Complaints

• Initial Complaint

  06/13/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On March 6, 2023 I had an appointment with the dentist and was charged $77.00 plus $3.00 tax for a total of *****. The clerk in the office said my insurance company never heard of me even though I have an active case and gave her my original insurance card. I had to pay on my credit card card and she told me to file the claim myself. It was denied because the form was not filled out correctly. The insurance company stated the dental office had to file the form not me. Finally the claim was paid by my insurance with the check going to the dentist (he was paid by me and the insurance company). When I asked the insurance why they paid him, they said he was in their network. I waited for reimbursement, but nothing came in the mail so I called. The clerk stated the check would go out on June 6, 2023, the day I called. I waited finally called again on June 12 and was told the accountant was sending it out on June 16. I am so frustrated by the whole matter. Please help. The amount paid by the insurance was$55.70 and it has been withheld from me due to errors made in the dental office

  Business response

  06/13/2023

  ***************** was visiting ******, from ********. She called with an emergency, and we fit her into our schedule  right away. During check in the patient filled out her insurance information.  The form was incomplete and did not have an ID number. Our office tried verifying insurance information with her social security number and were unable to get any insurance verification. Because we were seen the patient on emergency basis and does not live on the Island. We informed her that we could still see her, but the visit would have to be paid up front. We recommended that once she can figure out her coverage, she would be able to file a claim with her Dental Insurance.   
  On May 24th we received the correct information for her Dental information, in which we were able to verify her coverage. The claim was filed on the same day as insurance verification. (See insurance verification attachment.)
  On May 31 we received payment from Delta Dental of ********. 
  On June 5, 2023 We informed ***************** a refund would be issued.  Our accountant is in twice a month,On 31st  and on the 16th a.m., Because her Claim was paid on the 31st  after the accountant was in the office. Her refund would have to follow until the 16th.
  On June 12 ***************** called inquiring about her refund, we stated it would be send out on the 16th but patient is hard of hearing and was adamant that we said the 6th.  We repeated the 16th and specified numbers 1, and 6 but ***************** kept repeating her self that it should have been received if it was sent on the 6th.  **************** was verbally abusive to our office staff, calling us thieves, cussing out and calling the accountant lazy and cant get out of bed to go to work
  Our office has been compliant and has not been withholding any funds from the patient.  Services have been provided in a timely matter and patient was notify when the check would be processed. Our office gives great service to our patients. Statements can be verified from our ****** reviews. We are requesting this claim to be removed from the records as patient statement is based of off a miscommunication. 

  Customer response

  06/13/2023

   
  Complaint: 20177860
  
  I am rejecting this response because:Their response is a bunch of lies.  It was not an emergency to me, it was their perception. They expected me to fill out the insurance form when they had all my information on my dental card and withheld it from me. Later after the appointment they said I had to file when they already had called and gave the incorrect information to the insurance company, that is why the insurance company stated they didnt know me.   After calling them several times to get codes, doctors information, the insurance company denied my claim stating the dental office had to submit the form.  Finally the claim was approved and dental office received the check.  They didnt notify me they had my money and I had to call using my caption phone to record the conversation. My caption phone records both sides of the conversation.  Finally the clerk admitted the check would be going out on June 6.  My caption phone records both sides of the conversation so I know the clerk have the wrong date.  I was not abusive only stated the facts which they didnt like. Its too bad the dentist couldnt do anything to help me and then to go through the frustration of errors on the part of the dental office 
  Sincerely,
  
  ***************************

  Customer response

  06/16/2023

  I just found out that Lihue dental is in the delta insurance network and the dental is also in the network and so is the ******* ********* dental office is responsible for filling my insurance claim after making a photo copy of my insurance card
  

  I was given the erroneous information when they said they couldnt find me on the system  and told me I had to file my own claim.  Now they are withholding my refund money. Please help.

  Sent from Hedy's iPhone

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