ComplaintsforNorthpointe Family Dentistry

• Initial Complaint

  12/18/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  This is ******* and have been using Northpointe Family Dentistry located at 8591 Ownefield Drive, Powell, OH 43065 for our dental needs. I received a bill from them in the amount of $148.60 without any itemization/breakdown for the type of service performed. Whenever I ask for clarifications, they say that “Dental claims for insurance is more complex and we don’t receive the itemized cost from insurance and thereby we cannot provide you in detail”. Therefore, I calculated on my own the amount that I owe based on insurance claims and the amount that I paid at the time of service. I would like to split the cost of service in two parts for easy understanding. 1. Differences between the amount paid during our visits and the actual cost of co-pay provided by insurance Description Amount I paid in excess during my visit $37.2 My wife owes to Nortpointe dentist during her visits $5.8 Amount dentist owes me $31.4 2. Date of service Description Billed Member Rate Notes 19-May Panoramic X-ray not covered by Insurance $128 $55 I am willing to pay this amount ($55) 6/25/2021 Corebuildup W/pins $308.00 Insurance instructed me not to pay this amount. Refer the claims note in the attachment Amount dentist owes me (Refer previous table) $31.4 Final amount I owe $24 I tried to explain this to them in person but they are not willing to listen and they are coming up some random amount which they are not able to explain. When I asked for more clarification, they disrespected me. It was a very rude behavior and an unpleasant experience for me. I hope it can be resolved in good faith. In the attachment: 1. Bill received from Northpointe dentist ($148.60) without any itemization/breakdown for the services 2. Summary of payments during my visits, proof of my payments from my credit cards and snapshot of the insurance claims for me and my wife.

  Customer response

  12/20/2021

  ---------- Forwarded message ---------
  From: *********** ********** <************************>
  Date: Mon, Dec 20, 2021 at 2:22 PM
  Subject: Complaint ID:******** -- HIPAA Signed form
  To: [email protected] <[email protected]>
  
  
  Hello,
  This is regarding the complaint ID:********. Per instructions I am attaching the signed HIPAA form.
  
  Thanks,
  *******

  Business response

  12/30/2021

  December 29, 2021

  
  Re: ********

  
  To whom it may concern;

  
  I am writing in response to the complaint filled December 18, 2021. This patient has a dental insurance plan that many
  offices do not accept. Cigna DHMO has multiple coverage books. We have set our system to make the estimates as
  accurate as possible while reflecting each individual plan. We have seven different plans within the DHMO with a wide
  range of coverage. This plan makes a bulk payment for patients seen for all seven plans within one report. The report
  with the payment is not calculated. Therefore, each payment per patient is added, while processing payments. This
  process is extremely tedious for the most detail-oriented person. The patient was upset that when I gave him a copy of
  the (explanation of benefits) EOB, he could not understand it.

  
  He had called multiple times prior to coming in on that Saturday, I had called Cigna, because he was telling me that he
  was not responsible for the x-ray or buildup that they had declined to pay. Depending on who I spoke with, I would get a
  different answer. The following Monday, I called his plan again and informed them of the issue that the patient was
  having with me. I told them we needed to get the issue cleared up.

  
  After speaking to them on Monday, December 20, 2021, I adjusted the account to reflect the patient portion for the
  build up and was told that I would need to write off the amount for the x-ray. I emailed the updated statement to the
  patient and he paid the small balance online.

  
  Cigna had reached out to the office late 2019 and we started taking this plan January, 2020. We have put systems in
  place to make this as clear for patients and ourselves. I called provider relations after receiving the complaint to let
  them know and to ask if they could make changes to the way they send the payments and the explanation. I sent a copy
  of a report so they could see what I am working with. If patient is responsible for 100%, the items are not on the report. I
  explained that this makes it look as if we did not bill. We used the insurance portal to cross reference and found that
  the information given is misleading and not accurate. I am currently working with Provider Services to address the issue.

  
  I informed the patient that he is more welcome to find an office that will handle his plan better. However, I assure you
  that we take the time and care about our patients and will use this as a learning experience.

  
  Sincerely,
  Office Manager

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