ComplaintsforHigh Plains Periodontics & Implant Dentistry

• Initial Complaint

  01/26/2022

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  Both myself and my husband have had dental cleaning done by High Plains Dentistry. I had my teeth cleaned on 3/23/21 and 9/28/21. My husband had his teeth cleaned on 4/7/21 and 7/15/21. Each time the office charged us for what they thought my insurance would not cover and upon receiving the explanation of benefits from my insurance, the amount that they paid to our dentist was always more that the office had estimated. I asked for a statement of charges and an explanation. I never received either. On 3/23/21, I paid $51.60 and the insurance stated I should only have had to pay $27.00, On 4/7/21, I paid $42.60 and the insurance stated I should only have had to pay $27.00, On 7/15/21, I paid $51.60 and the insurance stated I should not have had to pay anything. And on 9/28/21, I paid $99.60 and the insurance stated I should only have had to pay $33.20. I have contacted the dentist office by phone and mail asking for an explanation and refund of the overage. They have yet to even answer me at all. I feel they owe me a combined amount of $158.20 for the year 2021.

  Business response

  08/24/2022

  Business Response /* (1000, 15, 2022/08/24) */ Our estimates are based off of the patient's insurance breakdown that we obtain directly from the insurance. The estimates are never a guarantee of coverage or an exact amount. Every time we submitted claims for the patients referenced above, the insurance company returned an EOB stating that the patient had an "Other Coverage Payment" which we were never provided information on and never received additional payments. The only payments received were from the insurance we had on file. This always left a balance on the patients' accounts, which is why statements were mailed with the remaining balance. If we aren't given the information, we are unable to coordinate the patient's benefits correctly and therefore cannot estimate their co-pay correctly. We never intentionally try to misquote a patient, but the insurances do not make that easy. We have copies of the EOBs showing these "additional payments" if needed and would be happy to supply them for reference. There is a small credit on the account and we will be happy to refund this back to the patient. However, the amount referenced by the patient is incorrect and we would be happy to provide a complete account summary showing all payments received and what is left as a credit on the account. Consumer Response /* (3000, 17, 2022/08/27) */ (The consumer indicated he/she DID NOT accept the response from the business.) This response claims several things that are not true. First, there was no other coverage, so they were not given any info on that. Their EOB showed "other coverage payment". We would like to see those EOBs as our EOBs do not have that. Second, they claim there was a balance left and that was why they sent a statement. We requested statements and explanations as to why they had charged us before treatment more than the EOB stated our portion should have been. We NEVER received any statements! We don't believe there was any more owed, but rather an over payment. Third, when we called and wrote multiple times requesting statements and explanations, we also requested refunds of the over payments each time. We NEVER received ANYTHING! I listed in my complaint the specific amounts we paid and the corresponding amounts the EOB stated we should have had to pay. The total difference over paid is correct at $158.20 for 2021. We could probably go back to 2020 and find they owe us even more, but we will be happy if they would just refund this amount for 2021. Business Response /* (4000, 19, 2022/08/31) */ All of the information stated above in my response is true, and I sent an entire packet via certified mail to the patient on 8/25/2022 and it was delivered on 8/26/2022 to the address on file. This packet includes a detailed letter, a copy of all EOBs from 2021 showing the additional payments, and a complete detailed ledger of the entire account for both patients. It also included a refund check for the amount we had on file as being overpaid. We have not ever "overcharged" the patient and have estimated their coverage based on the information we were given by their insurance. We cannot guarantee an exact amount as the insurance dictates how claims are processed. Their insurance sent us specific EOBs showing an additional coverage payment. That is all we can do is go off of those EOBs. We did send statements to the patients showing their balances, which in return they sent in checks to pay off the balances. I'm not sure why the statement was made that they never received statements as how else would they have known to send in checks to pay off the balances on their accounts? I do not know what else to say here as I have sent all of this information to the patient and done my best to highlight and explain everything. As I stated in the letter I sent, if the patient has any further questions, they are happy to contact me at the information provided in the letter. Consumer Response /* (4200, 21, 2022/09/10) */ (The consumer indicated he/she DID NOT accept the response from the business.) I received the packet of information sent and have reviewed the EOB's. They are the same as I have and I have no idea what GEHA is listing as "other coverage payment" as we have not received any checks for such either. We don't have any other coverage. However, that is not the point of my complaint. As I originally stated, we have paid a total of $158.20 more in 2021 than what the EOB states is "member responsibility". Each time we went in for our appointments, we were charged BEFORE being seen what they determined our share would be. There were NEVER any statements mailed to us afterward even though I called and wrote requesting explanations and refunds. Although I appreciate the ledger of our account, the payments it shows are the ones we made BEFORE being seen for our appointments. If they have sent statements as they claim, they should be able to provide me with copies of such. That was not how they did their business. The payments were made BEFORE services were rendered and not from having received a statement of an amount due. The check that was sent as a refund in the amount of $59.00, although appreciated, is woefully late and still short $99.20.

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