I was told they accept my insurance, but was never told it would be out of network. Had I known, I would have never gone there.
In Dec 2013, I needed what I thought would be a filling. I was in a lot of pain and I was looking for a new dentist anyway, ***** ******** DDS was close, so I decided if he took my insurance, I would give him a try. I called his office and asked if he accepted my insurance and plan and was told "yes." I got an appointment for the next day. When I went for my appointment and gave them my insurance card, I asked again if whatever I needed done would be covered. Again I was told "yes." It turned out I needed a root canal. I was referred to a specialist and given a quote of what I would owe. I had the root canal the next week. In January I received a bill from ******** and the specialist, both making it obvious that they did take my insurance, however they were out-of-network. Had I been told they were out-of-network, I would have NEVER gone there. I called *******'s office today and spoke to ******** himself who told me that he doesn't contract with any insurance company, therefore I feel like I was lied to in order to get my business. Sure, he'll accept your insurance but he'll be out-of-network and you'll be stuck with a huge bill. It's possible his employees I spoke to on the phone and in the office didn't know this, but I doubt that. Should I have verified with my insurance company that I would be covered if I went there? Absolutely. Lesson learned. But especially after going to the office, letting them see my insurance card, and asking them again if I would be covered and being told "yes", I believed them and didn't verify with my insurance. I thought, "Surely it must be covered. They would tell me if I would end up having to pay a lot of money, right?" Wrong. I called my insurance today who did verify that ******** is out-of-network and they told me that had he been in network, my visit to him and to the specialist he referred me to would have been covered almost 100%. So now I'm stuck with 2 hefty bills totaling roughly ****** My insurance paid less than *** total. I feel like ******** was misleading by making me think everything would be taken care of by my insurance. But I suppose no one with insurance would go to him if they were told up front that he will be out-of-network. Who would go to him if they can get the same thing done for 70-80% cheaper? I feel like I have been swindled and that my trust (and/or naivety) have been taken advantage of.
As unlikely as it is, I would like to only have to pay what I would be required to pay if he was in-network. Unfortunately, the significantly larger bill is from the specialist, and I highly doubt there is anything that can be done about that. The quote from the specialist was based on being covered by my insurance. I had to pay what wouldn't be covered up front ******* Since the referral came from someone out-of-network, my insurance only paid *** of a **** bill from the specialist. I don't know exactly what I owe ********. I have a bill for ***** but was told by his office on the phone today that I owe *****
I am responding to the patient who has made a complaint to the Better Business Bureau about my office. First, I have never met this person. He was in my office on December 5, 2013. That day 1 had to take my wife to two separate doctor appointments because of her health issues. Another dentist filled in for me
and saw patients for me that day. That being said, the policies are the same whether I'm there or not.
When I spoke with this patient on February 4, 2014, I explained. I was not signed up with any insurance companies. That meant I was not in-network. We do accept insurance and work with many insurance plans. Often, there is little difference in payment for services whether in network or out-of-network.
Sadly, for this patient, there is a big difference in coverage. my office said "yes" when he asked if we took insurance. During a phone conversation Doctor had with patient, the patient stated the front desk told him we were part of his network. The front desk staff would never tell him we are in his network. With networks,
the patients are restricted to a list of participating dentists. Right on his insurance card, it states his PCD dentist is Dr. Bruick Dentistry, not our office. His insurance company said this is his only in.-network dentist. They can't always go to the dentist of their choice without a financial penalty.
This issue is important to him financial, I can sense that concern. When my front desk staff initially spoke with him to set up his next appointment, he was given an estimate for future work, he said it was fine and he would just pay for it.
Twenty minutes later, the next call to the front desk was quite a different tone. He was determined that we were at fault for his financial state with, respect to the insurance companies stance. I understand that his network does pay out-of-network dentists. They will, pay very little, but they do pay. This particular claim went towards his deductible, Otherwise, payment would have been made. Many patients
are under the false assumption that their insurance will pay for everything, no matter what. Likewise, since he was referred to an out-of-network specialist â€" they will not pay. No endodontists in Fort Wayne are in his network. (The same applies to oral surgeons.) He would have to travel somewhere else geographically to find an in-network endadontist.
That day, he was in pain. The tooth throbbed and he had been up the night before. He was referred to the endodontist The front desk would never tell him the endodontist was in-network.
Again, we do accept insurance. I am not in-network with any insurance company. We arranged for him to get the proper treatment. We did not lie to him as he implied to get his business. In our phone conversation, he also accused me of "robbing people". His insurance company is robbing him with their restrictive rules. He said we stated he owes us $***. No one in my office told him that amount
Our excellent record speaks for itself. This is the only Better Business Bureau complaint in thirty-three years.
His balance is due. There are so many variabled in insurance company plans with different employers. We can only strive to do our best for our patients. Regretfully, the patient just had to look at his insurance card to see who his in-network dentist was. Any dentist other than the dentist listed , on the card would. be out-of-network. He would have the same situation in any office as he did in mine. He should be able to show you his card with the provider name on it to the Better Business Bureau.
We have a. copy of his card in his file.