Dentist
Whispering Oaks Family DentalThis business is NOT BBB Accredited.
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Complaint Details
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Initial Complaint
06/28/2024
- Complaint Type:
- Billing Issues
- Status:
- Unresolved
I received dental care at this dental office on April 15th, 2024 for a broken molar that needed a crown. I paid approximately $700 at this dental office on the day of treatment and on about May 30th, I received a bill from the dental office for the remaining balance because apparently my insurance hadn't covered any of this procedure at all. I called the dental office and spoke with ******* and she advised me that the dental office would appeal this denied claim and not to worry, it would likely be covered. I did not hear anything back again about this matter until 6/27/24 when I received a call from the dental office again to say that my appeal for this charge had been denied for a second time. At this point, I called United Concordia who advised me that there had not been any appeals at all filed on this claim. The *********************** staff also advised me that the only reason this dental claim was initially denied is because no information was received by them from the dental office to authorize this treatment and the claim couldn't be processed due to insufficient documentation. United Concordia staff contacted the dental office on 6/27/24 on my behalf and spoke to ****** and provided her with specific instructions as to how to submit an appeal for this denied claim. I then called and spoke to ****** on 6/27/24 and she once again stated that she has already submitted an appeal for this claim on two occasions and that she would submit it again. I want this dental office to fulfill their legal obligation to properly submit my dental claim to my dental insurance according to the specific instructions they have received from my dental insurance office. I should not be charged for the remaining half of this claim. I also have a picture of the broken tooth if I need to provide it.Business response
09/09/2024
I called Pt wife back as she was requesting a refund I had also called her to get her help with the insurance on her husband crown. Due to the fact that I had called **************** on 06/27/2024 and spoke with **** REF#*********** it was denied due to not a lot of tooth structure loss, we did send x-rays and narrative with the claim for a reprocessing and it was still denied. I was hoping to get *** or Mrs. ******* to help call the insurance company as sometimes calling them will help them pay on a claim. However the conversation turned into a refund that was at the time not listed on the account due to the insurance balance was not reflecting a balance owed due to the insurance denying the crown. I tried to explain to the Mrs. ******* that we do not own the insurance company we can not tell them what or when to pay us and that the entire family is on one ledger as like your bank ledger so because *** ******* claim has not paid the ledger was not reflecting a credit. I can not submit a refund if the credit is not showing on the ledger. I also tired to explain that once *** ******* claim is paid and the credit is shown I would be more than happy to refund the patient back the credit. She was very angry on the phone and really did not understand what I was trying to explain. Since this I have fought the insurance and was able to get them to pay on *** ******* Claim and there is a refund reflecting that will be summitted and return to the patient.Customer response
09/10/2024
Complaint: 21913111
I am rejecting this response because:This response represents yet another shining example of inaccuracy, poor administrative skills, lack of attention to detail, and zero commitment to follow-through. Whispering Oaks cant keep the details of my complaint straight and have no comingled an unrelated refund, which is a separate issue entirely. To recap my emergency procedure was completed on 15 April and a crown was placed as most of my molar broke away when I inadvertently bit down on a shell remnant in a power bar. I paid my portion of the bill (approximately half) that day and the other was to be billed to insurance. I received a bill noting an outstanding balance on 14 Jun 2024. I called Whispering Oaks and was told that I needed to pay my portion of the bill. I explained that I already paid my portion of the bill and that this was for the insurances portion to pay. They explained that the insurance rejected it, but that they would resubmit. As of 27 June, the bill was still not paid. I called United Concordia, and spoke to the patient representative and later to the Senior Representative in each if my 4 calls (listed below). **************** explained that they did not receive any supporting documentation for the crown and that the dental office needed to submit the required paperwork. United Concordia (**) placed me on hold while they called the Whispering Oaks. ** returned to the line and told me that they explained the requirements to the dental office and that the dental office stated they would submit the paperwork. UC also relayed that the person they talked to was snotty as it related to noting their obligation to submit the required documentation. I called Whispering Oaks after this call and asked them if they understood what needed to be done, and I can confirm the snotty, flippant attitude in terms of the billing staffs demeanor. I made similar calls in coordination with UC on 3 July, 16 July, and 1 August in an attempt to have Whispering Oaks submit the required documentation. In each instance, the dental office missed critical documentation, and did not send the documentation to the UC dental advisor as stipulated. The dentist office didnt fight anyone. They never acted proactively to the benefit of the patient. In fact, they we merely reactive when it came to the numerous calls placed to them buy UC, who was working on my behalf. If anything Whispering Oaks fought hard to not submit the required documentation to the correct office, and in each instance they became more cold, unfriendly, and unprofessional. In the end Whispering Oaks fought very hard to avoid the administrative burden of sending the Narrative, Picture, X-Ray, and Chart notes to the Dental Advisor at ***************** This is truly shameful that Whispering Oaks was so unwilling to complete something as simple as a routine task, which was ultimately at the detriment of the patient. The truth is that United Concordia and I worked together on numerous occasions in an effort to get Whispering Oaks to complete their requirement. They would rather have me pay the other half of the bill rather than submit a fully developed claim to the correct office.
Regards,
****** *******Initial Complaint
06/28/2024
- Complaint Type:
- Billing Issues
- Status:
- Unanswered
I received dental care at this dentist office on June 6, 2024 for my cleaning, exam, x-rays, fluoride treatment and I decided to order new retainers. I paid $500 for the retainers and $20 for the fluoride treatment. I asked the staff to please verify coverage with insurance first because I knew I had 50% orthodontic coverage and I knew the fluoride treatment was covered. They told me they called my insurance to verify and that I had no coverage for either of these services. I called the dental office back two weeks later when I received an EOB from United Concordia which showed my dentist office had submitted a claim for $650 to my insurance for the retainers while they had charged me $500 and my insurance did pay 50% of the orthodontic charge and it covered the $20 fluoride treatment. I asked about the billing discrepancy for the retainers and about getting a refund because according to my EOB, I should not have paid them more than $300. They said they have heard nothing back at all from my insurance company and that if there is any kind of overpayment on my part, it would be held in my account at their office as a credit so I would not be receiving any money back. I spoke with them again on 6/27/24 and was told they still hadn't received any payment from my insurance for the retainers and fluoride treatment and they have no idea about any kind overpayment or credit on my account. When I spoke to my insurance company on 6/27/24, they advised me that they sent a payment of $630 to this dental office on 6/18/24. When my insurance company contacted them on my behalf on 6/27/24, they were told by ****** that she refused to answer any questions about my charges and that because I share an account with my husband, any credit I have with the dental office would be deducted from my husband's bill. I want to be refunded for the overpayment. This office has received an overpayment of at least $220 for charges on 6/6/24 and I am told I will receive no refund for overpayment.
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BBB Rating & Accreditation
This business is not BBB Accredited
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Customer Complaints Summary
2 total complaints in the last 3 years.
2 complaints closed in the last 12 months.
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