ComplaintsforValley Family Denistry

• Initial Complaint

  02/27/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I've been a patient of Dr ******* ***** for over 40 years. This experience happened on my second visit with his son **** *****. I'm a senior citizen, with a limited budget, I want to be loyal to Dr ***** but always confirm my dental care is in network with my insurance and covered at 100%. --- 11/1-called VFD, receptionist confirmed my insurance accepted. 11/23-Provided receptionist insurance card on arrival, asked receptionist again to confirm. 11/23-I asked dental hygienist to confirm my x-ray coverage, she returned, x-rays were due and they would be covered at 100%. 11/23-Dr. ***** recommended optional, preventative care. I asked office manager, ******* for an estimate. Estimate provided: $109. 11/23-Leaving the office, I was given the impression that the staff had confirmed my insurance (via phone call or electronically) to get correct, up-to-date details on my policy and coverage, that I was in network, and that based on these, an accurate estimate had been provided. 12/15- Told I have balance of $83 from 11/23 (that was supposed to be covered 100%). Office manager said, "I'm very confused, it looks like they should pay, but also looks like they're not. Let me check and I'll call you." 12/15-******* called, "You're actually not in network. You owe us $518.20." I reminded her of the estimate of $109. She was not willing to honor 11/23 estimate. Told to call when received statement. 2/9-Received statement $518.00, called *******, she said, "we've figured out what we did wrong so it won't happen to anyone else." Not willing to honor original estimate. 2/9-2/24-Made numerous calls requesting a call back from Dr *****. No call received. --- I was out of network, my up-to-date insurance card was provided, and I requested an estimate multiple times, they had weeks to verify. I received a bill for over $400 more than the original estimate. Valley Family Density needs to accept their mistakes, do the right thing and honor their original estimate of $109.

  Business response

  03/03/2023

  Patient provided Valley Family Dentistry with her ***** insurance card prior to dental treatment.  Card states that preventive care is covered 100% and Basic Restorative is covered at 80% after deductable.  We estimated patient would owe 0% of work provided on 11/23/22 and 20% if total cost provided on 12/15/22. The total estimated cost of 12/15/22 treatment was $536 of which the patient was estimated to be responsible for 20% or about $109.  The balance or about $427 was estimated to be paid by *****.  The dental work was completed and insurance was filed.  ***** ended up only paing $296 on the 12/23/22 claim, far less than 80%.  Additionally ***** only paid $98 of the $181 charged on 12/15/22 that they were supposed to pay 100% on.  All patients including this patient sign a financial agreement before treatment agreeing to pay any payment not made by insurance.  We gave the estimate based on the information (insurance card) provided by the patient.  Because we are participating providers with ***** we are legally unable to discount any charges that are the patient's responsibility.  If the patient feels ***** did not pay their obligated amount she needs to contact *****.  There is nothing else we can do about the charges or amount owed by the patient.  As a courtesty to the patient we attempted and will continue to attempt to work out a payment plan that works for her.

  Customer response

  03/03/2023

  I have reviewed the response offer made by the business in reference to complaint ID ********, and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.I called ***** today and they told me Valley Family Dentistry does not take my specific ***** PPO plan. VFD claimed they did.  Is VFD still claiming they take my plan?VFD website even says they take "***** PPO". Do they take all ***** PPO plans? If not, why does the website say this? That is misleading.****************************************************** also added that VFD should have known they don't take my plan simply by looking at my card, and that they should have called ***** to verify and for pre-approvals. They had plenty of time and opportunities.VFD claimed to accept my specific insurance plan, gave me the impression I was in network, and that they had checked with my insurance prior to providing estimates. Either that is negligence or willfully misleading me, or both. Which is it? Regards, ***** ****

  Business response

  05/04/2023

  Consumer has a newer ***** PPO plan - PPO Advantage.   She's been a patient so when she came is she gave them her newer plan card.   They can only estimate the cost of service.  It is ultimately up to the patient to confirm with their insurance the business is "in-network" with any new plan.   business does try and verify with insurance what the cost would be but it can take 3 - 6 weeks for the insurance co. to get back with them.

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