Complaints

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• Initial Complaint

  Date:09/10/2024

  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 was referred to Oral Surgery Center and on 6/12/24 I received an estimate from Oral Surgery Center based on referral. My dental insurance was charged for the consultation and **** scans without my knowledge or consent.I called to discuss what services I could afford and was unsure of the remaining benefits amount.I selected the extraction and the discounted implant from the estimate. I was told the pricing difference for the 2 implants was due to what my insurance dictated.I was told I could wait for the second implant until my insurance renews in 2025.On 07/31/2024 I paid for the agreed services at the agreed price, in full, before the procedure, based on the estimate that included the charges for the consult and scans.I had the extraction and one implant for tooth #** as per the estimate dated 06/12/24.I left the office knowing I had paid in full and was thinking about following up in 2025 for the remaining implant.I received an adjusted statement from Oral Surgery Center dated 09/03/2024 for an additional $1387.00 The new statement shows payment of $343.00 from my insurance but doesn't show any of the discounts for the implant or the extraction that had also sown a discount on the estimate.I called to ask about the new statement and ***** said my insurance carrier, *****, requires them to collect the additional charges because all of my benefits had been used.I spoke to Aetna on 09/09/24 and Kailey stated that this is not their policy. I tried to speak with ***** at Oral Surgery again and she will not explain all the details.If you look at the estimate and the new statement the numbers don't add up to what she is stating.The estimate says there's $482 remaining yet they received $343 from Aetna, which leaves $139 to pay for the insurance part of their estimate.The statement then charges back the $42 discount from the evaluation on 06/12/2024.The statement is not ************ can they charge back something they were paid for?

  

  Business Response

  Date: 10/09/2024

  My name is Patricia Anderson and I am a Patient Account Advocate at Oral & Facial Surgery Centers of Washington.  I am responding to a letter/complaint that we received from your office on our patient, Joseph Zaichkin.  Mr. Zaichkin was referred to our office by his general dentist, Katherine Bieker, DDS for oral surgery.  He presented on June 12, 2024 for his initial consultation/exam. At that appointment he was given a benefit quote/fee estimate for an extraction and placement of two implants, as per the referral.  Mr. Zaichkin did not schedule at that appointment but called back on July 8^th and scheduled surgery for the recommended procedures for July 19, 2024.  On July 9^th, the next day, he called and moved his appointment to July 31^st and stated that he only wanted to proceed with the extraction and one implant at the present time.  He was then quoted a revised “estimate” for the requested surgery. Surgery was performed on July 31^st.  His benefit quote for that surgery was estimating that Aetna would pay $139 (benefits remaining) and his portion would be approximately $1508, after required write offs, which he paid. At that time, Aetna was showing that he still had a remaining annual benefit maximum left of $139. Aetna insurance will allow and require the preferred provider discount on an individual procedure as long as they paid on that procedure and benefits are remaining.  However, we were not aware that Mr. Zaichkin still had outstanding claims with his general dentist that had not been processed by Aetna. 

   

  When our claim was processed on August 7^th, his annual benefit maximum had been utilized by his general dentist’s claim. Because of this, Aetna dental plan did not give the patient the contractual write off or pay what was anticipated.  Mr. Zaichkin called on September 9^th very upset that he had received a statement. It was explained to him in detail what happened and why he had a remaining balance.  He did not understand or want to hear what was being explained, so he was directed to call his insurance for further explanation to help him understand.  Later that day Edna from Aetna Dental MedAdvantage called on a 3-way call with the patient and myself. The same explanations were discussed and Edna confirmed and told Mr. Zaichkin that the remaining balance was the patient’s balance and responsibility in full. He was still not happy and insinuated that we were not doing things right and were scamming him. He also stated, with Edna on the phone, that he was not going to pay the bill so we might as well turn him over to collections now. I apologized for his misunderstanding and the phone call ended.

   

  Our benefit quote/fee estimates do state…”I understand the above is only an estimation of my total coverage. Oral & Facial Surgery Centers of Washington cannot guarantee my insurance coverage as other claims may not be processed or changes in coverage may have occurred.  I agree to pay any difference in the amount I have been quoted.”  Mr. Zaichkin did sign the estimate at his initial consultation/exam.  At no time was Mr. Zaichkin told that his $1508 payment was payment in full.

   

  If you need any additional information, please feel free to reach out to me with any questions at 253-445-0022 Ext 107.  Thank you for hearing this response. 

   

  Patricia Anderson  

  Patient Account Advocate

  Oral & Facial Surgery Centers of Washington