ComplaintsforDentistry by Design, LLC

• Initial Complaint

  10/01/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  My husband and myself have gone to Dentistry by Design since January of 2023. We have ********************** and were assigned this dental office by our dental insurance. We have had appointments on the following dates:January 18 January 27 January 30 May 12 Upon our visits, we presented our insurance cards and were told that we were being charged according to our insurance costs. On the May 12, appointment, my husband was told the insurance did not go through and he would have to pay cash, which he did. I have since verified that our insurance was valid and effective during the dates of our appointments. For the last couple weeks, I have been requesting statements of our accounts via phone and email and requested they file the claims for our appointments and refund us the appropriate amounts. They have failed to produce any statements and as of today, ***** has informed me that no claims have been filed.

  Business response

  10/02/2023

  The office has spoken to the patient as well as the insurance company Cigna. Patient is on an HMO plan in which we charge the patient according to her fee schedule. (please see attached). Patient was under the impression that the office was to submit claims for ***** to reimburse the office for treatment performed to the patient. This is not the way her plan works. The office submits claims to Cigna so they have history on file and if there are any capitation payments due to the office, they will then reimburse us, not the patient. Capitation payments are payments made to the office for the patient being assigned to us as a provider. Example exam and xrays we do not charge the patient, but ***** sends us a monthly check for the patients that are assigned to us in addition to any additional payments we, the office, may be ***********.

  Patient is not comprehending how the insurance works. Sienna from Cigna called us today and she was going to speak to the patient. Pateint has a cleaning scheduled with us tomorrow 10/3/2023 @ 10am for a dental cleaning.

   

  Customer response

  10/02/2023

  I spoke with ****** at Dentistry by Design who told me that they are not required to file claims. I was not under any impression that ************ would issue me, the patient, any reimbursement and understand that the reimbursement is issued to the dental office. I then called Cigna to verify that no claims need to be filed, but they told me that claims are indeed required. The Cigna representative then placed me on hold, called Dentistry by Design to give them this information. The billing person at Dentistry by Design told Cigna that they will be providing the information to Cigna in order to file claims, so that I can see my claims history and verify payments made were indeed according to the Cigna schedule of payments. I will be able to see my claims history on Cigna within ***** business days and update BBB.

  Alyssa at Dentistry by Design said she cannot email any statements of accounts to Gmail email addresses, and I said I will come to the office in person today to pick them up. I will pick up the statements today, and upload them as well as the Cigna schedule of costs.

  Customer response

  10/02/2023

   
  Complaint: 20682360
  
  I am rejecting this response because:

  the charges on the statement provided by Dentistry by Design ************* on October 2, 2023 do not match the Cigna Dental Schedule of Costs.

  The following charges are not correct:

  *******************************

  1/10/2023 Code D0150 Charge: $115 Cigna Dental Cost: $0

  1/10/2023 Code D0210 Charge: $165 Cigna Dental Cost: $0

  1/18/2023 Code D4921 Charge: $15 Cigna Dental Cost: $0

  1/18/2023 Code D4921 Charge: $15 Cigna Dental Cost: $0

  1/27/2023 Code D4921 Charge: $15 Cigna Dental Cost: $0

  1/27/2023 Code D4921 Charge: $15 Cigna Dental Cost: $0

  1/30/2023 Code D9910 Charge: $45 Cigna Dental Cost: $15

  *****************************

  1/10/2023 Code D0150 Charge: $110 Cigna Dental Cost: $0

  1/10/2023 Code D0210 Charge: $165 Cigna Dental Cost: $0

  1/12/2023 Code D4921 Charge: $15 Cigna Dental Cost: $0

  1/12/2023 Code D4921 Charge: $15 Cigna Dental Cost: $0

   

  The total overcharged amount is $675.

  Additionally, the code ***** X for needle free anesthetic totaling $60 does not show up in the schedule of costs, but may fall under D9215 Local Anesthesia, which has a Cigna Dental Cost of $0. This would result in the total overcharged amount of $735.

  To date, $677 has been paid to Dentistry by Design. Assuming the ***** X code falls under D9215, the total which should be owed is $432. I request a refund to our credit card of $245.

  I will be requesting Cigna Dental to assign a new dental office for future care.

  
  Sincerely,
  
  *******************************

  Business response

  10/02/2023

  After speaking with ***** and as per the patient stating we have not billed her insurance, all of the procedures were submitted 10/2/2023 to Cigna electronically. For codes D0150 and D0210 the exam and full series x-ray, the plan calls for $0 copay, however, in order for the office to submit a claim, there has to be a dollar amount attached to the claim. We cannot submit a claim with ****. The fees reflect our office fees. Once Cigna sends their explanation of benefits for those dates of service and/or any capitation payments, the amount will be adjusted. 

  Oraquix is a topical numbing agent that we offer the patient in lieu of the local anesthetic which is administered by a needle injection. Any codes not listed on the fee schedule are patients' responsibility as Cigna can explain if it is not mentioned on the fee schedule. 
  

  For the D4921 and the D9910 , if there was an error on our part, we will be more than happy to adjust those fees as our standard fees are what populate when the treatment plan is entered into our system. Any refund that *** be due back to the patient will need to wait until Cigna reviews the claims the patient requested we send today and we close them out. Accounting will not release any funds to the patient until all claims are clear and closed..The filing of the claims have nothing to do with the patient as the patient is not being reimbursed for anything, however, because they are open, accounting will need all the claims to be processed by Cigna. .

  Instead of writing bad reviews and filing complaints, these situations can be handled at office level. 
  

  Customer response

  10/03/2023

   
  Complaint: 20682360
  
  I am rejecting this response because:

  Thank you for submitting the procedures to Cigna. As of this morning, they have not received them, but let's allow ***** hours for the electronic upload to occur, per Cigna. It was my understanding that the amounts in the 'Charges' column of the statement received from DBD on 10/02/23 are the patient responsibility. If this is the amount you submit to Cigna for some procedures and not others (e.g. codes D0150 and D0210, but not D4342, D4921, D4342 etc.), I do not consider this to be transparent or in any way comprehensible to the patient. How can I interpret the statement if some line items are the charges I'm responsible for and others are amounts are placeholders for the insurance claim? 

  In regards to the charges for Oraqix, ORAQ X is not a CDT code. I understand that any CDT codes not listed in the schedule of costs is patient responsibility, but a CDT code must be provided in order to differentiate if this is a covered procedure. CDT codes begin with the letter "D."

  I'm glad you were able to discover and adjust your billing errors for codes D4921 and D9910. This billing error resulted in an overcharge of $120.
  
  It is unacceptable to require me to wait until claims are closed to receive overpaid amounts as fees are clearly listed in the schedule of costs, and you have discovered billing errors on your end that resulted in overpayment.

  I would have preferred this issue be handled at the office level as well. It has taken unnecessary time out of my life to write reviews and file complaints and caused unnecessary stress on myself and my family. I would have preferred this situation be handled at the office level. On September 18, I called the office and requested a statement and was told that the billing person was not working that day. I did not receive followup. On September 20, I called the office and emailed requesting a claims to be filed for my husband's appointment from January and May. September 27, I called the office and emailed again requesting claims be filed. I only received a call back, which occurred this Monday October 1, after filing a BBB complaint. During this call, I was told that due to the type of insurance we had, DBD does not file claims. Upon hearing this information, I called Cigna to verify. ***** told me this was misinformation, called DBD and informed the billing person that claims are required. After this call, I called DBD and requested a statement again. I was told that DBD cannot send statements to gmail email addresses. I picked up a statement that afternoon, and only then was I able to compare it to the schedule of fees and find DBD billing errors. I have no confidence that this issue would have been resolved if a BBB complaint was not filed. 

  I still have the options of filing complaints with ***** and the *************************** if these issues are not resolved, but I hope it does not have to come to that. If you think this is how I want to spend my day, you're mistaken.

  Sincerely,
  
  *******************************

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