ComplaintsforEndodontic & Periodontic Associates, LTD.

• Initial Complaint

  08/09/2023

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  I informed the front desk that I had 2 insurances, both which are contracted with this provider. I had to pay $160 up front, even though the contract rate is lower for the office visit. They billed my insurance 2 days later and I found out I dont have a copay. I have called 3 times to get my money back and its 30 days later and Im still without my prepaid overpayment for an office visit.

  Business response

  08/11/2023

  We believe the patient was fully informed of the deposit and costs and also willingly agreed to the $160 deposit.  In fact, the patient signed documents at the time of service attesting to that.  The patient could have opted at any time to not seek a dental evaluation with us but still chose to make the deposit and did receive the requested evaluation.  The sequence of events are the following.
  

  1. The patient, a child, was referred to our dental specialists by their general dentist.  
  2. The patient's mother called our office to schedule an oral evaluation appointment on behalf of her child.  She was informed over the phone that we required a deposit fee of $160 at time of service.  Patient agreed to pay and made an appointment for her child.
  3. Patient and parent arrived at our office and signed the ***************** Responsibility Form and the $160 cost quote and then paid the $160 without complaint.
  4. At that time, the patient's mother provided information for both primary and secondary insurance carriers that are Out of Network with our company.  Thus, it's impossible for us to know with certitude the patient's eventual out of pocket expense for the evaluation and resulting treatment, hence the estimated deposit.  Deposits prior to treatment are common in the healthcare industry.   
  5. The patients' child saw our Endodontic Specialist for an evaluation and apparently was satisfied with that service as the patient scheduled with our Endodontist the necessary treatment for a later date.  
  6. But then the patients mother subsequently cancelled treatment and presumably went to another provider.
  7. Had the patient not cancelled treatment, any deposit overpayment would have been applied to the treatment, which, according to the primary insurer, is NOT a covered service and only minimally covered by the secondary insurer.  
  8. By cancelling the treatment, the patient circumvented that process causing us to refund her $86 instead of applying the $86 towards the treatment, which would have involved substantial out of pocket expense.
  9. We removed the patient from our schedule, per the mother's request, and facilitated the $86 refund to her on 8.10.2023.
  

  We believe this matter is resolved.  If there is anything else required of us, please let us know.
  
  
  
  *************************
  

  Customer response

  08/14/2023

   
  Complaint: 20447510
  
  I am rejecting this response because:

  The provider stated that they are out of network for both my primary and secondary insurances. This is a false statement. I purposely researched an in network carrier that accepted both of my insurances. They filed a claim with my first carrier within 2 days of my visit. I did sign the paperwork required by the provider, but I wasnt aware that BOTH of my insurances fully paid any evaluation fees until I left and followed up with them. 
  

  Additionally, I believe this provider is in violation of the no surprises act. Since they claim to be preferred providers with both of my insurances, I should have been billed the CONTRACT rate as agreed upon in their respective agreements with ********** and United Concordia. I was reimbursed $86, but there is still another $74 owed to me. The $160 is NOT the agreed upon contract rate for services, I demand my balance be returned to me with interest immediately. 
  

  I will be reporting them for their violation of their contract terms with both providers.
  
  Sincerely,
  
  ***********************

  Business response

  08/17/2023

  To Whom it May Concern,

  1. We did not tell **************** that we are in network with her two insurers carriers. 
  2. But we contacted the insurers AGAIN today and so far, at least one is stating **************** is Out of Network.  
  3. We are still waiting on a second insurer to adjudicate ******************** claim as the insurers perform that task sequentially, not concurrently, hence the delay.      
  4. The attached Financial Responsibility paperwork signed by *************** states in Section I (a-e) that her insurance coverage is a contract between her and the insurer and that insurance coverage greatly varies.  And **************** also signed that she agrees she is ultimately responsible for payment, not the insurer, regardless of in or out of network status.  
  5. The attached Good Faith ******** signed by **************** states that the $160 is a deposit only towards treatment and that "final out of pocket will be determined once claim is processed by insurance".  Again, **************** signed the very clear Good Faith ******** and paid the amount noted on that form as an estimate and required deposit.  Again, this paperwork was signed by *****************   
  6. **************** paid the deposit towards treatment but opted to forgo the complete treatment which is why she is receiving at least some as a refund.  Had **************** completed treatment, in all likelihood she would have owed us additional monies due to her insurer/s being out of network.   
  7. We are still waiting for the second insurer to send us their EOB and we will then know whether any additional funds would be refunded to *****************         
  
  

  Customer response

  08/23/2023

   
  Complaint: 20447510
  
  I am rejecting this response because:
   
  I have provided an EOB substantiating that they are in network for FEP blue. I also see a claim payment from United Concordia, yet I STILL dont have my PREPAID money back. Its been 43 days of this business holding my money hostage, which affords them the opportunity to gain interest on the money owed to me. 
  

  I want my money back now with interest! 
  
  
  
  Sincerely,
  
  ***********************

• Initial Complaint

  04/20/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My dentist referred me to ****** Endodontic and Periodontic Associates for a root canal. When I called to make an appointment, I was told the cost of the procedure would be $1,048.00 I do not have dental insurance and being retired I thought this was expensive. I called another dental office and was told the root canal procedure was $1,020 since the cost was nearly the same. I chose to use ****** Endodontic and Perodontic Associates for the root canal procedure that my dentist referred me to. I had the root canal done on April 10, 2023. When I was checking out, I was told I owed $1.448.00. I told the girl that I was given a price of $1,048.00 on the phone when I made the appointment just a week before. She said, "I'm sorry, but they must have made a mistake, the price is $1,448.00. I paid $724.00 before leaving and owe $724.00 more. I feel that $1,048.00 is way overpriced for a procedure that took less than one hour and wasn't much different from having a cavity filled, and $1,448.00 is an outrageous amount to be charged. The resolution I am seeking in this matter is for the business to stick to the price I was given on the phone of $1,048.00. Thank you.

  Business response

  04/27/2023

  See attached response.

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