ComplaintsforUptown Dental Associates PA

• Initial Complaint

  11/03/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I had dental work on 9/20/23 at 1pm..for the last few years they contacted my insurance and I could only have x-rays every 3 years.the hygienist asked me if they could do x-rays and I asked if had been 3 years and she Said yes so I said go ahead.. well when sent into my ********** blue shield they wouldn't pay for the x-rays so I called BCBS and they told me I hadn't had full mouth x-rays since 8/20/13. Plus the x-rays needed to be full x-rays not bitewings that they did and the procedure code should be D9210..so I left it up to the dentist office all these years as they were the ones to inform me what they found out from my insurance company so I assumed the x-rays would be covered..I brought it their attention but the gal that handles the insurance wasn't it so they would let me know..I then got a voice mail from the office stating that the dentist Said they could not resubmit for new code and I needed to pay the ***** fir x-rays or I would no longer be seen at their office..it was not my error it was their error as they should of known what my insurance required just as they found out years earlier what was required..if i had known they would not be covered I would not of had the x-rays done as for the last three years I have refused..not sure why they keep pushing x-rays when I've had no complaints..I took the voice mail as a threat and not professional manner..they have a copy of what my insurance person informed me

  Business response

  11/14/2023

  every time patient has appointment if she has a bill after her appointment she calls and yells at us, we DO NOT preauthorize any preventive work so we do not know what is covered by each individuals plans, we just have a vague, it is up to the patient to know their benefits and what their insurance will cover and we have each patient sign a form that explains this. The patient presented for an appointment and we did x-rays and the xrays that the Dr recommended after insurance was billed out was not covered by the plan, we sent the patient a statement and the patient called back and stated that she called her insurance and we have to bill it out as a full mouth xray code but because we did not do an actual full mouth xray we cannot change the code to a full mouth xray code because that is insurance fraud. We called the patient and explained this and that she is in fact responsible for the balance so the patient turned a complaint in to the better business bureau because she did not get her way

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