ComplaintsforHealthy Smiles

• Initial Complaint

  06/13/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Last year Healthy Smiles Dentistry repaired several cavities I had. I went for my scheduled 6 month cleaning and I left the business thinking everything was okay with no payment required. When I returned for the next appointment to have the work I was told needed to be done, I was informed that I owed them over $200.00 for the work that was done at my last visit. I told the receptionist that my insurance covers fillings at 100% and there must be a mistake. I was not told beforehand that I would have to pay for this work out of pocket before it was done. The receptionist explained to me that my insurance would not pay again to have the fillings repaired for 3 years, leaving me with approximately 2 years before insurance will pay again for this service. This made me aware they were repairing their work and could not bill my insurance again. I am asking for your assistance in this matter. I was not told they were repairing their work and that I would have to pay out of pocket for the repairs. I would have declined the work. I also declined the work I went in to have done the day I was told about the expense they would charge me. I can contact my insurance to get the information I may need regarding this situation. Thank you.

  Business response

  07/05/2022

  ****** stated when she left her scheduled 6 month cleaning she left thinking everything was okay with no payment required, she was correct because her cleaning was covered at 100% but at her cleaning appointment she was told she had recurrent decay on several teeth and needed to floss better and more often.  Her clinical notes also state previously that she has had light to moderate calculus build-up.  This is what has contributed to the recurrent decay on the teeth in question.

   A couple months later she came in for some restorative work in which some of the teeth had been previously done years ago which is considered recurrent decay.  Not flossing properly or often contributes to the formation of cavities.  When you eat or drink food particles and carbohydrates they linger on your teeth, due to lack of oral hygiene, in turn which are digested by the bacteria in your mouth and in accumulated plaque.  These bacteria then create acids which can eat away at the enamel on your teeth.  ****** stated we were repairing her work that was not the case; we were restoring recurrent decay, not repairing. 

  According to ******’s insurance they will not cover restorations being done on a same tooth for 36 consecutive months it is the patient’s responsibility.  As shown on her EOB her responsibility was $265.00 we give her a discount out of the goodness of our hearts.  It is the patient’s responsibility to know and understand their insurance policy.  If the patient would’ve came to us about this issue things may have been different, we try to take everything in to consideration when it comes to the well being and financial situations of our patients.

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