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:11/16/2024

  Type:Order 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 am writing to formally address Boulder Smile Designs non-compliance with Colorados Patient Records Law regarding the release of my dental ********** per Colorado law, healthcare providers, including dental offices, must provide a copy of a patients treatment records upon receiving a written request. This must be fulfilled within seven calendar days. Furthermore, the American Dental Associations Principles of Ethics and Code of Professional Conduct explicitly states that a dentist has the ethical obligation to furnish such records. Additionally, the Dental Practice Law clearly outlines that failure to comply with the Patient Records Law constitutes a legal violation.I have made repeated written requests for my dental records, including requests on 7/18/24, 7/29/24, 10/11/24, 11/7/24, and even submitted a formal release form on 8/8/24. Despite being a loyal patient of this office for 30 years, I have only received records for my most recent treatment. My numerous follow-up emails and phone calls regarding the missing records have been ignored.This delay and lack of response is both unprofessional and unlawful. I kindly urge Boulder Smile Design to fulfill its legal obligation by providing a complete copy of my dental records immediately.

  

  Business Response

  Date: 11/16/2024

  The Colorado Dental Practice Act only requires keeping patient records for 7 years, so this is most likely all that can be furnished to this person.  In addition, we have no evidence of emails requesting these records other than 07/18/24, and her dental records have already been provided to her.  We have spent more time explaining to this patient the reason for her outstanding bills than anyone in the history of our business and yet she still refuses to pay for services/treatment rendered.  We have not withheld her dental records and we unfortunately now have to use the legal system to get her to pay for over $5000 in overdue medical bills.  This complaint is a fabrication and instead her way of trying to get out of paying her bills.  

  Customer Answer

  Date: 11/16/2024

   
  Complaint: 22564407
  
  I am rejecting this response because:
  

  
  I regret to inform you that the response from the office manager is highly inaccurate, and I can provide evidence to substantiate my claims.Below are the key points, along with the corresponding evidence in attachments:
  1. Failure to Provide Complete Records
  Despite my multiple requests, I was only provided with my most recent panoramic image (taken on 12/21/23) and bitewings (taken on 8/15/23).Records for the past seven years have not been furnished, which violates Colorado law regarding the release of medical records within 7 days of the request.
  I highlighted this legal obligation to the office manager in writing a week before filing this BBB complaint, yet I received no response. I have attached a document titled Re Dental Records as evidence.
  2. Misrepresentation of Communication
  Contrary to the claim that only one email was received, I sent four emails on the quoted dates. These email exchanges are included in the attachment ******************
  Regardless of the number of emails sent, the office acknowledged receiving my request yet failed to provide the records, which is a clear violation of Colorado law requiring medical records to be provided within seven days of a request.
  3. Billing Issues and Lack of Justification
  I always pay my bills on time. However, I was asked to pay $4,000 without receiving any statement. Upon requesting clarification, I was sent a bill for $1,429 riddled with errors. Despite this, the demand to pay $4,000 immediately remained.
  I specifically emailed the office manager on 7/29/24 requesting corrections and reiterated my willingness to pay the accurate amount once the errors were addressed. These communications are attached under FW Response to Your Email.
  Furthermore, my email titled Follow-up on Unresolved Billing and Claims Issues clearly outlines my willingness to settle the matter amicably.Unfortunately, I have not received any response from the office manager via email or phone since 7/25/2024.
  The office manager never disputed, corrected, or acknowledged my detailed email pointing out numerous errors in the last statement I received.Given the enclosed written records, the accusation that I am trying to avoid payment is slanderous, I formally request a written apology for this unfair and unprofessional accusation in addition to my dental records which have not been provided in violation of Colorado law.
  More details of my ****** review are below:
  
  Why I ********************* After 30 Years
  I had been with this dental office for 30 years. Unfortunately, I recently decided to leave due to administrative issues that have significantly affected my experience.
  
  Billing and Insurance Claim Issues
  For the first 27 years, I received consistent, accurate statements after each treatment. However, three years ago, problems started to arise. Claims to my secondary insurance began to be filed sporadically and stopped altogether in January 2023, causing me financial loss. I only received a handful of statements, most containing errors that were never corrected, despite my emails and a face-to-face meeting with the office manager on 2/6/2023. I documented the required actions from that meeting, but these were ignored.
  On 7/22/2024, I received an email from the office manager demanding $4,000 without any explanation or statement. After I requested a statement, I eventually received one showing a balance of $1,429 and a request to pay $4,000 the same day. In response, I sent a detailed list of the billing errors I found, expressing my willingness to pay any balance owed once the errors were corrected and the outstanding claims submitted. Despite my follow-ups, I received no response. I am still waiting for final corrected statement. Most billing errors were billing me out of network fees although the dental office had been in network for both insurances until January 2024 when one of them was dropped.
  
  Dental Records Request Issues
  On 7/18/2024, I requested my dental records over the past 30 years. After a number of emails and phone calls I only received my most recent images.According to the ***************************, full dental records should be provided within a week of the request.
  
  I have emails documenting these issues, which I am willing to share if this review is disputed.
  

  
  Additional Observations
  I believe the office keeps records for more than seven years, as Dr. ******************** has referred to records from several years ago to review prior treatments on specific teeth.
  
  Thank you for your attention to this matter. I hope this clarification helps address the inaccuracies presented by the office manager.Please feel free to contact me if additional documentation or further explanation is needed.
  

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

  

  Business Response

  Date: 11/24/2024

  We have responded to the original complaint, but now the nature of the complaint is changing, where the customer is instead concerned about a large amount of overdue balance.  Initially there was no mention of her balance or our numerous attempts to collect money for services rendered, but now that has been conflated with her issues of receiving her dental records.  The customer is wrong, however.  Her balance is over $7000 at this point, and we have been forced to employ legal means to collect.  

  If she can be more clear with what she would like from her records, we can attempt to satisfy those requests but obviously you can see that the real issue is not the records but rather the unpaid balance.  

  Customer Answer

  Date: 12/01/2024

   
  Complaint: 22564407
  
  I am rejecting this response because:
  

  1. Request for **************
  It is the responsibility of the dental office to understand and comply with Colorado law governing patient requests for records. I am asking for the dental records to which I am legally entitled under Colorado law, specifically Colorado Code of Regulations (3 CCR *****) Section 1.9 mandates that providers maintain and produce dental records upon request within seven days of a request. Note Section 1.21.3 specifies penalties for non-compliance.Despite four written requests (via email) and two BBB follow-ups over the last four months, I only received the most recent bitewings and panoramic image.This non-compliance constitutes a violation of Colorado law.
  If the records are not provided by 12/3/ 2024, I will report this violation to the *********************. While I understand records must be retained for at least seven years after the patients last dental visit, I have also requested older records due to my 30-year history with this office, as they are critical for continuity of care.
  
  2. Expansion of Complaint to Financial Discrepancies
  The dental office stated my complaint has expanded to include billing matters. This expansion originated from the dental office.
  For context:
  I received a demand for payment of $4,000 without supporting documentation on 7/22/2024. I immediately requested a detailed statement.
  The statement provided on 7/25/2024, showed a balance of $1,429 but the office still demanded $4,000 to be paid the next day. This represented an unexplained discrepancy of $2,571 (statement enclosed). I asked why there were missing insurance write-offs.
  I followed up with a detailed spreadsheet on 7/29/24, showing that charges were based on out-of-network rates instead of in-network rates. This spreadsheet remains undisputed, yet no corrections have been made.
  The most recent write-off on my statement of 7/25/24 was dated 1/19/2023, for services rendered on 6/9/2022. There have been no insurance write-offs applied in one and a half years. Despite my willingness to pay the corrected amount promptly, no write-offs flagged in my spreadsheet were applied the balance has escalated to $7,051.96 (as of 11/26/2024).
  According to *******, the in network providers are contractually and legally obligated to:
  Adhere to Contractual Fees: Patients with insurance that the dental practice is in must be charged in accordance with the in-network fees.
  Ensure Transparency: Providers are required to explain charges clearly to avoid patient confusion and to comply with contracts with insurance companies.
  ******* shared that charging out of network rates for in network services constitutes billing fraud.
  
  Unresolved Insurance Claim number ********** 99
  The dental office submitted a claim for service date 1/30/******* primary insurer, *******, has requested additional information to process it. Despite my numerous follow-up emails (enclosed), and direct outreach from ******* representatives,
  the dental office has not responded. ******* confirmed that after the required information is provided they would reprocess the claim. If approved they would pay $812. If the claim is denied this amount would be my responsibility. Failing to respond to insurance inquiries violates both contractual obligations and the duty of care owed to patients.
  
  3. Offer of Resolution
  While I had hoped the dental office would address the flagged issues and provide a corrected statement, they have failed to do so.Enclosed is my updated spreadsheet with my calculations reflecting missing write-offs. I am willing to pay $429.30 ($7,051.96 (5,886.50 + $ $736.16)),which reflects the statement from 11/29/24 less missing write-offs from the attached spreadsheet less unjustified interest and collection fees. If the claim number ********** 99 is denied after the dental office provides documentation requested by ******* I will pay additional $812.
  Furthermore, I request compensation of $6,000 due to overbilling based on out-of-network rates and unjustified interest and collection fees. This request is not punitive but acknowledges the undue stress and hardship caused by the dental providers actions.
  
  4. Request for Apology
  The dental office written accusation that I am attempting to avoid payment is both baseless and slanderous. My 27-year history of promptly paying accurate statements speaks for itself. I expect a formal,written apology for these unfounded allegations.
  
  Next Steps
  To resolve this dispute, I respectfully request that the dental office:
  Compensate me $6,000.
  Provide a corrected statement reflecting all appropriate write-offs.
  Respond to MetLifes inquiry claim number ********** 99 by 12/3/2024, to enable claim processing.
  Withdraw any collection claim.
  Issue a written apology for slanderous accusations regarding my integrity.
  If these issues are not resolved by 12/3/2024, I will escalate the matter by sharing documentation with both MetLife and the **********************
  
  Under the *************************** Code of Ethics,dental providers must adhere to ethical billing practices and communicate transparently with patients. Furthermore, the ********************* Laws and Rules (Title 12, Article 220, Section 12-220-201) state that false billing is grounds for disciplinary action.
  I hope this matter can be resolved promptly to avoid further escalation.
  
  Enclosures:
  Statement from 7/25/2024 (Balance: $1,429).
  Statement from 11/26/ 2024 (Balance: $7,051.96).
  Updated Spreadsheet with Billing Discrepancies.
  Email asking for follow up on ******** request for additional information for service date 1/30/2023

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

  Customer Answer

  Date: 12/09/2024

  I'd like to receive all my dental treatment records. This includes notes from all dental visits, diagnoses, treatment plans, and progress notes.
  Especially important is information on anything that is crowned - date when the crown was initially placed, date and reason for replacement if applicable. The same for crowns on implants - also brand and size of implants. The easiest way would be emailing me everything you have instead of sifting through and trying to pick what I may want. 

  

  Business Response

  Date: 12/12/2024

  This patient has been sent her records.  It does not matter how many times we give them to her, she is simply trying to hurt our business in any way she can and refuses to pay her outstanding balance.  We unfortunately had to have her removed from the office by the police and now have had to file suit in small claims court.  

  Customer Answer

  Date: 12/17/2024

   
  Complaint: 22564407
  
  I am rejecting this response because:

  The office has not addressed points 2 of my BBB complaint - Financial Discrepancies and an ******************** Claim. The false accusations in their latest response appear to be a deliberate attempt to deflect attention from their inability to resolve these documented issues.

  The offices latest response contains several false and defamatory statements, which I would like to address clearly:
  Police ****** Claim: I have never been escorted from any office by police. This claim is entirely untrue and defamatory.
  Intention to Damage Business: I have never intended to harm this offices business. The fact that I was a patient there for over 31 years is clear evidence of my good faith and loyalty. This accusation is yet another unfounded and slanderous statement.
  Reason for Escalation: The financial escalation occurred solely due to the offices repeated failure to respond to my simple question: Why am I not receiving the write-offs? I shared a detailed spreadsheet at the end of July, notified the office of my intent to escalate if my concerns remained unaddressed, and yet my communications were ignored. 
  Delay in Records Release: I had to wait over four months for my records, despite Colorado law requiring their release within seven days. This delay forced me to escalate the matter. While I eventually received the records on 12/12/2024, it highlights the offices noncompliance with legal requirements.
  Unaddressed Billing Discrepancies and Lawsuit Filing: I identified significant discrepancies in their billing, which I shared with the office in a spreadsheet containing 8 records. These were neither disputed by the office nor an explanation was provided, yet they have continued to charge me $554.20 interest, $350 collection fee and filed a lawsuit against me on December 3, 2024.  I will vigorously defend myself against these baseless charges.
  Unprofessional and Unethical Conduct: Most dental providers take overcharging complaints seriously. They would review the detailed evidence, correct errors, or clarify any misunderstandings. I repeatedly stated in writing that I would pay if the discrepancies were explained. Instead, this office has resorted to personal and defamatory attacks, in clear violation of the *************************** (ADA) **** of Ethics and Professional Conduct, enforced by the **********************
  Attempt to Resolve the Issue: In addition to filing a BBB complaint, I attempted to discuss the matter directly with Dr. ********************* However, the office manager claimed Dr. ******************** was fully aware of the situation and refused to facilitate a conversation. As a last resort, I arranged for a police officer to deliver hard copies of all evidence to Dr. ******************** personally on December 2, 2024, at 9:30 AM.

  I sent a letter with a check for the amount I believe I owe to the office on December 9, 2024 (copy enclosed). Throughout this process, my communications have remained professional and focused solely on the issues at hand. This stands in ***** contrast to the office managers unprofessional and defamatory responses, as evidenced in BBB records and elsewhere.
  

  The office fails to recognize a critical point: I am not damaging their reputation by exercising my legal rights under Colorado law or requesting adherence to the ADA **** of Ethics. Any patient in ******** is entitled to these protections. It is the offices actions - violating legal requirements,disregarding ethical standards, and making defamatory claims - that may have caused damage to their reputation.

  Id like to confirm that I received the dental records for the first time on December 12, 2024, with an enclosed note stating the office has blocked my email. This was the first full set of records I received, aside from the bitewings and most recent panoramic image I previously mentioned. While the office claims to have sent the records before, the dental record file creation date is December 11, 2024, at 8:48 AM, just one day before I received them. I had previously offered several times to pick up the records in person but received no response.
  

  I also noted that the statement dated December 3, 2024, enclosed in the court summons, includes several write-offs totaling $1,514.40. I appreciate that the office has partially corrected these discrepancies. However, I have requested clarification on the exact dates of the write-offs and have yet to receive a response. Two of these write-offs match items on my spreadsheet of discrepancies, but a third one is only 10% of the amount listed - perhaps a typo in the decimal point? This leaves $3,560.10 outstanding write-offs still disputed.  Can the office provide clarification please.

  Sincerely,

  **** ******

  

  Business Response

  Date: 12/19/2024

  Again, Mrs. ****** is conflating different issues.  Her initial BBB complaint only references not receiving records.  She has been given them multiple times, including the most recent one that she actually finally acknowledges in her response.  Receiving the records was supposedly what she claimed would resolve the issue, but she rejected that and now has issues with the billing.  She unfortunately will keep moving the goalposts and clearly has no interest in resolving this complaint.  In the interest of goodwill, we didn't think it was necessary to have the police department cite her for trespassing or theft for not paying for services.  We now have to wait for the legal system to force her to pay her outstanding balance, which is an unfortunately slow process.  

  Customer Answer

  Date: 12/24/2024

   
  Complaint: 22564407
  
  I am rejecting this response because:

  It was the dental office, not me, that conflated different issues. Their response to the BBB request for records stated: This complaint is a fabrication and instead her way of trying to get out of paying her bills. Clearly, it is the office, not me, that introduced the topic of billing.
  The dental office should address the following outstanding questions:
    Out-of-Network Charges: Why was I charged out-of-network rates for approximately 18 months when the office was in-network? Why has my spreadsheet of discrepancies never been addressed?
    Response to MetLife: When will the office respond to MetLifes inquiry regarding my treatment on 1/30/2023? A dental office is obliged to respond to insurance company inquiries, and this question has remained outstanding for over 20 months.
    Write-Off Dates: What are the relevant dates for the write-offs listed on the December 3 statement?
  I have demonstrated goodwill by consistently stating that I would be happy to pay the bill once the discrepancies were corrected or explained.  However, the office chose to do neither and instead decided to sue me while absurdly claiming 'goodwill' on their part. I have always been willing to pay for services that were correctly charged.Sitting in the waiting room in hopes of resolving the matter with Dr. ******************** does not constitute trespassing, and there has never been any 'theft.'
  Had the office followed standard practices, such as continuing to send statements after each treatment, this dispute would never have arisen. This is evident from the fact that there were no issues for 28 years when such statements were provided. Similarly, had the office answered my questions regarding the billing discrepancies, this dispute would have been resolved without escalation.
  Instead, the office has resorted to defamation, falsehoods, and a lawsuit.Such behavior is appalling, unprofessional, and unethical.
  The office manager should bear in mind ********************* Laws and Rules,Title 12, Article 220, Section (jj), which states that failing to respond in an honest, materially responsive, and timely manner to a complaint filed against the licensee is grounds for disciplinary action. By remaining unresponsive, the office manager is ultimately damaging the very office she works for.
  Given the number of false statements the office has made, my offer to pick up records in person, and the fact that the dental records file creation date was just one day before I finally received them, it seems evident that the offices claim of having sent the records earlier than December 12, 2024 is fabricated.
  It appears that the office not only blocked my email but also rejected the certified letter I sent two weeks ago, which included my check as a gesture of goodwill toward resolving the matter.
  The office has chosen to base their court case on half-truths, fabrications, and defamatory statements, while I have remained professional and focused on presenting facts throughout this discussion. The court hearing will ultimately determine which approach holds up under scrutiny. I have also noted on the summons form that providing false statements constitutes perjury. 

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

  

  Business Response

  Date: 01/13/2025

  Hi, 

  Paperwork was filed 12/03/24 with Boulder County Court and 12/06/24 with Boulder ***********************

  

  Business Response

  Date: 01/21/2025

  Once again, Mrs. ******** initial BBB complaint was about receiving her dental records.  She has received them multiple times via multiple methods. We have addressed her complaint and fulfilled what she stated would resolve the issue, please see previous responses.  However, that is apparently not acceptable to her.  This complaint should be dismissed as a waste of time and resources.  We already have to take her to court over her outstanding bills.  That is enough time spent and wasted.  

  

  Business Response

  Date: 01/28/2025

  1. We have been out of network with ******* since 2023, which is why out of network rates were charged.  

  2. We have already addressed all of the insurance inquiries, there is nothing outstanding, no open inquiries, etc.

  3. Attached above is the 12/03/24 statement that Mrs. ****** is referring to.  It's not clear what relevant dates she's referring to, but the statement (ledger) shows transactions in our system.  Treatment done in our office is ordered by the date it was performed, and an insurance claim is attached to that treatment.  When the insurance company pays the claim, there is usually a write-off (meaning a difference between what we charge normally and what we are allowed to charge to the patient for being a contracted provider with that insurance company).  There is also often a patient responsibility or patient portion of the claim, which is the amount of out-of-pocket money the patient owes for that treatment.  Insurance claims often take a long time to process and pay, sometimes even needing to be resubmitted for a variety of reasons.  Once the claim has been paid, we can read the information and apply it to the system.  To be clear, the patient receives the exact same information (called an Explanation of Benefits), and is actually supposed to receive it before the provider.  So in effect, Mrs. ****** has known about her outstanding balance longer than we have.  When we apply the claim information (payment, write-off, patient portion) to the ledger, it tracks it as the date in which it was entered.  We make notes to tie it to the correct claim, but with multiple treatments over time and Mrs. ******** insistence that we resubmit already processed claims for her over and over again, the ledger becomes harder and harder to follow.  However, you can still clearly see that all of her claims have been closed and that there is no outstanding money coming from the insurance companies.  What is left over is her responsibility, which is why she has a balance.  The difference between the number on top of the statement and her own balance in the middle of page 1 is because her husband had a credit on his account from overpayment.  Note that we have since refunded his credit, and his balance is now $0.  

   

  Customer Answer

  Date: 02/06/2025

   
  Complaint: 22564407
  
  I am rejecting this response because:

  There are still two items outstanding.
  
  Point 1: 
  The specific in-network date of the dental office is crucial, as it clearly determines whether I should have received write-offs. ******* has confirmed that the dental office was in-network from April 18, 2016 to November 26, 2023. This is also stated on the corresponding EOBs from MetLife which the office has.  The disputed claims,where the office applied out-of-network billing (i.e., no write-offs), fall between February 10, 2021 and September 19, 2023, well within the period when the office was in-network with *******. Every EOB in question explicitly states that the office was in-network. The office has had access to this information all along, making it indisputable that all disputed charges occurred while the office was in-network. For reference, I have enclosed one EOB, please see the first sentence in Note section on page 1.
  In-network providers are required to apply write-offs as soon as they receive the Explanation of Benefits (EOB) from the insurance company. The final bill should reflect only the patients portionsuch as co-pays, deductibles, or uncovered charges. Patients should never be billed for the written-off amount when the dental office is in-network. This would constitutes balance billing,which is prohibited.
  Yet, this is exactly what happened in my case. In July 2024, I received a statement with no write-offs at all applied for dental treatment since November 3rd, 2022.  Additionally,some write-offs were missing even to prior treatments. Given that 9 to 39 months had passed since the disputed period (depending on whether one considers the start or end of the disputed period), the office should have applied the write-offs long ago. Instead, they chose to ignore them, inflating my bill by over $5,074.50 and engaging in prohibited balance billing.
  When I pointed out this discrepancy, including a detailed spreadsheet, the office ignored my emails. Rather than addressing the issue, they sued me,presumably in the hope that I would simply pay. To this day, they have not explained why they have not applied the write-offs.
  The office is well aware they are supposed to send bills with write-offs.  Had they done so this dispute would have never happened.  Is there any explanation other than the office deliberately overcharging me by over $5,074.50 and charging me interest and collection fee on this inflated incorrect balance?  I have been asking this question since July, and they have yet to answer. The BBB can contact ******* to validate the offices in-network status during the disputed period.
  
  Point 2: 
  I agree that ******** outstanding question from February 2023 has finally been answered and the claim has now been resolved. As a result, ******* issued an additional payment of $529.80 to the dental office on January 27, 2025.  It took almost two years for the dental office to respond.
  This payment directly contradicts the dental offices statement: 
  "However, you can still clearly see that all of her claims have been closed and that there is no outstanding money coming from the insurance companies." 
  This is yet another example of the office either misrepresenting the facts or demonstrating serious issues with its billing practices.   

  Point 3:
  I appreciate the dental office taking the time to explain the process. Based on my review of Explanation of Benefits (EOBs), insurance companies typically process claims within a few days to a month. When a claim is processed, payment to the dentist is issued. When comparing the dates of insurance claim processing with when payments were applied to the ledger, I found delays ranging from 5 to 16 months. These delays have artificially inflated my balance. Additionally, when payments are applied to the ledger, the corresponding write-offs should be should be calculated and recorded at the same time. The lack of write-offs also artificially inflated my balance.
  To summarize:  The following five write-offs are still missing for the corresponding service dates:
  February 10, 2021
  March 8th, 2021
  November 3rd, 2022
  January 30th, 2023
  September 19th, 2023
  When the office was in network all write-offs should have been included before the statement was sent out.
  Several write-offs were suddenly applied to the ledger on December 3rd, 2024, the same day the summons was filed, up to 2 years after the insurance payments. These write-offs should have been recorded at the time of insurance payment. Furthermore, these late write-offs do not indicate the specific dates of service they pertain to, making it extremely difficult, if not impossible, to follow the ledger. While some write-offs may be identifiable by their amounts, others are too small to be clearly linked to a specific service date. Some of these appear to be only partial write-off.Please provide the corresponding service dates for the following write-offs posted on December 3, 2024:
  12/3/2024       $15
  12/3/2024      $287.80
  12/3/2024       $159
  12/3/2024       $4.60
  12/3/2024       $90
  I also need to correct the false statement: Mrs. ******** insistence that we resubmit already processed claims for her over and over again. I challenge the office to provide evidence supporting this claim. If they cannot, they should issue an apology and refrain from making further false statements.
  At no point did I request the resubmission of claims that had already been processed. However, I did request that several claims be submitted to ************ because the office failed to submit them in the first place.Approximately one-third of the claims to ************ were either never submitted at all or were submitted too late, resulting in their denial. Due to these errors, I have incurred financial losses. Furthermore, I have found no ledger notes indicating that claims were resubmitted, so I fail to see how resubmission could have made the ledger difficult to follow.
  I do not believe it is my responsibility to maintain the ledger, as implied by the statement: The patient receives the exact same information (called an Explanation of Benefits) and is actually supposed to receive it before the provider. So, in effect, Mrs. ****** has known about her outstanding balance longer than we have. It is the office responsibility to provide accurate and timely billing statements. The office has adopted irregular billing practices, made significant errors as outlined in point 1 and refused to acknowledge them.  I have never encountered billing issues with any dental office before 2021, despite having been with the same practice since 1994.
  My complaint is based on written documentation not on verbal assertion without supporting data.
  
  Sincerely,
  
  **** ******

  

  Business Response

  Date: 02/17/2025

  Please provide a response addressing the customer's question of
  1. Why out of network charges were billed when the business was in network from 2016 to November of 2023. 

               -- They weren't.  We don't bill out-of-network or in-network charges.  We bill one fee regardless and then make appropriate write-offs to the patient's account based on the payment of the claim.  Here is what I sent her husband via email regarding the exact same question:  

  "We dont bill in-network or out-of-network. We send an insurance claim in with the full fee, also known as the *** fee (usual, customary, and reasonable). That fee is what we charge to uninsured patients, since we do not have a contract with an insurance company to charge them less. It is what we believe the treatment should cost. Billing the insurance company with *** fees is standard practice in our industry.
  
  
  What comes back from the insurance company is a payment along with an ***, an explanation of benefits.  The *** shows the fee we submitted, the fee they allow for in-network providers, the payment by the insurance company, and finally the patients responsibility for any remaining amount due. The difference between the *** fee and the allowed fee is called a write-off. Whether we are in-network or out of network, we still get a payment and an ***. We then enter those figures into our system and have to ask the patients to pay their balance, which reflects the same number on the *** under patient portion or patient responsibility or what you owe, which is how it shows on MetLifes paperwork. 
  
  
  That is what comprises your wifes balance. She has the same ***s from MetLife as we do. In fact, the patient receives them before the provider. The numbers we have match the numbers from *******. They are not arbitrary and not based on what we think the patient should pay. That is why there are no adjustments and no audits left to do. The balance is accurate, it has absolutely nothing to do with the date we exited MetLifes network, since we bill the same fee regardless of network participation. Hopefully that clears things up."

  2.  Please provide the corresponding service dates for the following write-offs posted on December 3, 2024:
  12/3/2024       $15 - 2/22/24
  12/3/2024       $287.80 - 1/30/23
  12/3/2024       $159 - 11/22/22
  12/3/2024       $4.60 - 8/15/23
  12/3/2024       $90 - 4/17/24

  Customer Answer

  Date: 02/24/2025

   
  Complaint: 22564407
  
  I am rejecting this response because:

  The statement from the dental office is still missing several write-offs.

  The office states: We don't bill out-of-network or in-network charges.  We bill one fee regardless and then make appropriate write-offs to the patients account based on the payment of the claim. That is indeed how it should work,but it did not happen in my case.
  In July 2024 the office demanded a payment of at least $4,000 towards my balance claiming that the July 2024 statement was accurate. This claim was false. This statement failed to reflect any write-offs since November 3, 2022. After reviewing the statement, I identified and sent the office a list of eight missing write-offs, all of which were clearly absent from the July statement they provided. In December 2024, the office made partial corrections, including three of the missing write-offs. However, they never apologized for their errors and instead chose to sue me.
  Similarly, the claim that my balance is accurate today is also false:
  The office failed to apply the correct write-off, as confirmed by its own correspondence. In a February 10, 2025, email to my husband regarding the January 30, 2023, treatment, Dr. ******************** stated, 'The MetLife write-off is $3,084.'However, the office only applied a write-off of $287.80 per their latest BBB response instead of the correct amount of $3,084.  The office has yet to correct the discrepancy.
  Write-offs are clearly visible on office statements. Claiming that write-offs were applied while failing to identify them on the statement is not credible.
  I have attached a spreadsheet detailing:
  The missing write-offs
  The write-offs the office corrected (including one non-write-off item that was delayed due to the offices failure to respond to MetLife for almost 2 years)
  ***** actual outstanding balance
  Additionally, I have enclosed the MetLife EOB for the 1/30/23 treatment.
  As a reminder:
  In-network providers are required to apply write-offs as soon as they receive the Explanation of Benefits (EOB) from the insurance company. The final bill should reflect only the patients portion (e.g., co-pays, deductibles, or uncovered charges). Patients should never be billed for the written-off amount when the dental office is in-network. Doing so constitutes balance billing, which is prohibited.
  By failing to apply the required write-offs, the office has engaged in balance billing.  The outstanding write-offs which are supposed to be applied as soon as the office receives the **** show a delay of 14 to 47 months (!).
  Additionally:
  I challenged the office to provide evidence supporting its claim that I repeatedly requested the office to resubmit the claim. The office failed to provide any proof or issue an apology -another false accusation.
  The office falsely stated: You can still clearly see that all of her claims have been closed and that there is no outstanding money coming from the insurance companies. This was proven false when ******* issued an additional payment of $529.80 to the dental office on 1/27/2025.
  
  Sincerely,
  
  **** ******