ComplaintsforSouth Penn Dental

• Initial Complaint

  08/17/2022

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  I went to South Penn Dental to a cleaning done this is the second time I go there. The first time no issue with billing. Scheduled the second cleaning after the first gave plenty of time to check my insurance and to notify me if there was any issues with billing. Appointment was made on April 18 2022 got the cleaning done on that date, now I'm notify Metlife my insurance didn't cover the cleaning, I'm being charged for the cleaning and interest on top of that. I asked them why I was not informed of this before the cleaning was done and they couldn't answer this. Please help

  Business response

  08/31/2022

  Good afternoon, Our office made initial contact with ***** on 06/24/2021 at 1:20pm- scheduled on appt for 10/11/2021 at 2:00 pm.  At that time, insurance was verified and found to be active.  ************* policy was checked again prior to the appointment on 09/27/2021 and found to be active.  The patient was seen on 10/11/2021, he pre-appointed for his second bi-annual cleaning and checkup for 04/18/2022.  Prior to the April appointment, his dental insurance was verified on 04/04/2022 and was found to still be active under the same employer group.

  At the completion of his 04/18/2022 a claim for services was submitted to Metlife Dental.  On 04/20/2022, our office received notification from Metlife dental that their payment of $82.00 for the services was applied to the patient's $100 deductible. Per the guidelines in our contractual agreement with Metlife, a statement was submitted to the patient. 

  Our office felt the claim was processed incorrectly by Metlife and made contact with both Metlife and the dental insurance network ************************.  ************************ indicated that they would send a message to their Metlife liaison to have our network status updated and the claim reprocessed.  *****************, the provider of services was in network since she joined South Penn Dental in 10/2021. Metlife processed *********************' claim out of network (which is why he had a $100 deductible), stating ********** wasn't in network until 05/2022.  Because this information was incorrect, we sent multiple notices to ************************ and Metlife Dental to have the claim reprocessed for the patient.

  At this time, our office as exhausted all options and resources available.  The issue lies between the patients dental insurance and their network. Per state insurance commission regulations and our contractual agreement, we are legal required to bill the patient for his $82.00 deductible. 

  Kindest Regards,
  

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

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