ComplaintsforEndodontics Of Greater St Louis

• Initial Complaint

  06/20/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Unresolved

  More info

  4/27/23 Root Canal Treatment. Appointment was scheduled the afternoon before. I was a returning patient (had a root canal at this office with the same insurance previously). Office staff informed me that the insurance company recently changed their payment policy and required patient to pay upfront, they would submit the claim and the ins. would reimburse me. I questioned this, as I had treatment done recently at my dentist office and this was not the practice, they assured me that this was a very recent change in policy with the insurance company, nothing more. Once my ins company received the claim I found out that this office was no longer in network. This was not communicated at all, only the lie about a change in payment policy. Had I known that they were now out of network I would've gone elsewhere. I was charged $1500 ($1370 paid after some sort of discount) for a service that would've only cost me $111 if it were in network. This is s recent issue and there are several online reviews regarding patients being lied to. I have never had a medical provider not inform me that they were out of network. This was deceitful and done purposely so I would schedule my treatment with them. I have reached out to the office 3 times with no response. I want a refund of the charges not covered by my insurance company; the ones I incurred because they lied to me rather than tell me they were out of network.

  Business response

  06/27/2023

  Our patients are made aware of their out of pocket estimate prior to their treatment, either via phone call or in the office when they check in for their appointments. We did have a change with ***** *******s payments, which was clearly explained according to the original complaint. We assume that the patient's have verified their coverage and network participation prior to making any appointments with our office. We do feel badly Delta Dental did not reimburse the patient at a fair rate, but unfortunately we cannot predict exactly what dental benefit providers will cover. Delta Dental states their information is never a guarantee of payment like all dental benefit providers. It is also office policy to file claims as a courtesy to our patients so that they may be reimbursed for what is covered by their plan. Our office staff intent was not to deceive anyone, as most patients check their dental benefit coverage as it is their dental plan. We did not lie about the what the patient would owe the office and extended a discount for a service that was rendered which is not typical. 

  Customer response

  06/27/2023

  Complaint: ********
  
  I am rejecting this response because:

  Your office staff chose to state that delta dental changed their payment policy, NOT that you were no longer in network. Your office staff specifically chose to omit the "out of network", even though you knew you were no longer in-network. This, infact, IS deceitful. Delta Dental did NOT change their payment policy, as your staff stated, you were no longer contracted as in network. Your response is not factual, as you were NOT upfront about the change in network status with Delta Dental. The estimate was given the day prior, at the end of the business day, and the appointment first thing the next morning. A repeat patient, who was IN NETWORK at the last visit should have been informed of the change in status. When the estimate was given, it was stated that payment was due upfront because delta dental changed their payment policy and no longer pays the provider directly. You chose to omit the fact that they would not pay you directly because you were no longer in network. I questioned this during the phone call and was assured it was simply a policy change on their end, nothing else and shouldn't be worried. Perhaps you need to go over the wording to use with your staff, because they were deceitful in how it was presented. I am still requesting a refund of the charges not allowed by my insurance, due to the fact that your office was not honest about being out of network. I will continue to file every complaint necessary until this is properly resolved. This falls under the No Surprise Billing Act. Again, your office stated delta dental changed their policy on payments. They did not. YOU went out of network. That is entirely different than them changing policy.
  
  
  
  Sincerely,
  
  ********* *******

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