ComplaintsforPatel Family Dental PC

• Initial Complaint

  04/25/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On 05Oct21, ******* **** (spouse), went to Patel Family Dental as a 1st time, new patient, looking for a routine oral cleaning. After speaking with Patel Family Dental and providing dental insurance information, the employee stated they were in-network for our dentist insurance plan. Therefore, my wife scheduled an appointment. They stated that a day before service, go onto their online website and fill in your insurance information. On 04Oct21, one day prior to day of service, ******** as instructed, went onto the website and filled in the dental insurance information. On 05Oct21, day of service, the receptionist handed ******* some documents to sign, stating something along the lines of "sorry, we normally don't do this but out systems are down". ******* recalls this being odd, and that they never asked for any identification or her dental insurance cards (although she did use the system as instructed day prior). During service, the dental facility performed additional non-cleaning procedures, ******* questioned "Oh, this is a lot of X-Rays", and the tech stated "well since you haven't been to the dentist in two years this is what we do". Following service it was assumed all was well. However, in the beginning of November of 2021, we received a bill from Patel Family Dentist. I called the Dentist office to question why we are being charged and they stated they did not accept our Dentist plan. I said that was not acceptable, as they stated over the phone they accepted the insurance and it was in network. Additionally, the day of service, being a new patient, they should of ran the insurance prior to service, which my wife would of declined if Insurance was not covered. Furthermore, if they ran the insurance, they would of been able to provide options , such as, "Do you want X rays, they will cost XYZ dollars?" Due to the dentist office computer system down, they lied regarding being in network and gave inaccurate information to gain a new customer (# ****).

  Business response

  04/26/2022

  In response to patient’s complaint submitted on 4/26/22. ******* **** was seen as a new patient in our office on 10/5/21. Per the complaint he stated that ******* was instructed to fill out new patient paperwork online, which she did. We have a few in office forms that new patients sign the day of their visit , at the time of her visit our communication system was down and we did ask her to sign a few forms the “old school” way with a paper and pen. Patient did not have a copy of her insurance card as she stated they do not give us cards so we did not have physical form of her insurance. We are in network with ******* insurance which is what the patient has but we do have a very strict, scripted, phone policy when scheduling new patients. When a patient states which insurance they have we let them know if we are in network or not, if we are in network we say only a PPO plan and always recommend the patient calls their own insurance company to make sure they are on the provider’s list. Patient was seen for her prophylaxis cleaning where she got a full mouth set of X-ray, her teeth cleaned and an exam by the doctor. No non-traditional dental services were provided like the complaint says. In response to the complaint stating “Oh, this is a lot of X-Rays”, it is standard of care for any dental office to take full mouth diagnostic X-rays to diagnose and treat new patients, we cannot see under the gums or the root of your teeth without a diagnostic film.  A full mouth series of X-rays is always standard in treating a new patient especially when not seeing a dentist in a few years while Bitewing (cavity detecting x-rays) are done once a year. In the beginning of November (11/5/21) patient was called and asked if she had a different insurance as her claim had been denied or if she had a copy of her card so we could submit it properly and get payment. At that time patient had emailed over her insurance information and that is when it was determined she had an HMO plan and a PPO plan. Patient was texting back and forth with the front office where she stated she was not going to pay any balance. Patient and her husband (*****) called on 11/8/21 while having the office on speakerphone and he stated he has insurance and is not paying any balances. After trying to re explain the conversation we had with his wife we did inform him that as a courtesy and to help with the balance we could waive Dr Patel’s exam fee of $125.00 but patient is still responsible for the remaining balance. He stated he would like the exam fee waived and that he would deal with that balance at a later date. On that day the exam fee was waived. (Please see attached account ledger). In conclusion, the patient nor her husband were not lied too or given any false information. Had the patient had her insurance card at the time of her visit we would have known it was an HMO plan as it clearly states. It is not the responsibility of the office to verify insurance benefits of every patient. It is our responsibility to know our guidelines and contract with the insurance companies we are in network with. It is the patient’s responsibility to know their plan and contract. Attached is a copy of the account ledger.

  Customer response

  04/28/2022

  I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.   Please find attachments showing the patient did indeed have the ******* insurance card prior to time of service. The attachment shows a picture of our up to date ******* insurance card taken at 12:44 pm, on 05Oct21, prior to service which was approximately 3pm, on 05Oct21. The business again is lying regarding their mistake in their own processes. This all comes down to the business trying to gain new clients. The patient , ******* ****, documented the insurance as requested on 04Oct21. The patient brought her insurance card information for Day of service, but the dentist office never asked for it. Prior to new patients or services, medical providers run insurance to avoid these types of issues. Patel Family Dentistry ignored these standard business practices and lied regarding us being in network. We provided the information as requested , your response states you the business tells people if they are in network, and they told us we were and we were not, come to find out after service. Should we be responsible for a surprise medical bill when we called around looking for a dentist office and this business stated we were in network and then a month after service is sending us a bill stating we are not in service? Where is the accountability on the businesses mistake to own up to a fault in their training and insurance billing practices. What if this was a bigger bill and we went through with surgery and then you stated it was not covered? That's not how it normally goes, providers run insurance and let you know ahead of time, this is the fault of the business for lying about coverage and after the fact realized their mistake and trying to blame the new patient. In conclusion, the office had all of the information needed and due to their negligence or failure in following standard operating procedures , it resulted in a deviation of normal medical providers to provide an accurate assessment of insurance coverage prior to service. They never once stated we might not be covered or there are multiple ******* policies we may or may not cover. I appreciate BBB in helping us resolve this and I hope the attachments demonstrate the deceitful response from the business. Regards, ***** ****

• Initial Complaint

  01/04/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I received a Bill from Patel Family Dentist dated for 12/9/2021. This is the first Bill I received from them since my Appointment in August 2021. It claims I am both 30 and 90 days late stating amount due is $429.00. The account number on my statement is ****. I received this about 12/20/2021 and paid the Bill on 12/22/2021 after talking to the receptionist over the phone. Before August (before my appt.) I asked if they took my insurance, in which I was told yes over the phone it was in-network. they did not allow anyone to come in person unless they had an appointment. while on the phone with the receptionist to dispute this late Bill, I had asked the lady a few questions about it: Q: if they could tell me if any other bill had been sent out? A: they did not have that information Q: I had called before my appt. to see if it was in-network and now I'm being told its out-of-network, why? A: we have had many people come and go, so it could have been one of them. Q: I was told this bill was considered out-of-network, so I asked if she could tell me which insurance was under my account? A: they could not do that again Q: I am just receiving this mail and nothing before this, why haven't I gotten a Bill before this one? A: it probably just got lost in the mail. The receptionist seemed to not have any answers to my questions nor be able to find out an answer for me. After asking these questions I paid the Bill over the phone, with my credit card, so it would not be late and could not be charged again. This is not the first time I have seen this happen; it has happened to my father when I was living in his household. I will be cancelling my appointment and finding somewhere else to go. A proper business should try to resolve problems and/or try to fix their mistakes. The staff seemed not being able to help me in any way besides giving me inadequate answers.

  Business response

  01/21/2022

  In Response to a patient’s complaint submitted on 1/4/22. Patient, **** ******, has been seen in our office since 2015. Both her and her family are patients of our office. **** has always been on her parent’s dental plan until her appointment that was scheduled in August.  When patient presented her new insurance card in office it did not state directly on the card which plan she has as there are lots of different dental plans under the same company name.  While patient stated that someone told her “we have had people come and come go”, that is true as the whole world is facing a staffing shortage but we hold a very strict scripted phone policy, so when she stated that someone told her that we do take her insurance, We do take *****, but the next line always is “only PPO plans and only through an employer”. We also recommend to each patient with new insurance or new patients calling the office to call their insurance company and make sure we are on their provider’s list. We also encourage patients to know their benefits and their plans as it is a contract between them, their insurance company and their employer. In response to her statement saying that we couldn’t tell her insurance, each team member has access to the patient’s chart and information.  The patient did receive a statement in December which would of made the balance 90 days overdue but the patient was not charged any late fees or finance charges and no penalties against her. The statement came later as the claim was still open and didn’t get closed until November after the office made three attempts to get the claim paid by her insurance company. Once the claim was closed the patient had received the statement.  In this case when the patient had called to pay the balance on the account she did not ask to speak to an office manager or higher up to resolve any issues.  Her being a long standing patient and knowing our standard of care the patient should know the office manager would have answered any questions she had and resolved any issues.

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