ComplaintsforFirestone Family Dental, Inc.

• Initial Complaint

  12/07/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I visited this office for a routine procedure. I was told I needed to return for additional treatments. I submitted my primary and secondary insurance info. I later received a bill and called the office to ask what the bill was for. They informed me that I was not covered under the secondary. I paid the bill at that time. I then contacted HR for my husband's employer. They discovered a clerical error and corrected it at that time. I called back to FFD to report the mistake and they agreed to resubmit the claim to the secondary. I visited this office 3 more times. on 7/27 I paid $858 because they claimed the secondary did not yet respond to the claim. I called back in September and was told they had a new system and actually had not resubmitted any claim and to call back in a couple weeks. I called back and was told the secondary still did not respond. I called the secondary, they made a 3 way call with me to FFD. They verified that the 1 claim submitted by FFD had been paid and the check had been cashed. They said they would look into this and call me back. They called back to say my primary denied my claims. I called primary, they called FFD to verify the payments of each claim. FFD sent me a check for $280.95. According to my EOB from each, primary only denied duplicate claims and only 1 claim was submitted to the secondary. When I tried explaining that I would like FFD to please take a closer look since there is no way the secondary would cover anything before the primary. And I could also see from the EOB's that the primary paid each initial claim. I was told "I didn't know what I was talking about" from employee S and was hung up on. Each time I've tried to call back to FFD, no one has answered. Since they claim part of the reason for all the confusion is due to their new system, I would like a full audit of my account that includes each claim FFD submitted to primary and secondary. And finally, a refund once the claims are paid by the secondary.

  

  Business response

  01/06/2022

  [[BBB TRANSCRIPTION VIA FAX FROM THE BUSINESS ON 1/3/2022]]

   

  BBB Complaint ID:********

   

  The patient came to our office as a new patient on 5/25/2021 and only presented us with one insurance at that time. Patient then came back in June for treatment and again in July, which is when patient presented me with the secondary as well as informed me that the primary insurance was incorrect due to an error of the HR department at the place of employment. When correct information was finally received we were in the process of changing software systems so I had to get everything entered in and get it resubmitted. We did receive payment from the primary insurance company, but still have not received anything from the secondary insurance. Patient did receive a $258.95 refund after payment from primary insurance was processed. Patients account is now at $0, so unless we receive additional payment from the secondary insurance, this matter has been resolved, as it seems to be a misunderstanding by both parties.

  Sincerely,

  *** **** *******

   

  *Please see attached

  Customer response

  01/06/2022

  [[BBB TRANSCRIPTION VIA EMAIL FROM CONSUMER ON 1/4/2022]

  Hi ******, 

  
  

  I wanted  To contact you because I have additional information to add to my complaint. The source of my complaint starts with the company claiming that my primary dental insurace denied a claim for me. I just received an Explanation of Benefits from my primary insurance coverage and in fact, it was denied. Firestone Family submitted a claim using my maiden last name,  ********. Im not sure how they would know my maiden name since my Driver License and both insurance cards I provided to them show my current last name, ******.

  
  

  I can see there has not yet been a response from their office. Would it be in reason for you to contact them again to request the claim be resubmitted using the correct first and last name?

  
  

  Thank you for your time,

  
  

  ****** ** ******

  Customer response

  01/10/2022

   I am rejecting this response because: Being a new patient, I was asked to submit my insurance info over the phone when I made my 1st appointment. I did. When I arrived at my 1st appointment, I showed each card. I later received a bill so I called to ask why. I was told the secondary listed me as not covered and I paid the bill at that time. I asked my husband to speak to HR at his job. HR reported a clerical error on their behalf. Since there was clear evidence my husband’s intent was to add me to his coverage, the effective date of coverage was retroactively made back to 1/2020. I called back to FFD to report this. I was asked to bring the card again to my next appointment which was in June, not July. I did. At that time, I was referred to a specialist by FFD. I went, submitted both insurances, paid up front and promptly received a refund after that office submitted claims. I returned to FFD and paid the balance due for that next visit. When I returned in July, I was told I would receive a refund because all claims had been submitted and receptionist said she didn’t need to take the payment due for that visit because I would "get it right back". Each time I called back I was told they were waiting on a response from the secondary. It was not until late in October when the "new system" was mentioned. And at that point is when I was told the claims to my primary were denied because I was not covered. That is incorrect. They were denied because they were duplicates. The attached document shows no claims submitted from FFD to my secondary. At no point ever did I mention any issues with my primary insurance. There were none. I never spoke with *** ******* about any of these issues so I’m sure she is reporting on the behalf of her staff where indeed, is where the misunderstanding lies. I’ve submitted each claim myself at this point. I’ll received a status when the are paid to FFD and expect my refund promptly. I acknowledged my receipt of the refund from my primary in my initial complaint so I’m unsure why that was mentioned. The response to my audit request that I have a $0 balance does not suffice and is another reason I would like this experience on record with the BBB. I would also like to add that the additional info I submitted regarding claims submitted under my maiden name to my primary was a system error, not by fault of FFD. Additionally, the fact that there are duplicate claims to my primary and none to my secondary from FFD are consistent with the misunderstandings with their staff.
  
  

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