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:02/15/2023

  Type:Product 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.

  My initial office visit with this office was on 8/25/22 @ 2:30 pm. During this visit, I was given a quote in which I have attached to this email of $5440.00(Subtotal), $1925(Insurance), $3515(My out of pocket). Prior to me having the surgery, I was advised that my quote increased to $5215 out of pocket. On 1/10/23, I came into your office and paid the total amount of $5215 using two different credit cards ************ checking account, and FSA spending account) both screenshots are attached to this email. I then proceeded to complete the surgery with Dr. *********************** After the surgery days had gone by and this office had not put a claim in to my insurance company. After involving Delta Dental in this matter and making a few conference calls with this office, they finally submitted a claim. According to ***** who is a compliance representative at Delta Dental, the billing coding that this office submitted was incorrect and had to be re-done by Delta Dental. After receiving the explanation of benefits, I was only supposed to pay $1931 out of pocket which means Dr. ********************** owes me a refund of $3283. I have contacted this office via phone and email regarding them over billing me and per their email I would be refunded. I haven't received a refund or any communication from them. The quality of the work done by this office was also poor. This is unethical and not right. I would like a refund of what is owed to me immediately. I have disabilities which the stress of this matter is affecting my health tremendously. Please help!

  Business Response

  Date: 03/06/2023

  Please see attached response:

  Patient ********************************* presented to out office 8/25/2023, her entire mouth had severe infection to the point where the tissue was so inflamed, we could barely see the teeth. She told us she had been to several other offices but they would not treat her.

  Although it was a complex case we wanted to help her and give her a treatment plan to extract all upper teeth and most of lower teeth. I explained to her since I could not even see the teeth we would extract, and see what we can save on the lower, then should would heal for several weeks & then dentures could be made.

  The surgery was a long & required a lot of work but everything went well. We saw patient 1-2 days after surgery and she looked great & told us she felt great. Patient was happy we completed the surgery for her and we were extremely happy we could help her.

  Patients surgery was performed on 1/10/2023, at the end of each day the dental claims are sent to our clearing house A clearinghouse electronically checks dental claims for transaction compliance errors to ensure accuracy before being processed by the payer. Once these claims are proofread and cleaned, the claims and any associated dental or medical records and attachments are sent electronically to all appropriate organizations.

  Patient continued to call asking why Claim was not submitted to insurance company I did explain the process to patient but she felt it should have been done faster. We can only send the information to insurance company and wait for them to process.

  Then it is sent the insurance company. Delta Dental received that claim on January 16th, 2023. The time for a dental insurance carrier to process an insurance claim varies. At least 38 states have enacted laws requiring dental insurance carriers to pay claims within a timely period (ranging generally from 15 to 60 days)

  Patient also wanted to be written out of work because of her surgery. Patient wanted 3 weeks off of work. Patient called the morning of procedure asking if we can write her out of work from 1/3/2023, she said she was having bad anxiety about the surgery and blood pressure was elevated. We had to fill out claim with her work also. The kept requesting more information about patient and surgery. They also questioned why we wrote the patient out on 1/3/2023 instead of 1/10/23. Patient was upset that the claim was taking so long, we sent all information to them on what they needed.

  Patient called office on 1/23/2023 she wanted to cancel all appointment with Dr ********************** and didnt want to come here anymore. We cancelled all further appointments for patient.

  We have just received payment for this surgery on 2/23/2023. The claim was not paid in according to all the work that was performed on Patient and Dr is sent an Appeal to the insurance company. We are waiting for appeal to be processed, They have up to 30 days to respond. We have spoken to ***** from Delta Dental and she is aware of appeal.

  If patient is due a refund, we will gladly send it to her as soon as all claim is finalized. We did give patient a refund ck of $415.00 written on 2/23/2023 on what we felt was patient refund.

  Customer Answer

  Date: 03/09/2023

  1/10/23.
  Complaint: 19411755
  
  I am rejecting this response because: the response from Southbay/Dr *******************************/***** contradicts with the records I have, and I have not received a refund. I visited this office not on 8/25/23(hence this date has not arrived yet) but on 8/25/22 after being referred by a general dentist Dr. ************* During my initial visit with Dr. *********************** my gums were severely inflamed and severe infection. I never spoke to anyone at this office and stated that I had gone to several dentist and they would not help me. I have had the same dental plan with Delta Dental since April of 2019 and my first time visiting the dentist was with the referring dentist Dr. ***** Prior to that, I had not seen the dentist in decades hence to why my teeth and gums were in such poor condition. (I included a copy of my dental visits per delta dental) As for this being a complex case, after being seen by Dr. **** she spoke highly of Dr. ********************** and said they were good friends, and he would be able to take good care of me. She also spoke to me directly on the phone prior to the initial surgery date which was first scheduled for 11/3/22 and stated that she would be attending the surgery as well. I have also had a couple of second opinions and per the x-rays done by Southbay (which were emailed to me), this response is conflicting. I was not "helped" in anyway being that my insurance company and I paid for a service that was rendered by this office. This was not a charity case. If this was too complex for Dr. *********************** why wasn't I turned down for the service? I have spoken to other surgeons who could have performed the surgery. (I can provide any 2nd opinion information if needed) The surgery was not long. My appointment on 1/10/23 was scheduled for 9:30am. (This also included paperwork, payment, vitals, prep time, and the administration anesthesia). I confirmed with ******* that the prescriptions for me to take after the surgery were sent to them at 8:50am on 1/10/23 and we picked the prescription at 11:48am on 1/10/23. I was not seen 1-2 days after the surgery; however, I was told to come in the next morning after the surgery. I arrived on 11/11/23 and Dr. ********************** looked in my mouth and said everything was fine. (Never touched inside only looked) I did mention not being in any pain especially with me taking the pain medications I was prescribed. Also, I was given Fentanyl by Dr. ********************** which I wasn't aware of until after I received my medical records from ***** at Southbay which I was surprised because ******** is not listed as one of the medications listed on their website for sedation. I then visited Dr. ********************** a 2nd time after the surgery which was on 1/17/23 for my post-Opp appointment. The assistant removed the stitches and Dr. ********************** spoke with me briefly after and looked in my mouth (did not touch anything inside) he said I was healing great and fast. He also told me that he removed all the infection, and I should now start feeling better. (This information was incorrect per 2nd opinion dentist, tooth at the bottom was left in with severe bone loss and infection in it which has since been extracted. Can provide info if needed). I spoke to ***** prior to surgery date around 1/3/23 and told ***** that my dental insurance had started over for the year and asked her to get a preauthorization and she advised me that she would. (I have included on the initial complaint the phone log history on the days I spoke with ***** but can send find history again if needed). While working with ***** trying to get the documentation submitted by ******** for disability, one of the questions was left unanswered and that was the question asking Southbay for the coding for the procedures I had done by ************* ***** wrote on the disability document that their office does not use codes. (I also was sent this document by ***** via email and can provide this if needed). Per Delta Dental, all dentist offices have to use billing. This is what initiated my calls to Southbay about the claim because the claim done at my initial visit on 8/25/22 was sent and processed to them right away and they were paid by Delta dental. Which I was told by ***** that my insurance was maxed out and I would have to pay Southbay $5215.00. If there was never a preauthorizing submitted or any type of claim, how did ***** know my insurance was maxed out and told me to pay $5215.00? (Which I paid using my capital bank account and my fsa card. Bank statement is included) I was also contacted by Dr. ************* office and spoke with ****** who said ***** advised their office that Dr. ************************ surgery maxed out my insurance completely so I would have to pay out of pocket for the cost of the dentures when I returned to their office for them to be put in. At this time, I was in contact with Delta Dental and filed a complaint with ****** ***** informed me at that time that there had been no claims submitted or preauthorization submitted by Southbay. Why was ***** advising another office this information and had not submitted any claims? I was informed by ***** at Delta Dental that the claim submitted on 1/16/23 had incorrect coding for the work that was done by Dr. *********************** and it had to be resubmitted. This claim was denied.(I have a copy of the denial if needed) Southbay has since been paid by Delta Dental $2000 and per the explanation of benefits which I have included shows my out-of-pocket cost should have been $1931.00 not $5215.00. I emailed Southbay about the discrepancies and ***** stated that if I am owed a refund, they would refund me.(I previously provided this information can provide again if needed). I am very high risk due to my disabilities. I suffer from hypertension, depression, and severe anxiety. I called and spoke to ***** the week of 1/3/23 prior to the surgery and advised her that my blood pressure was extremely elevated, and my anxiety was at an all time high. I am a manager in an escalated queue at work and could have possibly been at risk for a stroke due to my anxiety of going through surgery. This is why I filed a disability claim to be out of work prior. I was not offered any type of medication prior to surgery to help with my anxiety which now after receiving a 2nd opinion and undergoing 2nd surgery with a different surgeon, I could have been prescribed something by ************ to help with my anxiety. I was never seen for a pre-Opp appointment. Dr. ********************** had not seen me since my initial visit on 8/25/23 and proceeded to do the surgery on me with elevated blood pressure and anxiety. (Dr. ************************ assistant confirmed my blood pressure was elevated when she took my vitals). My disability was completely covered after going to my Primary doctor, they were able to confirm my elevated blood pressure and anxiety due to the stress of the surgery. I was scheduled for a follow up appointment with Dr. ********************** for 1/31/23, I decided not to follow up with this office after everything that I had gone through and the poor treatment by them. I never called to cancel my appointment, I actually canceled this appointment and any further appointments via email. Which is the same email I included in my initial complaint. (Can provided if needed). I have not received any refund of $415.00 from this office. If a check was issued, please provide the check number. I have checked my mailed daily and have not received anything. Why do you feel I am owed $415.00? Please let me know where that amount is coming from. I did dispute a portion of the $2361.79 that was billed to my capital checking account by your office. The amount I disputed was $430.79 which would have left you the out of pocket amount I owed you which according to the explanation of benefits from Delta Dental is $1931.00. You also charged my FSA card for $2850.00. This should not have been billed at all because I only owed you $1930.00. If you are filing an appeal with Delta Dental, that has nothing to do with me and what I paid you out of my pocket. I have had to put out more money in the meantime to have another surgeon remove another tooth that Dr. ********************** left in and flatten my gums so that dentures will fit properly. I have also had to visit primary care doctor multiple times due to my blood pressure and anxiety that this ordeal has caused me. All I am asking is for you to do the right thing and refund my money to me. It is not ethical or right to withhold money from me that I never owed you in the first place. 
  
  Sincerely,
  
  *********************************