ComplaintsforMountain View Pediatric Dentistry

• Initial Complaint

  04/30/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  A year ago my son had cavities filled and a broken tooth removed. I was quoted a price and told they over estimate so there’s no surprises. I kept track of the time he was in the office as they bill for anesthesia by 15 minute increments they ended up charging me hundreds more than they should have and I worked that out with the anesthesiologist separately after her harassing and verbally assaulting me for an entire day over text messages that I still have. I paid for all of the service up front. Months later I start getting several bills each saying insurance paid less than expected but I called my insurance and it’s not true, and the amount I paid up front was accurate. After calling several times and then sending collection notice I sucked it up and paid. Now today OVER A YEAR later I’m getting another bill yet again stating insurance paid less than expected and I owe ANOTHER 86$. This office is committing double dipping fraud by collecting payment both from insurance and myself and still trying to get more. If this is not resolved I will be filing official complaints for fraud and seeking out legal advice. The doctor is phenomenal but billing fraud is not acceptable in any way, unfortunately we will never return to this facility and I’m here to say I will not be bullied into paying fraudulent charges.

  Business response

  05/18/2022

  Good Morning,

  Thank you for sending us the information regarding the complaint against our pediatric dental office.  We take any complaints very seriously.  I apologize for the delay responding to you.  We were doing an audit on the account and discussing the case with the CRNA  office used during the IV sedation mentioned in the case.  

  
  

  We are a pediatric dental office with two locations.  We actively strive to give the best care and service to our patients and their families.  Because we work with young patients who can be fearful and not cooperative for needed procedures we utilize different types of sedation to help make the experience better for the child.  On this particular case we felt in office IV sedation would be best for this patient.  Risks and benefits were discussed with the mother and she consented to in-office IV sedation.  

  
  

  On the initial exam we recommend 7 white restorations and one tooth to receive a stainless steel crown and to do a pulpotomy which is cleaning out some of the affected nerve.  On the day of the IV sedation appointment new x-rays were taken because the x-rays taken at the initial exam were more than 3 months old.  These new x-rays revealed the tooth that had recommended to have a pulpotomy and crown was now abscessed and need to be removed and a space maintainer placed to prevent teeth from shifting.   The change in treatment plan with recommendation was discussed with the mother and she gave the approval to proceed with the change. 

  
  

  The case was estimated to take 60 minutes for dental working time.  The anesthesia billing portion begins as soon as the patient receives the sedation medications.  In this case the patient received the medications by an intramuscular injection.  After the injection is given it typically takes 3-5 minutes for the sedation mediation to take effect and for the patient to be brought back to the treatment room.  Once in the room the CRNA applies monitors, positions the patient, puts the patient on oxygen and prepares them for us to start the dental portion.  Once the patient is ready we take x-rays, do a thorough exam and adjust the treatment plan as needed.  Once all of this is completed then we begin the actual treatment.  Once we complete treatment the patient is monitored and prepared to be moved into the recovery area.  Once the patient is moved to recovery and not directly under the observation of the CRNA the anesthesia billing period ends.  According to the notes from the CRNA the anesthesia period began at 11:20 and ended at 13:10.  

  
  

  I was unaware the patients parent was unsatisfied with the IV billing until later in the day.  According to the CRNAs record the patient was under their care for 110 minutes, every 15 minutes is a $75 charge.  I received word later in the day the patients parent had called the the CRNA office to contest the charges.  The person she spoke with is a CRNA but not the CRNA who treated her child that day.  The CRNA on the phone didn’t understand the situation completely without looking at the records and was currently at their sons lacrosse game.  According to the CRNA who was on the phone with the parent, the CRNA told her she would have to look at the paperwork before she could give a reasonable answer.  According to the CRNA the parent told her to “**** Off!” and hung up the phone.  The CRNA and the parent began texting each other at some point.  Once the CRNA looked at the anesthesia records she reduced the charges which were put on Care Credit  by $75 and then issued a refund check to the parent for $100 because the mom was so distraught according to the CRNA.  

  
  

  Working with insurances in based on estimates.  We bill the patient what the insurance estimates will be covered.  Once we submit the information to the insurance it can takes weeks to months to receive payment and explanation from the insurance company.  The families primary dental insurance is a prevention plan only. This simple means they only cover preventative procedures and not dental treatment such as restorations or crowns or extractions.  This patient also had a secondary insurance so after we submitted the information to the primary insurance we had to begin the same process with the secondary insurance.  If there is an additional balance at that point we forward the information to the family for payment.  We wish we could give every patient an exact amount owed but unfortunately that is not realistic with insurance companies, especially when working with a primary and a secondary insurance company.  The bottom of every signed treatment plan reads, “Treatment Plans are Estimates Only.”  We want to give the best care we can not only in our clinical care but our front office systems as well.  On the day of services we took 4 additional x-rays of the patient.   These x-rays were not covered under the patients insurance plan so we wrote those off $123 worth of x-rays for the patient on the day of service.  

  
  

  I can see how she is frustrated, charges that are different than what the estimates expected.  According to the CRNA there was a complaint with the BBB against them also.  The CRNA refunded over $175 worth of anesthesia time.  Our office wrote off $123 worth of x-rays without being asked.  We followed routine insurance billing procedures for this case.  I feel badly the family is so frustrated with the outcome.  As we have audited the case we feel we followed insurance billing protocol. been as timely as we could based on the primary and secondary insurances we were working with.  We feel badly the patients parents wasn’t happy but from a dental standpoint we are following the systems within the dental insurance system.  In regards to the anesthesia billing they are an outside company who bills independent of our dental services.  If feel badly the mother and the CRNA with the anesthesia company had such a bad interaction between them.  

  
  

  Thank you for your patience while I shared this,

  Cam

  
  

  Fellow of the American Board of Pediatric Dentistry
  Mountain View Pediatric Dentistry
  *************************
  Pleasant View ************ (****)
  Farmington ************ (****)
  www.themoosedentist.com

  Customer response

  05/18/2022

  
  Complaint: ********
  
  I am rejecting this response because:

  I was told by the office the X-rays were covered. They did them and I never heard anything of it until they tried justifying the bills coming months later then they said they have already done enough for me because they didn’t charge me for it. I did tell the anesthesiologist to **** off because she called me a liar when I have time stamped proof of how long my son was under sedation she also proceeded to “taunt” me by telling me if I was a good month er or a good person herself and the office would have done ALL of my sons procedure as a charitable write off but because I was calling her at her sons sports game and making a big deal of the situation I’d get nothing. She proceeded to text me saying similar things. Now this specific complaint is not about anesthesia or that woman, it is about the bills I’m receiving a year later. I also did not have secondary insurance which I told them multiple times as they would not remove it from my sons billing file. I paid for ALL of his procedure up front over 900$ It was not a quote it was a bill I paid on site the day of the procedures. Months later I receive more bills 3 to be exact all of different amounts adding to over 100$. None of the bills have an explanation or a code they all say “insurance paid less than expected” that’s it. I called the office on these bills which ended in them telling me to pay or send it to collection, I told them go ahead. Around November my husband got a Christmas bonus from his job and I used it to pay these bills anyways and be done with this office. I’d be more than happy to provide proof of payment. But now once AGAIN over a year later they send me yet another bill for over 80$ still no description, or service code only “insurance paid less than expected”. I paid my dues and what was refunded to me already me (by the anesthesiologist NOT this office) was a rightful refund of overcharge, and I in fact did mention it before I left the office and was told they do not handle anesthesia fees as the anesthesiologist is an independent and not apart of the practice. I am not asking for a refund or free dental work, I’m trying to have this office stop scamming me for more money over a year after a procedure and after I’ve paid all fees Up front on top of the mysterious “insurance paid less than expected” costs from November. 
  
  Sincerely,
  ***** *******
  

  Business response

  06/08/2022

  Good Afternoon,

  Thank you for sharing the customers response with us.  I’m sorry she isn’t satisfied with our response to the situation.  We have always tried to do business as ethically as possible, always. This situation is no different.  Insurances, especially when a patient has dual coverage can sometimes be a little complicated to navigate for an office but even more so for an individual who doesn’t work with insurances on a daily basis.  

  
  

  The concerns with the anesthesia provider are difficult because we use the anesthesia provider to help us provide sedation while we do the dental treatment.  They are typically separate charges but Care Credit was involved with this case.  Because this particular anesthesia provider doesn’t take Care Credit we ran the anesthesia charges though Care Credit.  The discussions between the person filing the complaint and the anesthesia provider are affiliated to the complaint but not directly affiliated to her claims to our billing practices.  The insured stated she has stamped proof of how long the her son was under sedation.  This may be difficult to calculate because anesthesia “begins” when the intramuscular injection is given and “ends” when the patient is taken to the recovery area.  The parent is not present for most of the process and wouldn’t know the time we moved the patient into recovery to “end” anesthesia.  She has stated she has the information time stamped but I’m not certain what she is considering the begin and end time of anesthesia.  Our anesthesia provider goes off the intra-operative records they keep during the procedure.  

  
  

  The person filing complaint stated in her letter she told us multiple times she doesn’t have two dental insurances but we have two insurances on file and have worked with them both to help get her claim paid.  I’m not certain where the confusion is on this topic.  Because there are two insurances we have to submit the claim to the primary insurance, which is a preventative plan only, and have them deny the claim. This process can take up to 1-3 months.   Once the primary dental insurance has denied the claim we can submit the claim to the secondary insurance for payment.  This can take an additional 1-3 months.  This is the process we followed.  

  
  

  After this process was followed she states she received additional bills with the explanation, “insurance paid less than expected.”  This is very typical of the insurance industry unfortunately.  Our estimate, which she paid on the day of treatment, was based on insurance estimates.  After the claim had traveled through the primary and then secondary insurance any unpaid balance is the responsibility of the insured.  We have a signed treatment plan from this family where we state the cost of the treatment plan is an estimated amount.  We can only provide estimates when working with insurance companies.  Because we submitted claims to two separate insurance companies explains why the process took months.  Once the both insurance companies reviewed the claims, denied or paid on the claims and then communicated with us, we were able to submit the final amount to the insured.  We are not doubting the insured made a payment on the day of service, we have record of that payment.  We are trying to explain that was not the total for the treatment provided after the claim was submitted to both insurances.  Did she make another payment other than the day of service?  If so, can she provide a copy of that payment because we do not have any record of any additional payments.  

  
  

  To verify our records our front office spoke with their insurance representative.  We have a written explanation of benefits from their insurance company and we have verification from their insurance company that our records are correct.  

  
  

  We take claims of “scamming” and “double dipping” very serious.  This is not how we operate.  This is not who we are.  Yes, I do agree the final statement got to the insured later than I would have preferred but the timing does not change the balance due.  The insured has already spent an immense amount of time and emotion making her case against our office.   Our office has also spent a great deal of time researching her complaints and claims with her insurance company.  After deep investigation we do not feel we have done anything fraudulent or out of the normal insurance billing practices in dentistry.  Arguing over the disputed amount is not worth our time of theirs.  It appears both parties feel they are in the right.  I would propose we write off the unpaid balance on this patients account and this family finds a new dental office.  

  
  

  Respectfully,

  Cam Q***** 

  
  

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩