ComplaintsforKindle dentistry

• Initial Complaint

  06/07/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On my first visit, the front desk lady said my insurance was not active, so I pulled up my insurance information on my phone proving it was active and she says she will call again to verify. She calls, verifies that it is active and says oops, I must have misheard the first time I called. I went in for a maxillary partial denture that I needed and I asked if I prepaid for it, could they still submit a claim to my insurance company and would I get a refund on the amount my insurance company pays, the lady said yes, so I prepay close to $600. I wait for a month and I get no calls, no emails, nothing. So I called my insurance company and asked a representative if my dentist submitted a claim and they tell me no. I then asked if my insurance benefits cover a maxillary partial denture and the rep said yes, 50%, then I asked can my dentist still submit a claim for a procedure already done and she says yes, dentist has a year to submit a claim from the date of the procedure. The next day I go to the dental office and spoke to the billing lady and she lied to me saying that my insurance doesnt cover partial dentures. When I told her yes they do, I spoke to a rep from my insurance company, she lied again and said oh, well, I meant they wont take a claim for a procedure that has already been done. I said Yes they will, the rep said you have a year to send a claim from the date of the procedure. She responded with Oh, you actually spoke to someone at your insurance company? I said yes. So she grabs a claim form and fills it partially out in front of me and says she will submit it that day. 4 weeks later I get a letter from my insurance company saying they are denying the claim because they dont cover miscellaneous procedures. I looked at what *** billing code that lady at the dental office put on the claim and its a code for a miscellaneous procedure, not the correct code for a maxillary partial denture. She put the incorrect billing code on the insurance claim.

  Business response

  06/26/2023

  To whom it may concern:

  This is the responce for the recent complaint # ********. On March 3, 2023 patient came to the office for limited exam/ consultation in  getting a Flipper for tooth #7, before they start the treatment, front desk personnel and dental assistant was in the operatory room to explain to the patient about getting a flipper is not a covered benefit with her insurance, patient agreed to pay how much it cost. And for the peace of mind of the patient the front personnel went ahead and submit a prior authorization for her flipper # 7 even though she knew that is not a covered benefit. On March 31, 2023 patient came back to the office for comprehensive examination and prophylaxis and at the same time the provider went ahead and deliver her flipper. On April 4 patient supposedly called and left a message asking about her insurance if they approved the flipper or not and if she will get a refund, at the same day front desk personnel call her back to let her know that the prior authorization for flipper was DENIED because it's not a covered benefit but no answer. The patient complained to BBB about maxillary partial denture where this kind of treatment is different from flipper. The patient only missing one tooth (#7) so the provider gave her only two options which are to get a flipper or a bridge from #6-8. NO upper/maxillary partial denture was discuss to the patient only flipper due to that she only miss one tooth in the upper arch.

  Customer response

  06/27/2023

   
  Complaint: 20154162
  
  I am rejecting this response because:

  No one from this dental office spoke to me about the flipper being not covered by my insurance company until after I spoke to a representative from my insurance company myself. Flipper teeth ARE covered by my insurance company and I confirmed it with a representative FROM my insurance provider. I also confirmed the exact billing code that was supposed to be input on the claim WITH that representative from my insurance company. The maxillary partial denture is the correct billing code that was supposed to be used for the procedure that was done on me on March 3rd, 2023, which the dental office did not use. I should have looked at the reviews for this dental office before going to them, as insurance fraud is a common practice there. 
  
  Sincerely,
  
  *************************

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