Complaints

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• Initial Complaint

  Date:10/06/2023

  Type:Billing Issues
  Status:

  AnsweredMore 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.

  I needed to have a root canal done on one of my teeth. As per my insurance carrier (*******), I needed a referral, which I received from my primary care dentist to this business. I set up the appointment and had the work completed. Unbeknownst to me, there was a second appointment required by the provider. Upon arrival at the second appointment, I was informed that, I had to pay over 900 dollars upfront to the provider in order for the second portion of the procedure to be completed. The receptionist and the Dentist informed me that, if I had the second procedure completed the insurance would cover the cost of the procedure. However, they required me to pay over 900 dollars at that time. I do not have that kind of availability of funds, nor do I know anyone who does. The dentist then removed all of the protective equipment, (I was seated in the dentist's chair) and informed me that the procedure would not be completed unless I paid upfront. I then left the office voluntarily. I contacted my insurance carrier, and they will not pay due to the second procedure not being done. I find this situation unconscionable. I served my country for 20 years and to be treated in this manner is wholly unsatisfactory. I look forward to hearing from you.
  ***** ****

  Business Response

  Date: 10/23/2023

  Dear Mr. ***** ****,

   

  We initially saw you on an emergency basis on 07.13.2023 for an infected tooth. You had a great deal of pain and we explained your options in detail.  Due to your slight disability we took extra time to write things down so you can understand clearly. At your request, we can also provide you with copies of the chairside written explanation. Options were offered.  Since your intention was to preserve the tooth, root canal treatment was initiated. The standard of care for infected teeth is to medicate the treated canals for a period of time to ensure the infection is eradicated. Provided the patient is asymptomatic, only then is the root canal treatment to be completed. This being your situation, you were explained clearly these facts and agreed to a follow up appointment. As a gesture of trust and respect we did not collect a copayment at that time, although one was due. At your request, we generated a treatment  predetermination form and sent it to your insurance carrier to obtain the exact copayment amount. Per your insurance, your financial responsibility for the completed root canal treatment would be $948.00. Your insurance would cover the balance of $237.00. In order for this particular insurance to process and pay on the claim, preoperative and postoperative X-Rays are required, thus the treatment would have to be completed. For your convenience, we attached the Insurance Pre-Treatment Estimate.

   

  We met with you again on 08.21.2023 for the final phase of the root canal treatment. At this point you were perfectly comfortable. You were seated and we assured the temporary restoration placed several weeks prior was safely sealing the access opening. As we were preparing to complete your treatment, we presented you with the information your insurance company provided. Your reaction was categorical in saying you will not pay "anything" towards the treatment. You said the tooth does not hurt and you decided to leave the office without completing the treatment. In order to avoid any misunderstandings, our office sent you a letter explaining clearly that your treatment is not completed. In that letter, we provided you with information, options and suggestions and encouraged you to contact your general dentist or our office with any questions. We attached a copy of that letter to our response.

   

  Since the treatment was not completed, our office cannot submit a claim with a "completed root canal" code (D3330).  As explained in our letter to you, we filed the claim with your insurance as "Incomplete Root Canal Treatment" (D3332). Your insurance does not cover you for this service. The fee is $645,00. As a result, under their rules, this becomes your financial responsibility. We attached a copy of the "Explanation of Benefits" for your records.

   

  It is our hope that this helps you understand the very confusing insurance process.

   

  We were successful in treating your tooth and eliminating pain and infection. We made certain each time you left our office you were not in pain and the tooth was safely, temporarily protected. It is regrettable you decided not to complete treatment. Although we respect your choice, it is our duty to inform you of potential dangers stemming from incomplete root canal treatment. We did that through our letter. We feel certain our entire office staff treated you with respect and dignity. We feel the services we provide are of the highest standards and yield outstanding results. We feel our charges are more than reasonable. The fee for our services (incomplete root canal treatment) is $645.00 and that is considered to be well within the usual and customary range. As of today, we have not received any type of reimbursement for the treatment provided from you.  Your insurance carrier made it clear they will pay $0.00 for the treatment.

  We feel this is unethical and unfair. It is our hope that you will remit payment soon.

   

  Best Regards,

   

  Marius M********, DDS