Complaints

• Initial Complaint

  10/14/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Service provided January 19, 2024 that was covered by my insurance plan. Oasis dentistry staff claimed the plan did not cover services and I was charged out of pocket (routine cleaning, X-rays, and occlusal guard). On 06/05/2024, before my sons second cleaning of the year in August, I confirmed with the plan booklet and member ***resentative (who also directly called dental office and provided confirmation of coverage) and was told the information would be passed to billing specialist. No contact from anyone at the office until 08/15 when I called to let them know the claim was denied and EOB was sent on 07/11. The billing specialist claimed to never have received it and stated she would resubmit claim. After speaking with member *** again on 10/14 (after months of denials) they informed me the claim was denied again on 10/04 due to the missing information (same reason as previous denials). The billing specialist is now claiming to have done everything she can and suggests I reach out to **** (who informed me it is she who needs to reach out to provider line for help). I dont see a resolution in the future without help from someone like BBB. It seems the billing specialist is determined to blame the insurance company and the insurance company is determined to blame the billing specialist (although they paid a claim from 08/09/2024 for his routine visit). I also filed with *** per the ** consumer mediation website because they dont handle insurance disputes. It appears this dental office has a habit of insurance issue (denying coverage, over billing, providing services without prior authorization and billing patient for services, per reviews). I need some resolution with this issue as I feel like I have exhausted all my options trying to resolve it on my own.

  Business response

  11/01/2024

  Antonio **********-******** was seen in our office on 1/19/24 for an occlusal guard impression. The treatment plan was reviewed, discussed, and signed before performing treatment with the patient and parent present. Prior to this appointment a Financial policy was signed by the patient's father, **** **********, as it states that "..You are responsible for any money that your insurance does not cover..." ********** explains to our patients that  we file their insurance as a courtesy to them, although we verify insurance eligibility and benefits it is still their responsibility to know what their insurance covers and does not cover and patients are responsible for all services rendered. As you  can see from the attachments provided, our office has made several attempts to get the patient's insurance to reimburse for the claim, but  we have yet  to receive payment. This insurance was given 5 months after treatment was performed, mother of patient asked us to file for past services and reimburse her for the money that she had paid for the occlusal guard and our in office dental plan that father signed the patient up for. Advised mother that we would be happy to file that for the patient, however we could not reimburse for any money that was paid at this time. Advised mother that if and when the insurance pays we will reimburse them. Mother of the patient did not like this and has since disputed the payment she made using her Carecredit card and turned us over to the BBB and a Consumer Agency.

  ********** did receive a payment dispute from Carecredit that the patient requested a refund for payment, we responded to it and were not found in any fault or wrongdoing and provided proof of services provided. Despite our countless emails and phone calls with the patient's mother and father they are still displeased that they have not been reimbursed for the payment made although there is still a pending insurance claim. The patient's mother insists that we are filing the claim incorrectly despite showing her that we are  in fact using the correct code and billing this correctly to the insurance.

  ********** strives to give all of our patients top notch dental care as well as customer service. We feel that we have given this family that to the best of our abilities, however the patient is upset with circumstances that are beyond our control and our office has unfortunately been the victim of the consequences. 

  ********** appreciates the opportunity to address this matter and state our points on it. Please let us know if any further information or action is needed from us.

   

  
  

  Customer response

  11/01/2024

   
  I am rejecting this response because:
  As you can see with all of the correspondence that I have attached, including the original claims and the last EOB, Ms. ******************** is either clearly not informed (which I don't believe as I have included her in emails) or she is intentionally omitting facts (which would explain her many, many poor reviews on ****** and Yelp). I also have a voice recording of my last conversation with Ms. ***** (which clearly shows I am not allowing the calls to go to voicemail) about the numerous mistakes she have made since day 1, including NOT CHECKING THE INSURANCE THAT WAS ON FILE, which meant I had no choice but to pay the services as my son needed them. 
  
  
  Please investigate this practice for fraudulent insurance practices as there are numerous reviews about this very issues that I am having. In the letter she provided Care Credit, all of the facts are incorrect and she only provided the original EOB with denial for missing information. On the last *** with the denied claim it clearly shows that **** states that the PROVIDER IS RESPONSIBLE FOR ALL CHARGES DUE TO LATE FILING. This practice is committing insurance fraud and they need to be investigated. 
  

  Business response

  11/04/2024

  As stated in our last response, patients father signed our Financial Policy and was aware that PATIENTS are responsible for all payments. Please see attached New Patient Paperwork and see page 4. We file insurance as a courtesy to patients, it is their insurance to follow up with and know what benefits are covered. As the patient rendering services they sign our policy stating that insurance companies do not guarantee payment and the patient is responsible for ALL payments. We have advised several ties of our policy and that AFTER insurance payment has been made we will be glad to refund any credits on the account at that time. As far as insurance fraud, that is absolutely false allegations. We filed the insurance when it was given to us, every insurance plan has different stipulations on filing times, most are a year. This office has made every effort to help get this claim paid for the patient despite the threats and false allegations even though the responsibility is not ours.    

• Initial Complaint

  09/18/2023

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I have been going here for several years. The office customer service is lacking and they make mistakes on the billing. In addition, uncovered services are done without prior authorization/notification of additional charges. I have been in dispute with them regarding my dependent bills for both my daughters. I have asked for the owners to contact me twice because I was not a satisfied customer and have not received any call to discuss. They performed a fluoride/sealant service on my youngest daughter-*************************, this service was not approved by the insurance company due to age. Now she has a $294 bill to pay. She is a college student that was not prepared to pay this bill. This is under appeal with the insurance company. My daughter-*************************** came in for a cleaning. They mixed up the billing with ****** and charged her $65 for a cleaning service that is covered by insurance. They also added an uncovered x-ray expense. If they are doing uncovered x-ray they should inform the patient prior to doing it. My insurance company-MetLife advised that the x-ray shouldn't have been done until next year as it is an every 5 year approved x-ray and shouldn't be needed for a regular cleaning. The so-called correction on the bill is wrong. They should have only charged $89 not $122. As a long time repeat customer I'm very disappointed in this office and their lack of response and competence.

  Business response

  10/13/2023

  I just spoke to mom in regards to patient ****** and *******, both accounts have been resolved from our end. Please feel free to contact us if you have any questions or concerns. Thank you.

   

  Customer response

  10/18/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to my complaint, and find that this resolution is satisfactory to me.
  
  Thank you. 
  

*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. ↩