Complaints

• Initial Complaint

  04/11/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  The original service date was 01/27/2021 and I paid $4,845.00 via check. The total comprehensive orthodontic treatment fee was $6,350.00 and my dental insurance, Northeast ***** Dental, was to pay the remainder ($1,250.00). I paid in good faith my designated portion (account ******** and signed a Federal Truth in Lending Disclosure Statement for ************ Services Rendered. On 03/05/21 I received a $520.00 statement for a service provided in August 2023, but was dated 02/01/2021 (two years before the service was provided). The treatment code did not match the aforementioned service, and the statement was billed to the wrong address. This was concerning to me, so I brought it up with the office staff. They provided me with multiple EOBs, several years apart, and explained that my initial service was billed to my medical insurance (UHC) instead of my dental insurance, who denied the claim for obvious reasons. When I asked for clarification as to why the initial claim hasn't yet been processed through my dental insurance, I was told that ***** Dental had also denied the claim. I requested paper copies of each billing attempt and subsequent denial and EOB, and found that the orthodontic office had billed ***** Dental outside of the coverage period (prior to active coverage, and after coverage ended, well outside the period of timely filing). There was no attempt made to bill ***** Dental during the active coverage period, no accountability taken by the ******************* and no attempt to review the claim decisions or processing policies clearly stated on the EOBs. The staff openly admitted to regularly withholding statements and other billing information from patients, and the front desk staff stated I could not schedule my next appointment until I made a payment, despite having already paid the original designated portion. They've made no attempt to resolve anything, and never addressed my initial concern about the mis-dated bill for $520.00 from this year.

  Business response

  04/16/2024

  
  In response to the above complaint, 
  March 19,2024 was my first brief conversation with *************************** as she was checking out from an appointment here in the office. A statement of a past due balance  was given to her for services noted and charged from 10/03/2023 and (11/21/2023 corrected date( debanding / rebonding of braces) that we attempted to have paid by her insurance (UHC) under her dental coverage.
  
  ******************* came in for an orthodontic  consultation on 12/02/2020 -a payment option sheet was presented .The total fee for treatment was $6350.00.The treatment duration was approximately 33 months . We offer 5 option payment plans to parents/ patients in order to make orthodontic treatment as affordable as possible. - A 5% discount with a paid in full option was chosen for Evelyns treatment .

  A check was received in the amount of $4845.00 . 
  $1250.00 was an anticipated insurance orthodontic benefit which was inclusive of that $6350.00 fee.
  ******************* started her treatment on 01/12/2021. 
  On several occasions throughout ****** treatment she needed appliances removed / replaced for appointments to receive dental care outside of our office. On 09/26/2023 it was noted ******************* needed an MRI , in preparation for that test -Full Maxillary/Mandibular debanding appointment was scheduled for 10/03/2023-
  On 10/09/2023 ******************* came in to be rebonded , treatment notes state that she had not received MRI results back as of that date. It was advised to wait until the results were back before she was rebonded just in case she needed further testing. 11/20/2023. ******************* called the office to schedule the Full Maxillary/Mandibular rebond appointment ; we were able to see her the following day on 11/21/2023.

  
  ******************* was charged a nominal amount of $520.00 for both of these procedures ,as it was not part of the original treatment plan in 2021-  A claim was submitted to her insurance with anticipated benefits to be  covered- ******************* dispute regarding dates of the claim  , upon review , it was an oversight/ error  on this end . The claim was denied -  We received  the EOB  from UHC( explanation of Benefits ) the reason for the denial ,the patient did not have ORTHODONTIC coverage. Having a brief conversation about the charges, ****** wanted it to be submitted under a medical policy because she needed an MRI for medical reasons.
  I explained we did not submit  medical claims but I would be more than happy to print out the claim so that she can attempt to receive reimbursement through her medical policy.

  She did say there was another dental insurance policy but did not present that information at the time.
  On April 09, 2024 ******************* came in for another scheduled  orthodontic appointment.  After her appointment ,we sat to further discuss the initial claim for $1250.00. I explained my attempts to get the claim paid ;we were  trying to troubleshoot the reason for denial , 
  Many exhaustive attempts have been made to receive the $1250.00 orthodontic benefit from the insurance company(s). But because we had several different policies on file, things were getting delayed and denied for various reasons, (ie: policy terminated, or the insurance was the primary insurer, or the secondary insurer, or no coverage at all, wait period  or eligibility at time of service) . These denials required more extensive research; phone calls were placed to insurance companies, and resubmittals of claim, even though we are not obligated after 2 attempts -we did want to have to transfer the unpaid portion to the patient until we exhausted all means -All claims we submit are done as a courtesy on behalf of the patient.
   Per all insurances - benefits are never a guarantee of payment - policy criteria has to be met  by the subscriber .The contract signed by the responsible parties acknowledges anything not covered by their policy becomes their financial responsibility. 
  After nearly 2 hours of sitting and going over things with ****** and also a general conversation  she seemed comfortable with the explanation of what was happening with the claim .I gave her the documents - EOB s -  copy of claims as a courtesy to show her what was and is being done and because she was planning on making more phone calls as well to assist in this daunting ongoing task to get the initial claim of $1250.00 covered by insurance.
  Patient did present another insurance coverage ,Aetna , held by her father as the subscriber; she was hoping she can get some coverage paid of the $520.00  for the deband/ rebond services .
   I told her  that I would submit the claim but it would be submitted as a work in progress because the services were rendered prior to coverage with this insurance, it may not be covered .
  *Claim was sent electronically .
  We also chatted briefly about her brother who was actually in the office for an appointment . I checked the status of his claim and to date had not been paid yet. She and I said we would make calls to the insurance company to see if she can get anywhere with the outstanding  claims .

  It is my impression that It was a very cordial conversation between ******************* and myself that she was satisfied with everything we discussed and reviewed .
  Only until the patient was given a statement of unpaid services that she filed this complaint .

  As for her concern about wrong address information, It would be *******************' responsibility to provide us with updated account demographics .Her dad was listed as the responsible party , his contact information was used for all correspondence as it was also ******************* place of residence as well .

  To resolve this matter ,we will stop any further attempt to seek the initial claim of the $1250.00 and write that off as a loss .
  If the current Aetna policy does not cover the deband/rebond services  - it is the financial responsibility of ******************* for fees of $520.00 .
  We strongly feel we have been very accommodating and took exhaustive measures to resolve *******************' account and are extremely saddened that ******************* felt it necessary to file a complaint . 

   We have been providing services and involved with the community for 25 years with many many great reviews and satisfied customers.

  
  

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