Complaints

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• Initial Complaint

  Date:12/10/2023

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I called your office and made an appointment to look at a crack on my tooth. The Dr. advised me that my crown broke and needed to be fixed. She indicated that it was not an emergency. She indicated that she had time to do it at that appointment. I said I had the time but needed to understand the costs involved.While I was sitting in the dental chair for about 20 minutes, a staff person, who apparently no longer works there, went to check what my costs would be. She came back after reportedly checking with my insurance company and advised me that the crown would be covered and that I would be responsible for 50%, about $600. I agreed to have the work done based on that information and signed your paper outlining your estimate procedures.Unfortunately this was a serious error on the part of the person who no longer works there. The result of her error is $850 difference for me.It stated clearly that Prefabricated stainless steel crowns are coveraged at 50%. Nothing about porcelain at all was written. If someone checking does not see the key work pertaining to the work to be done, it is their responsibility to contact the insurance company and verify.In my case, I might have chosen to either get prices from other dentists, or secure different dental coverage that provided better coverage for porcelain crowns, if I had known that porcelain was not covered.I was clearly mislead and misinformed.This error is your responsibility, not mine.To try to charge me an additional $850 when the error was from your office, and I was given completely wrong information is extremely unethical.My insurance company indicated to me that the way your staff person verified my insurance was insufficient, not standard practice, and poor practice. My insurance company indicated that I have been treated unjustly and that it is unethical to charge me for your staff error.

  Business Response

  Date: 12/20/2023

  Patient presented to our office for a limited emergency exam in regards to a broken front tooth. His appointment was scheduled at 4:30 pm on Tuesday july 11, 2023.  I performed an examination, took xrays and did a clinical exam. 

  After I performed the examination I determined that a large portion of the existing crown was broken and a new crown would be necessary to restore the tooth. The situation was viewed as an emergency in my mind because it was a front tooth that was broken and patients don't want to present in public with broken front teeth, therefore it seems that it was urgent to have it fixed. Since there was time allocated in our schedule and we could perform the treatment,  I asked the patient if he wanted to have the tooth fixed on that day. We gave him an estimate in good faith after we pulled and reviewed the insurance ***************.  The online insurance benefits were reviewed and we believed in good faith that the insurance would cover 50% of the front crown. 

  We presented the treatment plan and had him sign a consent form (see attached from) in which we explain that we try our best to give accurate estimates, but these are only estimates and there are no guarantees of actual payment. It is the patient responsibility to pay for whatever the insurance doesn't cover.

  Patient said we didn't do our due diligence to call the insurance company to find out more details. His appointment in our office was at 4:30 pm.  ******************** was closing at 5 pm on that day.  By the time we took patient in, reviewed medical history, took xray and performed the exam, it would have been too late to call the insurance on the phone.  They would have been closed for the day, even if we were to call them.  We pull the information online, which is common practice in dental offices.
  

  The patient portion was estimated at a roughly $700. 
  
  Patient wanted to have the tooth fixed on that day, so we proceeded with treatment. Unfortunately the insurance did not cover any part of the crown because they had a clause that they do not cover porcelain crown and they only pay for stainless steal crowns.  They would have only covered 50% of a crown made of stainless steal.  However, a stainless steal crown is not standard of care for a front tooth. We did not have the information that porcelain crowns were not covered.   

  The insurance deemed the patient ultimately responsible for the entire portion of the crown. Per the insurance company, the new patient portion for the crown was supposed to be $1761. 

  However, since there was a misunderstanding and the estimate was not correct we thought it was a fair resolution to extend to patient the courtesy of offering the discounted insurance contracted fee of $1093 for the crown, instead of the full fee of $1761.  So in the end, we asked the patient to meet us half way and pay $1093 for the crown and not $1761 that the insurance suggested. 

   

  Thank you,

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

  
  
  

  
  

  Customer Answer

  Date: 01/09/2024

   
  Complaint: 20986834
  
  I am rejecting this response because:

  1. This was not an emergency which was confirmed by my regular dentist. Concerns about presenting in public are cosmetic, not emergency! I had no pain and no difficulty eating. 

  2. The 50% coverage that the dentist "believed" would be covered is exactly the problem as it stated very clearly on the website that 50% coverage was only for steel crowns, not the porcelain crown provided. The proof was reportedly put in my chart and requests to see my chart have not been granted. The dentist proves my point when she states that steel crowns are not typically used on front teeth. Porcelain crowns is not mentioned on my insurance benefit page at all.

  3. The only reason I chose to do the procedure on the same day was because I was told, incorrectly that I would be covered at 50%. Had I known I would not be covered I would have waited and explored my options.

  4. It was clearly a mistake of the dentist's staff and therefore the dentist should not charge me beyond the 50% that I already paid. I actually could have changed my insurance policy and received 50% coverage for porcelain, as per my insurance company, had I been advised properly.
  
  Sincerely,
  
  ************

  Business Response

  Date: 01/30/2024

  I have already answered to patient's complaint in my previous reply in December 2023.  Unfortunately there isn't anything else I can add to my original response. I understand the patient disagrees with the outcome of the situation but I have nothing further to add.  I'm sorry he feels the way he does, and that his insurance did not cover the crown, like we believed they would. Ultimately the insurance plan is a contract between the patient and the insurance.  We try to get all the answers, but unfortunately there are clauses sometimes that are not disclosed upfront and are omitted by the insurance.  I wish him the best.

  Customer Answer

  Date: 02/06/2024

   
  Complaint: 20986834
  
  I am rejecting this response because:

  The dentist states there is nothing else that can be done but that statement is both incorrect and again not showing good faith. The dentist office staff made a serious error that cost me a significant amount of money. The dentist should only charge me what she originally quoted based on the staff review of my insurance. The amount that I paid over that should be refunded to me.

  Dentist offices are rated for the skill of the dentist, but also of their integrity and ethics. The staff the dentist chooses should reflect the same integrity and ethics. When staff makes errors ethical dentist should correct errors and treat patients fairly.
  
  Sincerely,
  
  ************