Complaints

• Initial Complaint

  03/29/2023

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I had two permanent crowns done for implants. I was told I had to pay in advance and would be refunded when my insurance went through. I paid $2205.62 on 8/17/22 and $2205.62 on 9/15/22 for a total of $4411.24. My EOB showed I owed $2921.35 leaving me a credit balance on my account of $1489.89. On 11/17/22 I was at the office for a broken tooth and spoke to ******. She verified I had a credit balance of $1490.24 on my account. She said I had to now wait for the insurance to show my copay of $352.28 for the broken tooth which they would subtract from my existing credit balance and refund me the difference of $1137.96. 11/30/22 I was told someone from the office would contact me about the status of my refund check. I didn’t hear back so 1/27/23 I left a message on their voicemail. No one called me back. 1/30/23 I sent them a text message, I received message back saying they are still processing the claim, once it posts to my account the manager will issue my refund. 3/7/23 I sent them another text message..no response. 3/14/23 left them a voicemail to call me with refund status. ******* called me back and apologized, said she can see the credit balance of $1137.96 sitting on my account. She did not know why the check was never cut and could see that I had contacted them multiple times. She said she was putting a big note on the manager/owner’s desk to send out my check. I still have not received my refund check. I have been a patient for over 20 years !

  Business response

  05/16/2023

  CASE ID ********
  
  THE REFUND WAS MADE TO PATIENT.  THE PATIENT'S HUSBAND CAME TO OFFICE TO PICK IT UP.
  OUR BOOKEEPER WITHELD PROCESSING ' A CHECK' REFUND, DUE TO THE SIZE OF REFUND....TO SEE IF NEEDED TO GO BACK ONTO A CREDIT CARD.
  
  I MISSED THE NOTE BY THE BOOKEEPER.   IT WAS AN OVERSIGHT.   I THOUGHT IT WAS HANDLED. 
  I REALIZE THE PATIENT CALLED SEVERAL TIMES AND I DID RE-TRAIN THE STAFF ON HOW TO HANDLE SUCH MATTERS SO THAT IT GETS MY ATTENTION.  THAT THEY NEED TO BE FORWARD MOVING ON ALL PROBLEMS AND ADVOCATE FOR THE PATIENT AND GET BACK TO THE PATIENT WITH AN ANSWER ESPECIALLY ON MULTIPLE CUSTOMER SERVICE CALLS.
  
  We did apologize to the patient and will send her a gift card for her inconvenience.
  --
  ***** ********
  Clinical Administrator

  Customer response

  05/16/2023

  [A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. 
  
  Regards,
  
  ******** ******
  
  

• Initial Complaint

  10/18/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I called the office today to cancel an appointment I had with them in December, because I found a new dentist that was In Newtork that covered most of my treatments. The staff members never informed me they were Out of Network, and when I handed my insurance card over to them I was just told "You're all set", and I never got a bill in the mail of any balance I owed. When I called today to cancel, I was informed over the phone that I owe a balance of over $300. I believe that as nice as the staff was, that communication should've been better. I should've been told they were Out of Network as soon as I gave them my insurance card, but instead they told me of other services that weren't teeth cleaning and the high prices (which I turned down because I couldn't afford them out of pocket), and referred me to another dentist that was Out of Network that said it was $900-$1000 to remove one wisdom tooth, and they didn't take my insurance. I checked my information on the ******* website, and Lehigh Valley Smile Designs never submitted anything to them. If it was rejected I never got a notification for reason of rejection either. If it is covered I need it to be submitted through insurance and if its not I should've been told that in the first place so I knew to stop going there a long time ago. I'm new to having high coverage insurance and I shouldn't have been left in the dark just to then deal with a high bill I was never informed of.

  Business response

  12/08/2022

  12/06/2022 
  TO: BBB 
  1. Not being told we were out of network. 
  a. The patients insurance plan is non-restrictive. This means that the patient has benefits anywhere he/she wants to go. As a new plan to patient and to us, we did not know the co-payments of her first visit until insurance had processed the claim. 
  . 
  i. Even though many plans state 100 % on preventive services, it does not necessarily mean 100% of the office fees. What it means is 100% coverage on a fee schedule that the employer chose to cover. The employer chooses the fees. The dental office does not set its' fees based on that schedule. In fact, that fee schedule is not listed when we pull benefits. We only receive percentages of what employer chose to cover. 
  b. It is the job of the employer to let employees know how to best utilize their insurance. 
  i. Since the patients had benefits here, our processes are about advising patients of copayments to the best of our ability. 
  1. It is not required for us to advise the patients on network status. 
  2. Electronic Claim Submission: 
  Our claims our submitted daily to insurances. Not all electronic submissions are received and there can be occasional glitches. Currently, we start to review claims at 90 days that have been sent and not paid. In non-covid times, we were able to follow up in 30-60 days. Insurance companies now have long delays in response times and have been keeping our phone inquires for up to three hours on a single claim. 
  3. Referral to Specialists: 
  We refer to a select team of specialists whom we know well and for whom we can vouch for quality of care. 
  b. We do not refer to random specialists whose work we do not know. 
  C. We do not refer to a specialist due to network standing with an insurance company. 
  i. If this is important to the patient, they need to let us know that they need an in- 
  network specialist. We sometimes can accommodate that request if the patient provides us a list of possible names. 
  ii. The dental field is not connected to a general insurance listing to participating providers of said insurances. There is no central data base for this. 
  1. IF the patient provides us with this list, and if we have experience with anyone on that list...we may be able to provide a recommendation. Otherwise, we need our patients to follow our referrals to the specialists on our team. 
  a. If a patient wants the insurance company choosing their doctors instead of our general dentist, they may not be a good fit for our office. 
  4. For this case, we did not hear from Insurance until the middle of November. Bills would be sent at the time that the Insurance payment was posted. The account balance was zero at the time of posting insurance check because the patient made co payment prior to insurance check being posted here. 
  5. We do not have monthly billing here. Patients sign a financial policy as a new patient that they agree to pay their account in 60 days of service.  

*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. ↩