Complaints

The complaint text that is displayed might not represent all complaints filed with BBB. 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.

• Initial Complaint

  Date:10/11/2022

  Type:Billing Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  When I called to make an appointment with Dr B****, I was told she was unavailable for a quick appointment and she suggested Dr K****. I asked if Dr. K**** was an In-Network provider for******. The receptionist took my insurance information and responded Dr. K**** was In-Network. When I asked why she wasn't listed in******'s website she responded the Dr. K**** was new, so I made an appointment. When I checked in form my initial exam and x-rays on 5/17/21 I gave them my insurance card. After the exam I was given a Treatment Case which included my cost for debridement, tooth extraction, cleaning and other work at the in-network price. I had two more appointments (5/28 & 6/9) and was scheduled for a cleaning when I got a bill from the dental office. I called and told them I paid for each appointment in full on the day of the appointments and should have a zero balance. The receptionist said not to wory they are working with****** to correct the issue. I called back a week later to see if the problem is resolved and was told they are working on it and assured me that I should come in form my scheduled cleaning and it will be covered. I canceled the appointment until resolution. I called the office and talked to Megan, in finance, and was told I owed the money because I am not in-network. She said at the time I called they thought Individuals and Groups were covered by Individuals are not. I am in an Individual plan which is clearly marked on my insurance card. I did my due diligence and was told multiple times that Dr. K**** wa In-Network. The person dealing with****** should know how to communicate with insurance companies. Note: At the time Dr. K**** was listed as an In-Network provider on the website for a different location which is why I believed them when they told me they were working on it.
  

  Business Response

  Date: 11/22/2022

  Business Response /* (1000, 8, 2022/11/03) */
  Patient ***** *******, scheduled an appointment on May 17"' 2021 for a new patient comprehensive exam with x-rays. Dr. K**** had
  recently bought the practice and at this time was working on credentialing with various insurances. Due to this fact, her insurance was
  then veried via phone, as an in-network plan with our ofce. At that time. we were not informed that the insurance companies were
  conrming Dr. K****'s network participation based on the dentists previous office locations and gave the patient the information that
  her insurance had provided to us. After billing the insurance for the services provided, and providing additional services on May 28"'
  2021, we received correspondence from the insurance on June 16"' 2021 that the new patient comprehensive exam on May 17"", 2021
  was being denied due to frequency and at that time we were informed we were an out of network Pl'°\'ldEi- When ieeaichig Wily this
  claim was denied due to frequency, we discovered that she had a previous comprehensive exam with x-rays within a 12 month period
  that the patient had not informed us of on her new patient paperwork or when the Dr asked about her last dental visit. The only
  information provided to us was that she had a limited exam. We contacted the patient leaving a vcioemail and sending out a statement
  via mail on June 20"', 2021. On July 20"' 2021 Mrs. ******* contacted the ofce with ccnoems that she was being tied to after receiving
  the statement from our otce with the balance le after the out of network benets were paid. We explained to the patient that we le
  with insurance s a courtesy to the patient. that we can only go off the information that the insurance company provides and that
  according to her nancial agreement signed by the patient before any services were rendered, she would be responsible for balances
  not paid by insurance within 30 days or be subject to an annual interest rate of 16% applied. Due to the fact that this error was not an
  error on Dunnellon Center for Complete Dentistry the patient was billed accordingly. in good faith to the patient, in an attempt to resolve
  the issue, we waived any interest on the balance due and adjusted off the balance remaining from insurance for the extraction on May
  28'", 2021, leaving the balance from May 17ths new patient comprehensive exam which was not denied due to our out of network
  status but due to frequency. At that time the patient tried to negotiate the paymentdown even lower and then let us know she would
  check her records and then call us back. On July 22"" 2021. Mrs. ******* called back with more concerns and spoke with our nancial
  manaoer in this regard where he offered to let her make payments on this balance.
  
  
  Consumer Response /* (3000, 10, 2022/11/07) */
  (The consumer indicated he/she DID NOT accept the response from the business.)
  She says they are only charging me for the xrays and comprehensive exam. After looking over my ***** policy I would accept that, but that is no where near the amount on the latest bill. And at no time was I told that this was the reason for the denial by *****. In every call it was just to blame me and not work anything out. The last full xray I had was in 2019 and I need to wait 5 years, but I can get xrays specific to problems. According to a previous bill I got the panoramic film is $83.00, The Bitewing film is $47 and the Comprehensive evaluation is $64 of which ***** paid $62.80 leaving a balance of $131.20 for the 5/17 visit. On 5/28 the charge was $144. I paid $97 at the time of the visit and ***** paid $140.50 leaving a $93.50 overpayment for the 5/28 visit. On 6/9 the extraction cost $207. I paid $41.40 and ***** paid $56. That leaves a balance of $109.60 for the 6/9 visit. Those combined balance of those three visits is $131.20 - $93.50 + $109.60 = $147.30. From that amount subract the $30.90 write off and the balance due is $116.40. Every number I used to illustrate is from your bills. If I were to receive a bill for $116.40 I would pay it immediately.
  
  
  Business Response /* (4000, 12, 2022/11/09) */
  In response to the patients billing concerns, please see below for the complete breakdown per the patients insurance. See attached documents for the insurances explanations of benefits for reference.
  5/17/2021 Comprehensive Exam was billed at $84, BiteWings was billed at $63, Panoramic X-Ray was
  billed at $108 with the total billed being $255 to *****. ***** paid $62.80 and patients
  responsibility was left at $192.20. As a courtesy to the patient, due to being told she
  was in-network, we billed in-network insurance fees to her instead of the office fees as
  follows: Comprehensive Exam was billed at $64, BiteWings was billed at $47, Panoramic X-
  Ray was billed at $83 with the total billed being $194 to the patient. After ***** paid
  $62.80, the patient paid $0.00, the total due was 131.20.
  5/28/2021 Full Mouth Debridement was billed at $170.00 to *****. ***** paid $29.50 and patients
  responsibility was left at $140.50. Again, patient was only billed in-network fees of
  $144.00. ***** paid $29.50, the patient paid $97.00, the total due was $17.50.
  6/09/2021 Extraction was billed at $340.00. *****'s rate is $207.00 and paid $56.00. The patients
  responsibility was left at $151.00. Patient paid $41.40, ***** paid $56.00, the total due
  was $109.60.
  The total due after the patients insurance paid, combined with the payments the patient had paid is $258.30. On 7/20/2021 a write off was given per the financial manager of $30.90 lowering the amount due from the patient to $227.40. Due to the frustrations with being out of network after being told she was in network we have adjusted off the balances due for the other two service dates and the corrected amount due from the patient is now $131.20 from date of service 5/17/2021 for the exam and x-rays due to the reason that the insurance denied them being frequency. After speaking with Dr. K**** to see how we can de-escalate the situation for the patient, she would be willing to adjust off the entire balance due, leaving a $0.00 balance on the account after confirmation of this review being removed. Please let me know how you would like to proceed.
  
  
  Consumer Response /* (2000, 15, 2022/11/12) */
  (The consumer indicated he/she ACCEPTED the response from the business.)
  The company is willing to credit the balance due down to zero.