Complaints

• Initial Complaint

  08/24/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My son got braces 2/17/22 @ $3995. His ins coverage was $2k and I paid the bal. in full of $1502.50 ($495 disc.) on 2/17/22. When he hit the end of his treatment (8/23) they notified him there was an insurance issue and I needed to call. Until this point NOTHING had been said, sent and no one reached out in any fashion. I played phone tag with their office, they do not call, they text. Finally at his last appointment (8/24/23) he got them on the phone with me. A few people spoke with me, all explained (almost scripted) that the insurance didn't go through for the last $1000. I asked HOW I could just be hearing about this when it was PAID IN FULL *18 months* ago. They all stated that since his insurance changed at the beginning of the year (almost 10 months after he got the braces) they didn't get the second insurance payment. NO ONE at any point in Feb 22 when he got them told us that they bill in or get paid in separate portions and that we should not make any updates to our insurance until after got the braces off. Now here we are, 18 months later being told that what we thought was paid in full is not, because they didn't properly explain the process that they should be aware of. The "contract" simply states..."If your insurance does not cover orthodontic benefits as outlined above or is terminated or adjusted for any reason, the responsible party will be responsible for the entire remaining balance and arrangements will be made to the autodraft monthly payments" . This DOES NOT in any way say anything about DURATION of treatment. There was NOTHING said at any point or in writing anywhere to lead us to believe 18 months later we would be having an issue. There was a clear failure on the part of the office staff to inform us of how their billing works and they failed to contact us in MARCH 2023 when they first knew there was an issue. I spoke to Delta Dental, they told me the provider should have told me how it was paid out.

  Business response

  09/08/2023

  Our office assists our patients in submitting the claims to the insurance for their orthodontic treatment.  If the patient's policy changes during the course of treatment or is terminated during the course of treatment, the remaining balance becomes patient responsibility.  For this particular account, we received the first initial payment from the insurance company on March 21, 2022.  The patient's policy pays 50% of their orthodontic lifetime maximum at the time of banding and one year later.  On that initial explanation of benefits, it does state "this is the first payment for this orthodontic case.  Additional installment payments will be made automatically, subject to the patient's continued orthodontic coverage and contract maximum at the time of additional payments".  Both our office and the patient receive copies of all explanation of benefits that are sent out.  The insurance released a second payment from the insurance company in a lesser amount and on the explanation of benefits it states that the patient's lifetime benefit had been reached and that this was the final payment.  Our office reached out to the insurance company two times in regard to this claim and why we did not receive the benefit.  The representatives that we spoke to at the time stated they would send it back to be reprocessed.  In August 2023, we did follow up on the previous conversations and we were told by that representative that the patient's policy had changed and their lifetime maximum decreased effective 1/1/23 and that we will not receive anything additional.  We reached out to the patient and parents, and we were provided a new insurance card, but unfortunately it is for medical coverage only.  When we received a call, we returned the call with voicemails and text messages.  Ultimately, it is the patient's responsibility to know and understand how their insurance policies work.  The initial explanation of benefits states that if there are any changes to the contract maximum or to the patient's coverage that it will affect the second installment.  Our financial contract that our patients sign, states that "It should be understood that you, (not your insurance company) are responsible for the full orthodontic fee.  We will be happy to assist you in claiming orthodontic benefits through your insurance plan.  If your insurance does not cover orthodontic benefits as outlined above or is terminated or adjusted for any reason, the responsible party will be responsible for the entire remaining balance and arrangements will be made to auto draft monthly payments." 

  Customer response

  09/08/2023

  [To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
  
   Complaint: ********
  
  I am rejecting this response because:

  Exeter Orthodontics knowingly and willfully did not communicate with us, the consumer how they handle billing and insurance.  Being strictly an orthodontic practice they are well aware of how the insurance companies pay out, and they neglected to notify us that we should not make any changes to our insurance until after treatment was completed. Their "contract" DOES NOT state anything about DURATION or COURSE OF TREATMENT.

  When they call the insurance company for coverage they are notified of amount and how it is paid (per the individual we spoke with at ***** Dental), so they were aware or else they wouldn't have known our coverage.

  When we PAID IN FULL in February 2022 we had NO reason to think this was anything but just that....PAID IN FULL. There was NO reason to think 10 months later an adjustment could not be made to our insurance. Who would think that unless told otherwise.

  We had communication issues with the staff from day one; between paperwork and payments, there was nothing but confusion.  One would imagine this is also why the ledger we found (attached) shows nothing paid/done until March 1, 2022 when we indeed started the process and made payment on February 17, 2022.  This ledger is impossible to decipher. You can't tell what was going on, we even asked a seasoned office manager of a dental practice to help and she couldn't. There are charges, adjustments, transfers and roll backs all over the place. The "roll back" of this charge wasn't even done until August 1, 2023. However, as they stated they found out in MARCH that there was an issue, almost, 5 months prior and NOTHING was said to us.  That is mind-blowing to me. As stated "Our office reached out to the insurance company two times in regard to this claim...In August 2023 we did follow up on the previous conversations and we were told by that representative that the patients policy changed..." .  When we spoke to the insurance company on 8/24/23 that IS NOT what we were told. She stated that they were notified in March when they got the remaining benefit, and that the practice should have notified us at the beginning how things would be paid out so we would be aware.

  They state "on that initial explanation of benefits, it does state "this is the first payment for this orthodontic case.  Additional installment payments will be made automatically subject to the patients continued orthodontic coverage and contract maximum at the time of additional payments."  First off we do not get these, the world is paperless these days. Second, there is nothing here that states WHEN the next payment would be made, and again WHY would I have any reason to believe it would not be until a year later when my CONTRACT had "expected insurance benefit $1997.50" and we had paid the balance IN FULL based off the information that was given to me by the staff who handled the financials at the time we started treatment.  If there was ANY inclination made to us at all that payments were made the way they apparently are, there would be NO reason we would have changed the insurance.  We paid EXTRA to have the extra coverage.

  They did not receive the expected payment from the insurance in March 2023, and they did not say a word to us, no letter, no phone calls, NOTHING. It was not until August 2023 at my sons next to last appt they told him he needed to have us call, that there was an issue with the insurance.  We called, they called us back ONCE and then texted any other time to call them back - "Hello, this is Exeter Orthodontics. Please give our office a call regarding your insurance at ###-###-#### and select option

  3.  Please do not respond to this automated message. Have a great day!" It wasn't until the next appt, his last, that someone was finally able to get on the phone and discuss the issue.

  What occurred between Match 2023 and AUGUST 2023 that no one at this office felt the need to reach out and say anything or for that matter what took that long to reach out to the insurance company to get their things settled?  We had NO reason to believe there was an issue for we had paid in full OVER A YEAR AGO.  

  "We reached out to the patient and parents and we were provided a new insurance card" - NO ONE ever reached out outside of my sons visits.  My son was ASKED for an insurance card ON HIS LAST VISIT 8/24/23, they already had one on file NOTHING about the insurance info changed.  He called me and asked me for a copy of his dental card at which time I sent it to him, so they had the proper card.  

  Again they want to quote their :"contract" that is clearly misleading and full of misinformation.   

  We were fully aware of our insurance coverage, $2k for orthodontics, what a consumer does not know is HOW you bill it and how insurance pays it, that is where YOU are supposed to keep your patients informed and in this case failed to do so.

  I am sorry that the office staff did not properly and accurately advise us of what they should have.  I do not know why we as the consumer have to suffer for the fact that the employees in the case here failed to do job accurately.
  

  This is a new form of theft by deception.
  
  Regards,
  
  *************************

  Business response

  10/06/2023

  At this time, we do not have any additional responses to the complaint. 

  Customer response

  10/06/2023

  [To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
  
   Complaint: ********
  
  I am rejecting this response because. At this time, we do not have any additional responses to the complaint is not response, its a quiet admission of guilt. 
  
  Regards,
  
  *************************
  

• Initial Complaint

  06/19/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I paid for service for myself and daughter and treatment was stopped before it was complete

  Business response

  07/03/2023

  The patients were dismissed due to disrespectful and aggressive behavior towards staff while in the office and over the phone.  While a patient is in treatment with our practice, we require the patient to be consistent with their appointments and the patients have not been compliant with our appointment policies.  Our office requires recurring monthly payment arrangements and the patients have not been compliant with our financial policies.  

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