Complaints

• Initial Complaint

  03/31/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  07/26/2022 first oral evaluation at DR Periodontics,they said they take **% down payment in cc if necessary,later the front desk said no,they take only **% at least as down payment. X-rays were taken. the front desk said CLEANING is scheduled 11/22/2022 the CLEANING is performed. 1 ½ hr procedure under anesthesia. I left the office in severe pain.I *** ******** **** **** *****, high sensitivity in every single teeth and jaw pain from that visit.11/29/2022:1 1/2 hr procedure,front desk mentioned the insurance, and ask how was my SCALE (AND ROOT PLANING),I said it was scheduled as CLEANING,not a scale and root planing,front desk said they are the same.The insurance company ******** said cleaning and scale are 2 different things, and scale is a major procedure,while cleaning is not, while I was sent home any recommendation post-op.The insurance stated that because scale is a major procedure, the gum draft was denied, only to be available after July 2023. 01/12/2023.I returned to the office to the procedure date (gum draft and surgery) the front desk lied,said the insurance didn't answer their claims, the front desk mention the last appt was a scale, I confronted the receptionist about the procedure that was never told me that was a scale, even during the first evaluation, since there was no need a scale at this point bcs its too late.I complained about the severe sensitivity in every single tooth. Dr. ****, applied fluoride, examine as fllowup, but the front desk handed a bill of $*** (periodontal reevaluation $*** + Caries arresting meds- per tooth $** + Application of desensitize med $**) I never returned their calls, or show up for appointments after January 12 2023. Dakota Regional Periodontics actively lied to me in every single visit. I am not sure what kind of procedure was done, if a scale or cleaning, after all. They lie to me and now I am constant pain from a reckless procedure.No they are pushing me to pay $******* in 'completed' procedure.

  Business response

  04/22/2023

  Luisa self-referred to our office was originally seen on 7/26/2022 with a chief complaint of previous trauma to the gums on the lower front teeth. She also reported that she had been told she has gum disease.  The exam noted red irritated gums on the on the lower front teeth with gum recession and tension from the lip attachment.  A gingival graft on the facial surfaces of the lower front teeth was recommended to increase attached keratinized gingiva, remove frenum interference, and prevent further recession.  The initial examination also included full mouth periodontal probing which showed generalized 4-5mm interproximal probing depths with localized probing depths up to 9mm.  Subgingival calculus could be felt on the root surfaces and generalized bleeding on probing was present.  These findings indicated active periodontal disease though radiographs were needed to finalize diagnosis.  Because the initial exam was for a gingival grafting consultation, time was insufficient for a periodontal evaluation appointment. A follow up appointment for a full periodontal evaluation was recommended and completed on 9/22/2022 which included full mouth radiographs, information/education on periodontal disease including causes, treatment, treatment risks, and probable consequences of periodontal treatment.  The full mouth periodontal examination resulted in a periodontitis diagnosis. Prior to the above noted gum graft procedure, treatment recommendations included full mouth scaling and root planing followed by periodontal re-evaluation to compare post treatment probing depths with initial probing depths to determine response to treatment.  It is important to first treat and control periodontal disease before moving forward with gingival grafting.  Scaling and root planing was completed on the left side of the mouth on 11/22/2022 and the right side of the mouth on 11/29/2022.  The most common post procedural consequence following scaling and root planing is temperature sensitivity which is usually temporary but can linger.  This possibility was covered in the appointment discussion as indicated by the attached appointment notes.  At her periodontal re-evaluation appointment on 1/12/2023 the temperature sensitivity was discussed with the patient and addressed topical treatments applied to help alleviate the issue.  Additional follow up and application could be helpful to improve or resolve the sensitivity but the patient has not returned for any office visits. By no means is scaling and root planing a “reckless” procedure as the patient indicates in the complaint.  It is the standard of care and very much indicated in her type of case given her presentation of oral conditions.
  
  In regards to the confusion over planned procedures and financial policies, at the initial appointment, the treatment plan was given to the patient which clearly indicates that the planned treatment was for scaling and root planing and not just a “cleaning” which would be indicated as a prophy or periodontal maintenance.  In cases of mild to moderate periodontal disease, scaling and root planing is the most common treatment and not an unusual or major treatment.  It is most often performed by a dental hygienist and generally not performed by a dentist.   Also at the initial visit, the office financial policy (document attached to file) was reviewed and signed by the patient which clearly states that **% of the fee is due at the time service.
  
  Our office is not a contracted provider with her insurance companies but the claims were filed with to her primary insurance as well as her secondary insurance provider.  The primary insurance claims were denied and the explanation of benefits indicated that the reason for denial was that “these charges were incurred prior to the effective date of this plan or enrollment was voided. As a result, these charges are not covered”. The secondary insurance did pay $****** for the 7/26/22 visit which was received by the office on 9/1/22 and it also paid $****** for the 9/22/22 visit which was received on 11/22/22. The patient refers to instances with the staff told her that the insurance didn’t answer claims.  Our insurance coordinator reports that the secondary insurance did not receive some of the claims which were re-submitted. The remaining claims were submitted and denied in a normal timeframe as indicated in the attached domumentation. Total payments received from the patient were $***** on 9/22/22, $***** on 10/20/22, and $***** on 11/22/22. The remaining balance from completed treatment along with a late fee (as indicated in the signed financial agreement) is now $******* and the patient has not made any additional payments during which time 8 billing statements have been sent.  As the patient indicates in her complaint, she has not responded to phone calls or returned to the office since 1/12/2023.  At Dakota Regional Periodontics we strive our very best to provide the best care possible in the most professional way.  I am confident that our staff never lied or misled her and the patient signed documentation indicates our policies and procedures clearly to which the patient agreed. 

  Customer response

  04/26/2023

  
  Complaint: ********
  
  I am rejecting this response because: (my answers are between ***; also there is a color coded copy attached)

  Luisa self-referred to our office was originally seen on 7/26/2022 with a chief complaint of previous trauma to the gums on the lower front teeth. She also reported that she had been told she has gum disease. The exam noted red irritated gums on the on thelower front teeth with gum recession and tension from the lip attachment. A gingival graft on the facial surfaces of the lower front teeth was recommended to increase attached keratinized gingiva, remove frenum interference, and prevent further recession. The initial examination also included full mouth periodontal probing which showed generalized 4-5mm interproximal probing depths with localized probing depths up to 9mm ***(8mm was the highest number noted at the moment)***.

  Subgingival calculus could be felt on the root surfaces and generalized bleeding on probing was present. These findings indicated active periodontal disease though radiographs were needed to finalize diagnosis. Because the initial exam was for a gingival grafting consultation, time was insufficient for a periodontal evaluation appointment. ***(The initial complaint was the gum injury at the front lower end, and the assessment was that possible a localized cleaning, followed by the surgery day due the emergency of the matter. Never was mentioned lack of time for full evaluation, never was mentioned full evaluation. The evaluation was booked for another day)***  

  A follow up appointment for a full periodontal evaluation was recommended and completed on 9/22/2022 which included full mouth radiographs, information/education on periodontal disease including causes, treatment, treatment risks, and probable consequences of periodontal treatment. The full mouth periodontal examination resulted in a periodontitis diagnosis***(for my information the evaluation was procedure in order to proceed with gum draft and correction of the injury).*** Prior to the above noted gum graft procedure, treatment recommendations included full mouth scaling ***(they said cleaning, a cleaning was necessary before the surgery)*** and root planing followed by periodontal re-evaluation to compare post treatment probing depths with
  initial probing depths to determine response to treatment ***(not true, the cleaning was scheduled and then the surgery was scheduled after the cleaning).***

  It is important to first treat and control periodontal disease before moving forward with gingival grafting. Scaling and root planing was completed on the left side of the mouth on 11/22/2022 and the right side of the mouth on 11/29/2022.  The most common post procedural consequence following scaling and root planing is temperature sensitivity which is usually temporary but can linger. This possibility was covered in the appointment discussion as indicated by the attached appointment notes. ***(Lies: the office never said 1 word about the "cleaning" which became named as "scale" - I left the office in terrible general pain, pain also in the left jaw joint. in the following days I had fever and flu symptoms, which I thought was covid catch from reused office sunshade during 1 1/2 cleaning)***

   At her periodontal re-evaluation appointment on 1/12/2023 ***(this date was the date of the surgery, and for lack of payment they said they wouldn't not perform the surgery, I complained about huge amount of pain, fever and extra sensitivity - the front desk quipped "now you come complaining for something done in november)*** the temperature sensitivity was discussed with the patient and addressed topical treatments applied to help alleviate the issue ***(the office charged $*** for this follow up; including $** for a sample of fluoride from a bulky pot, given in a medicine orange container)***.

  Additional follow up and application could be helpful to improve or resolve the sensitivity but the patient has not returned for any office visits ***(there was not follow up scheduled. The next scheduled appointment was for the surgery)*** . By no means is scaling and root planing a “reckless” procedure as the patient indicates in the complaint. It is the standard of care and very much indicated in her type of case given her presentation of oral conditions ***(The cleaning which become "scale and root planing" on the spot left some infection  that I suffered of fever and flu symptoms at slight drop of weather temperature  on and off for >3 months, until my provider prescribed amoxicillin 850 mg 3x a day for 2 weeks on April 10, 2023)***

  
  In regards to the confusion over planned procedures and financial policies, at the initial appointment, the treatment plan was given to the patient which clearly indicates that the planned treatment was for scaling and root planing ***(not true, the office never mention that was a scale until the second part of the cleaning)***

  and not just a “cleaning” which would be indicated as a prophy or periodontal maintenance. In cases of mild to moderate periodontal disease, scaling and root planing is the most common treatment and not an unusual or major treatment (insurance company ******** ** ** disagree and establish scale and root planing as major procedure, which the office never mention of the seriousness of the scale and root planing because was not scheduled as such, but a mere cleaning, and submitted to insurance as scale and root planing)  . It is most often performed by a dental hygienist and generally not performed by a dentist. Also at the initial visit, the office financial policy (document attached to file) was reviewed and signed by the patient which clearly states that **% of the fee is due at the time service

  ***( upon to sit down inside the examination room, Kayla said they were very flexible, the down payment could be **% which could be paid in credit card, and financing the restant, the signature was collected electronically without seen the document and a copy was not given - and I certainly trusted in a health provided, like many other, that my information is also kept safe under HIPAA law, document that I didn't read because was not open, but I trusted the contains are according to the law. I trusted Dr. **** ***** and his team and their word, but they lied to me, presenting a document with a different verbatim that was voiced by the nurse at the examination room).***

  
  Our office is not a contracted provider with her insurance companies but the claims were filed with to her primary insurance ***(**** was never the primary insurance provided at Dakota Periodontics front desk because I was not a federal agent at the moment, I don't know how they found ****. My primary was ******** ** **, an insurance card was shown. **** was named in the first statement, and I notified the front desk about their mistake, which was never corrected)***  as well as her secondary insurance provider.

  The primary insurance claims were denied and the explanation of benefits indicated that the reason for denial was that “these charges were incurred prior to the effective date of this plan or enrollment was voided. As a result, these charges are not covered” ***(that is **** - which should not be used at any time)***. The secondary insurance did pay $****** for the 7/26/22 visit which was received by the office on 9/1/22 and it also paid $****** for the 9/22/22 visit which was received on 11/22/22. The patient refers to instances with the staff told her that the insurance didn’t answer claims ***(exactly, the front desk said it couldn't have their calls answered by ********, that was by mid December, so from the cleaning to mid December the front desk could not speak with ******** but continued to make appointments, until I called the insurance myself, at ******** notified me that scale and root planing were a major procedure, and the gum draft cannot happen before July 2023)***.

  Our insurance coordinator reports that the secondary insurance did not receive some of the claims which were re-submitted. The remaining claims were submitted and denied in a normal timeframe as indicated in the attached domumentation. Total payments received from the patient were $***** on 9/22/22, $***** on 10/20/22, and $***** on 11/22/22. The remaining balance from completed treatment along with a late fee (as indicated in the signed financial agreement) is now $******* and the patient has not made any additional payments during which time 8 billing statements have been sent. As the patient indicates in her complaint, she has not responded to phone calls or returned to the office since 1/12/2023. At Dakota Regional Periodontics we strive our very best to provide the best care possible in the most professional way. I am confident that our staff never lied or misled her and the patient signed documentation indicates our policies and procedures clearly to which the patient agreed.

  ***(**** ***** staff actively lied about procedure names, methods, and post-procedure treatment. Dates, and payment plans. **** ***** staff lied about the procedure of what supposed to be a cleaning, and was billed as scale which is a major procedure and now my emergencial treatment is delayed until July 2023, worsening my condition. I am contacting ******** with this complaint where **** ***** said scale is not a major procedure, but the insurance said it is and the reason for the denial of claim is that the next major procedure must be done after July 2023, that is were the periodontal office plan didn't work when they switch cleaning to scale and root planing in the claims forms. I have had fever and tooth pain since 11/22/2023, in April my skin turned pale greenish and I have deep eyes, and dark circles. My physician saw me on emergencial appt, put me under antibiotics, which relieved my tooth pain and ceased the fever so far.*** 
  
  Sincerely,
  
  Maria ***** ********

  Business response

  04/27/2023

  The notes and files in the patient record indicate that all of her procedures were discussed and office policies followed with regards to information given and informed consent.  Our office strives to do our best in communicating in ways so that everyone understands and is aware what is happening at all times.  It is unfortunate that the patient feels otherwise, but our office records indicate that the complaint issues which she is detailing were discussed and covered. 

  Customer response

  05/08/2023

  
  Complaint: ********
  
  I am rejecting this response because: Dakota Regional Periodontics actively lied about procedures; the equipment used was dirty causing a root infection that lasted 6 month until I had amox 875 dose 3x a day for 2 weeks; the reckless procedure caused constant fever, which resulted in drastic reduced work hours and earnings connected with attendance issues. I've been in many dentists' offices, including in many third world countries, but I never had a bad post procedure or infection; still this office claims that was not a major procedure, meanwhile authorities and insurance say otherwise. How could I have a tooth root infected if it was not a major procedure? No one deserves to be seen by Dakota Regional Periodontics without knowing the probable consequences. Still, **** ***** and team decided to keep up with their dishonesty. Good riddance.   
  
  Sincerely,
  
  Maria ***** ********

  Customer response

  05/16/2023

  **** **** ****** *** insurance company stated that is NO claim submitted by Regional Dakota periodontics after September 2022; as previously mentioned by me. **** **** do stand to the case that Scale is a major procedure, and major procedures are approved once for year - that means I wouldn't be able to have any procedure done until July 2023.. Dakota Regional Periodontics didn't file a claim for any procedure made after September, working exclusively to put me in debt on purpose, based on ******** ** staff which didn't bother file a claim. This only proves that Dakota Regional Periodontics lack of ethics and honestly. Because Dakota Regional Periodontal knows my previous affiliation to federal employment and the necessity of keep a security clearance, which a debt collection will block and dismiss a sec clearance request, the periodontics staff didn't file a claim because its too much work, throwing to collections, putting pressure and panic in my life, which cased accident at work, jeopardizing my ability to keep any substantial income. **** ******** ** ***** **** ******* ***** ****** **** * ***** ******* ** ****** **** ***** *** ***** ** *** ****** Stop being lazy, Dr *****, without a claim properly file and the results, that is no payment for you.

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