Complaints

• Initial Complaint

  02/26/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  On 1/17/23 I was told I had a balance of $375. I asked ***** if they could call insurance and find out why it was not paid and she said no, that I need to call. I called insurance when I left the office and they confirmed that I have a $500 ortho allowance and informed me that SSD submitted a claim for the full lump sum of $5,500, and according to my plan, all ortho claims need to be submitted monthly. I could see the claim that was submitted online, as well as the remarks section that reads "A CLAIM MUST BE SUBMITTED MONTHLY FOR BENEFIT REIMBURSEMENT". I called the office back and as I started to explain, ***** told me that this is "not their problem" and "they don't make mistakes." I asked her if she was looking at the claim, and she said no, she does not have access to it. I'm not sure how she could make those statements without looking at the claim. I asked for *****, the office manager, to call me the next day, and she did not. When I finally spoke with her, she assured me the claims would be redone. I followed up on 1/24, 1/31, 2/2, and 2/7, most of which went unanswered. On 2/18 I requested an itemized bill for three dates of service so I could attempt to do the claim on my own (as they still had not done it), I got a response with an invoice showing that I had paid $0. I e-mailed them back and said I have been paying monthly for these services and to please send a new bill, and again I got no response. They have since submitted a claim, but insurance said they are submitting fees of $0. I followed up on 5/8 and asked them to contact insurance, but they still refused. SSD scheduled me an appt for 2/19/24, which they even confirmed, and then refused to see me when I got there. I was told by ***** and ******** that ***** would call me that day. 4 days later she has not called. The front staff has been unprofessional and dismissive. If insurance said this would not be covered, I would of course pay, but that is not the case.

  Business response

  03/11/2024

  Hello,
  We have, indeed, submitted the patient's orthodontic work as the patient and insurance requested, as separate visits, labeled periodic orthodontic visits, as you can see attached. Unfortunately, the insurance still has not paid. I also attached a screen shot so you can see just how many times we attempted to get the insurance to pay for this, there are over 12 submissions for the same thing. At this point, the patient is more than welcome to submit these invoices to her insurance herself. Please let me know if there is anything else I can do. 

  Customer response

  03/12/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

  The issue is not the claim being submitted monthly at this point, as requested by insurance.  The issue is that insurance said the claims are coming through as $0.  In my initial post, I included screenshots of e-mails from the insurance company stating that the claims are being submitted electronically and are coming through as $0.  They stated that the business either needs to speak to their clearinghouse to figure out why it is coming through as $0, if they are indeed submitting them for a greater amount, or submit paper copies of the claims and mail them in.  I have asked them to reach out to insurance, but they refused.  I also had previously requested an itemized bill from the business so that I could submit paper copies of the claims on my own.  They responded to my e-mail and sent me an itemized bill showing that I paid $0 at each visit.  I e-mailed them back and asked them to send me a corrected bill that shows the corrected amount, as I was paying monthly, and they did not respond.  I had also included screenshots of this in my initial complaint.  I have also been waiting on a phone call from ****** the office manager for the last three weeks.  I was told by ******** (I believe), *****, and ****** (on three separate occasions) that she would definitely be returning my phone call and she never did.  They have made no attempt to speak with me and rectify this matter.  E-mails and phone calls have not been responded to.  They had no problem calling me on January 15th and asking me to do them a favor and come in early because of the snow, yet the next time I went into the office they were completely rude and dismissive.

   

   

   

   

  In order for the BBB to appropriately process your response, you MUST answer the question above.

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

  Business response

  03/13/2024

  Hello

  I do apologize if your insurance company is giving you different information, but I do assure we have made endless attempts to submit this on your behalf, including manual claims that we have printed out and mailed. I have attached a new claim form that you can definitely send to your insurance and I certainly hope you have better luck. Please let me know if there is anything else I can do. 

  Customer response

  03/14/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

  Right, I have your office telling me one thing, and I have insurance telling me another, which is why I have asked for you to contact insurance to figure out what the issue is. I'm not sure why that cannot be done.  I have also been waiting on a phone call for weeks to rectify this situation, and you have never contacted me.  I'm not sure how you expect the situation to be corrected when you do not return phone calls.

   

   

   

   

  In order for the BBB to appropriately process your response, you MUST answer the question above.

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

• Initial Complaint

  05/24/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  In early November 2021 I needed to have an emergency tooth extraction, so I contacted Shore Smiles Dental. I had the procedure and was very happy with the staff/process overall. On the way out I met with the billing person, who told me I owed nearly $700 after insurance was applied. I provided payment before I left the office, without issue. Shortly thereafter I received a letter from my dental insurance provider advising that my total out of pocket should have been about $200 for the services rendered. I contacted the office at Shore Smiles in mid December to inquire and was told that they did see a $500 overpayment on my account. They never reached out to me to advise of the overpayment until I contacted them. I was told at that time in December that a check for the overpayment amount would be mailed to me. Its now the end of May and I still havent received that check. Ive called at least 5 times to check on the status of the payment. I was told a check was mailed in January, but I never received it. Every time I call I am told something different about the status of a new check being issued. It has been over 6 months with more than 6 phone calls and I am still owed $500+.

  Business response

  06/14/2022

  Although her first check somehow got lost in the mail and was never delivered to her, we were able to verify with the bank that the check was never cashed and we then reissued a new check and had ******** come pick it ** in person to avoid the same thing happening. 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. ↩