (New Patient Impression Visit with Exam/Imaging) is where there seems to be confusion between the parties and whether medical insurance was to be billed for those dates of service or whether those dates of service were to be billed as cash pay services. Post on-going communication with the individual post both dates of service, it was agreed that cash pay was the intended method. Thank you for the opportunity to resolve the matter. 

   

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