Complaints

• Initial Complaint

  05/08/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On February 7, 2024 I went to Narcoossee Dental for an annual appointment, check-up and cleaning, same as I had last year that was covered 100% by my insurance except a cancer scan where they asked me if I wanted it to have done, which I agreed and paid for it.When I was checking out they told me I owe $10 which I asked why if my annual check-up is cover by my insurance 100% and the ** staff told the that it was for some x-rays the insurance did not cover and I paid the $10 even thought I was not aware of that service not been covered ahead of time.Today May 2,2024 I received a phone call from the office trying to collect $40 that was outstanding in my account because the insurance did not cover the x-rays and it falls on my deductible therefore I was responsible for. I asked why I was never informed that I was having a set of X-rays my insurance did not cover 100% and at first they said they did not know what the insurance cover and what wasn't. Then I was told by another staff member that they did have the confirmation of the insurance that it was going to be cover, but when the claimed was submitted they denied the payment for 100% coverage and it was subject to my deductible. Different versions of what I consider is unfair to a patient to not provide the correct information ahead of time before the services are done. They can't pretend that a patient will be always responsible to pay for something that was not requested or agreeing by me with the excuse that I signed a document where I was responsible for amounts insurance wouldn't cover. I expected to have the same services I had last year; and if they were doing something different that was not covered and I would be responsible to pay for; as a patient I had the right to know and make my decision if I want it or not.

  Business response

  05/22/2024

  To whom it may concern:
  ******************************* was seen for the first time on January 23,2023 for a comprehensive exam (D0150), on which day a full set of images (D0210) was taken as standard of care for a new patient. This set of 18 images is taken on New Patients and is retaken every 5 years to update patient records. Patient was seen again on August 09, 2023 for a prophylaxis (D1110).This cleaning is provided for healthy gums every six months. On February 7,2024, ******************** was seen for her yearly checkup. On an existing/established patient, a periodic exam (D0120), four bitewings (D0274), and two periapical images (D0220 and D0230) are taken to diagnose any changes in bone levels and detect decay. Bitewings alone are not sufficient on recare (routine visits) as these only include premolars and molars. Periapical images of the anterior teeth are required in recare visits to diagnose any changes in the front teeth.Procedures performed are standard of care for a returning patient in a dental establishment. Billing to insurance is a courtesy to patient. Verifying insurance is also a courtesy to a patient, just as it is in any medical establishment. Patients are responsible to know what their coverage is and any out of pockets they may have as also expected in a medical facility. We do, as a courtesy, an estimate of their copays for their visits. We bill insurance and any remaining co-insurance is billed to patient thereafter. When verifying co-insurance for patients visit on February 7, 2024, we were not aware her deductible would apply to preventive and diagnostic. Many dental plans waive deductibles for diagnostic and preventive services. Her policy did not waive any deductibles for the routine visit.
  Just as any medical practice, patient is seen; a statement of completed services is billed to insurance and any uncovered portion or deductible not satisfied is billed to the patient. In our practice, we send two statements and provide a courtesy call to discuss any questions the patient may have regarding their bill. If they have questions of their insurance policy, we go over as best to our knowledge and refer them to call insurance as well. When we called ********************, we asked her if she had received any of our statements and wanted to see if she had any questions. She proceeded to yell at our staff saying she was not going to pay her bill and hung up. She then called again upset regarding this bill; we tried to explain that this is a policy guideline of her coverage.  Unfortunately, she only yelled over the phone and did not allow us to explain any further. Deductibles and co-insurances are patient liability and based on the benefits they have with their plan. As in any medical facility, benefits are never guaranteed because insurances do not guarantee that the benefit information is accurate for coverage or payments of services. We can only do our best for our patients to estimate as close as possible to what their out of pockets are. If you require any other information, please contact us during our business hours.
  
  
  
  *********************, DMD

  Customer response

  05/22/2024

   
  Complaint: 21656609
  
  I am rejecting this response because:

  I was never informed that what they were doing on my annual check up include images that the insurance may not cover or fall under deductible. They stated that they call as courtesy to the insurance plan to confirm if the patient is covered. For my understanding and for what my insurance company told me, it is their responsibility to call ahead of time to confirm the insurance and benefits information and provide the patient with any uncovered service before they are performed. This is a very poor response to expect the patients are responsible to pay uncover amounts without notifying them it was not included under the plan, and even more to expect the patients to know what billing codes are cover by insurances.

  I have used my dental insurance for years and at every office I have went, all annual preventive check-*** are covered 100%, if they decided to do something they though it will be beneficial for my oral health they should have discussed that with me before and let me make the decision.  

  
  Sincerely,
  
  *******************************

*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. ↩