Complaints

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• Initial Complaint

  Date:07/27/2023

  Type:Service or Repair 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 had a root canal procedure done by the dentist. My insurance did not cover the cost of the procedure, however the doctor advised me that he would charge me what his insurance fee would be for that procedure. I have since received the attached bill totaling $6519.00 for a procedure that is listed as $3006.24 based on typical insurance payouts. Attached please find an updated bill as well as my response to the bill statement as well as the remediation I proposed.

  Business Response

  Date: 08/25/2023

  To whom this may concern,
  
  The assertions of fact presented in the undated letter, received on August 14, 2023 (along with a check, oddly dated May 24, 2023), for a bill that he asserts he received "for the first time, on May 23, 2023, of patient M. L. are clearly and indisputably incorrect and the record, to be presented herein, will amply demonstrate so.  I will respond to the relevant assertions of fact in as concise and clear manner as possible.
  
  Assertion 1
  
  *** ** *. states, in paragraph. 1 that the statement he received on 05/23/2023 is " the first and only statement he has received since my procedure"
  The implication is demonstrably false .  
  A) *** *** was sent multiple statements just in 2023 alone: 02/09/23, 03/10/23, 4/26/23, 05/16/23.,etcetera.  None of the statements were returned by the USPS.  As well, there were in excess of 10 (ten) messages sent to him between 04/01/2022 and at least 6 calls in 2022 and 4 calls in 2023, none of which did he answer nor respond to the message left each time. (he also never once reached out to us to figure out the balance due for services.  Not once in 18 months.  Not once.
  B) If, in fact, he never received the other bills, and thus this is the first he ever received, why did it take approximately 18 months to he date of the May 23 bill, and then only by way of ostensibly making a demand that we accept whatever he is paying and, by extension, his dictating fees. And, even more disturbing, why did it take him almost 18 months to "reach out to us?
  C) Indeed, I cannot divine what he did or did not receive, however, I can, with certainty and clear knowledge, attest to the fact that he was sent multiple bills, all to the same address, did receive the one in May, which took him 3 months to act on.  I can also attest to the fact that all of our attempts: by phone, by text and by email were met with radio silence. The result of this is the clear and obvious conclusion that the problem was not the lack of receipt of the other bills but rather his indifference to responding to any and every effort, by multiple means, sent to him. 
  
  Assertion 2
  
  ** *** (to be referred to as ** henceforth) asserts in paragraph. 2  that "Upon my first consultation with the doctor, [I] explained that [I] do not carry dental insurance..."
  This is demonstrably false.
  A) **'s electronic chart clearly has ****** ********** as the insurance of record.  As such, we did NOT take full payment for each of his procedures at the time of treatment, as is the policy in our practice and the policy for which he acknowledged in his intake paperwork, which he signed, that clearly states: 
  Payment is due at the time services are rendered
  B) We submitted to insurance claims for services rendered on 3/23/22 (Consultation, Comprehensive evaluation and Radiograph) and, on 3/23/22 (Root canal treatment of a molar tooth) and  3/24/22 (treatment of canal obstructed >90%).  We received a letter from insurance on or about 3/26/22 stating ** is not currently an insured patient {FLN number: ***************).  Pt was informed of this on or about  4/04/22 at which time he reiterated that the information provided for insurance was correct.
  As a result, in deference to him, we proceeded to provide further services on 4/04/22 for a Ceramic crown and  core build-up and  therefore took only payment for his calculated portion of the insurance scheduled amount (as required by the insurance policy of receiving patient's portion at time of service.  These procedures were then also sent to insurance but with the same result: Payment denied for this claim due to ** not being an actively insured patient [FLN Number: ***************].
  C) for services on 3/23 patient made a payment of 372.00 but for the 3/24 treatment, no payment was received at all.  It stretches credulity beyond breaking pint to imagine that we would know he is not insured and would accept as payment for 3/23 372.00 for all of the services rendered on that date, and no payment at all for services rendered on 3/24 after (he contends) we had been told by him that he has no insurance.  Why would we ask only for the calculated patient co-payment if he had told us, a priori to treatment. that he was not insured.  This makes no sense and it clearly shows, ipso facto, that his assertion that he had informed us that he was not insured is meretricious (a specious assertion) and without plausible basis.  This is especially true as the billing staff always and without exception inform the pt that their payment is the "expected co-payment amount but is not a guarantee of insurance payment and they could have further costs associated with this and any other treatment."  How possibly could ** or any other patient conceive that procedures amounting to $2,348.00 for the 3/23 visit would be adjusted to $372.00 AND that the 3/24 visit which costs $1,334.00 would have him paying $0,00.00?  This brings into even clearer focus the frank absurdity, writ large, of his contention that he "told the doctor that he would be paying "out - of -pocket" and that the doctor " assured [me]that the cost of the procedures would be billed at the rate charged by the insurance scheduled fee..."
  D) to charge a non insured patient at any fee other than the stated insurance fee is insurance fraud.  The office represents to the insurance companies that the fees charged to non insurance patients is the actual fee that non-insurance pay and if a practice says they charge $1,861 for a root canal of a molar, but we are really charging some patients $1,043 and others other amounts, that is a clear and indisputably fraudulent representation to the insurance companies of a practice's fees.
  E) if in fact the patient thought that the fees would only be "the insurance scheduled " amount , why did he pay nothing for the 3/24 visit?  did e really think that the tortuously difficult procedure of struggling to get through a calcified canal would be free?  Did he really believe that all of the procedures for 3/23 would be only $372.00?  
  Assertion 3
  The patient argues that  "All the dental fee schedules for all the major insurance providers are readily accessible with a brief search on any search engine."  And therefore?  what is he trying to say?  is he saying that we have a responsibility to review online via a search engine the fees of insurance payment amounts for each procedure?  This just makes no sense, at all.  Every dental practice that participates with a given insurance has in its possession the fee reimbursement schedule for any and every procedure for which the given insurance company provides reimbursement (and, those fees for which there is no reimbursement provided, the practice is allowed to charge their regular normal non insurance fee). But, even more odd, and revealing, the patient says that he said he would be " paying out - of- pocket" and therefore, the reimbursement by insurances would be irrelevant, except, it also shows that he knew, or "readily " could have known "by doing a brief search on any search engine" to ascertain what the fees for the services he received actually could be from any of hundreds of plans. Yet, he never reached out to us to figure out how to satisfy the large outstanding balance, nor sent a check: for almost almost exactly 1.5 years (!), for the difference between what he asserts I had agreed to charge him in lieu of the office fees.  Does this sound like a person who actually intended to pay anything more than the co-pay?  this reveals that his argument is specious and that he tried to avoid paying even the insurance's scheduled fee!
  
  Assertion 4
  
  The fees are "a bit excessive, bordering on the abusive"
  
  I fail to see the relevance, especially as:
       1) he failed to pay even those "insurance schedule fees as listed by his insurance" which by his own admission are "readily accessible with brief search on any search engine"  that he asserts I agreed to accept in lieu of the office fees (never mind that that is, as made indisputably clear, never occurred and for which, after all, he had 18 months to pay, but never so much as responded to a single call, nor VM message, nor bill  sent him until he received an ultimatum. Then, he went directly to the BBB, instead of a good faith effort to resolve the matter with us directly. It is quite odd given that the BBB is, as I understand it, only to be used when all other efforts and remedies have been tried and found ineffective.   He made exactly zero efforts, in spite of a year and a half to do so, and our many, attempts to reach out to him by myriad means.
  
      2)  Rather, the actual "abusive" behavior/ actions are the following:
            a) his refusal to pay for the services provided, 
            b) his representing that he has insurance (****** **********) when he apparently, and evidentiarily, clearly knew he did not,
            c) his confabulation of a story that he told me that he has no insurance AND that I agreed to accept the Insurance's fee-schedule,
            d) his delay of almost 3 full months before sending us his extortionary letter received  in even sending us a response to our bill of May 2023 for 
            e) his refusal to respond to many attempts to reach him by several means (phone, email, text and USPS),
            f) his  failure to act in good faith: neither paying his balance nor reaching out to us to negotiate this debt for 18 months, with radio silence, however, instead, then using the BBB as a cudgel to both get out of his debt and to besmirch my good name, one who provided uncompromising care, all in lieu of either simply paying what he (falsely) contends I had agreed to accept nor even to make any good faith attempt to contact us: never  bothering, to this very day, to respond to even a single one of our innumerable attempts to reach him,
             g) his assertion, by implication, that he alone gets to determine our fees for the extensive, very high level care we provided,
             h) his playing fast and loose with the facts of this matter that include, amongst all of the above: also his asserting, one the one hand, that he said he had no insurance but knowingly gave us insurance information that he knew was invalid and then expecting for us to treat him as if he has insurance.  This is tantamount to representing himself as being in the military, when he is not, and then demanding to receive the Military discount at a business that offers such, but absent actually having even ever served in the military...and then acting as if he is the aggrieved party!
              i) his arguing, ostensibly, that he should get a ******* *** or ***** for the price of a ********** or ******.  I do not do "discount" level care  and do not in any way EVER compromise the care I provide, whether the care is paid for by insurance, with its significantly reduced reimbursement schedule that they allow (typically 30-60% less than the office's fee for service fees) or by the patient at Fee For Service  rates.   No matter what the insurance reimbursement is, even when it is abusively poor/low, I ALWAYS provide the very highest level of meticulous care, without caveat.
               j) finally, if he did not have insurance and I somehow had agreed to charge him "the insurance schedule fee,"  what insurance fee would I even go by?  There are literally hundreds of insurance plans with each Insurance carrier having multiple plans, each of which has a different fee schedule?  I would not even have any idea which of the hundreds of insurance plans' fee schedules I would even go by.  This is not only absurd, but reflects the impossibility of anyone even making such an offer (setting aside that it is, as noted, illegal).
  
  Had ** reached out to us, instead of failing to follow up, to respond to nearly innumerable messages, and confabulating with a non-sensical story, yet then expecting to get a discount for which he is not entitled in any way, shape, form nor manner, we would have discussed a solution.  To wit, and specifically because, it is insurance fraud to offer different uninsured patients different and varied discounts, we offer patients an "In-House insurance" for $500 /year which provides 20% discount on all procedures AND up to 4 intraoral radiographs as well as one cleaning per year.  This is what would have ben offered to him had he actually told us he has no insurance.  It would have resulted in a discount of over $1,300 and a free cleaning and comprehensive general exam (this normally costs $300 - $488.00 absent insurance) which itself would pay for the yearly In-House insurance.  We do not offer this to make money, because it obviously would not make any money, but rather as a means to LEGALLY provide a discount to any patient that does not have insurance: thus avoiding, unwittingly, insurance fraud.
      3) Privately owned businesses, as a rule, have the prerogative of setting their own fees: as do a hair salon, an eyeglass seller, or a plastic surgeon or a mechanic.  It is no different for a dental practice.  What is different is that it is illegal to collaborate with other dentists to set prices according to other independent practices.  The fees are generated by an algorithm provided by the software and the ADA based on specific region and type of practice.
  
  My Position Going Forward
  ** has a legal responsibility to pay what is due for the work performed.  Of this, there is no debate and no way to parse this.  Doctor provides a service, patient has responsibility to pay: if insured, they pay their portion according to the contract guidelines of their insurance company.  If there is no insurance, the patient pays the fee for service rate.  This is no different than any other business: Want to buy a 100K *******? Pay the 100K . Buy a gym membership ad get massages at that gym for 20% discount. Or, if you do not have membership to the gym but want to work out at the gym and get a massage, pay the fee to use the equipment and pay the non member price for the massage. This is how the social contract works.  It is ubiquitous and not arcane nor complicated. You do not get to dictate the price of the *******.  You want non-member use of the gym?? You do not get to , you do not get to say the fees are "a bit excessive, bordering on abusive,"  then dictate the fees AND then ALSO refuse to pay the cost of the use of the gym and its services of which you made use and from which you benefitted.  Nowhere is that how the world works and Georgetown Advanced Dentistry is not an exception.
  
  My Expectation
  ** shall pay the outstanding balance.  However, I would be willing to, retroactively, provide all the discounts available to a patient that has no insurance and purchases the In-House Insurance plan.  This would afford him a reduction in his total bill of 20% plus the elimination of cost of radiograph ($57).  Also, given that he received the care for which he had sought the consult, that charge should have counted toward the cost of the care he received subsequent, and directly related to the consult ($290), deducted from the total amount due.  Furthermore, a procedure, Core build up ($499) was billed as "Prefabricated Post and Core ($793).  This requires an adjustment of $294. Thus, his bill, before an In-House discount ($495) would be reduced by $584.  His remaining balance would then be $4,580 - 20% (If he wishes to purchase the In-House for $500) = $3,664 + 495 (for the In-House Insurance) = $4,159 - $52 (radiograph done at time of consult) = $4,107 - then his balance would be as follows:
  
       Total due before check (#576) tendered                                                     $5,164
       Minus: Consult ($290), Prefab core error ($294)                                            -584  
       Total before in-house insurance                                                                  $4,580  
       In-House insurance   20% deduction + radiograph                                         -916
       Total, not including $495 cost of In-House insurance                                  $3,664 
       In-House Insurance                                                                                        +495     
       Total due after In-House Insurance                                                              $4,159      
       Radiograph discounted b/c of In-House Insurance                                        -  $52                                                                                                             Total due (exclusive of tendered check                                                        $4,107  
       Check #***, tendered on 8/16/2023 (dated 5/24/2023)*                              -1,711.49
       Outstanding amount due                                                                              $2,395.51   
  
  *All outstanding debt will be considered resolved upon receipt of balance due ( check for 2,395.51, pending 1,711.49 check, received clearing the bank (given it is dated May 24, 2023, in excess of 3 months ago)
  
  Please let me know how he wishes to proceed. I will honor the above detailed offer for 14 days from the date of this letter.  Should he elect to not accept my generous offer, it will force Georgetown Advance Dentistry to send this delinquent account for services rendered to a collections attorney, at which time the offer will no longer be valid and the full amount will be due plus interest from 60 days after the last date of treatment, all costs incurred to obtain payment in full (minus the consult and incorrect procedure overcharge).
  
  Respectfully,
  
  Respectfully,
  ******************************, D.D.S
  ************ (o) *********** (e)

  Customer Answer

  Date: 09/04/2023

  Complaint: ********
  
  I am rejecting this response because:
   Attached is a slightly redacted letter that I sent to Georgetown Dentistry.  As a small business owner, my business was closed during the COVID  pandemic and my insurance was dropped.  I specifically told this to the doctor.  The receptionist said that they would try to send the through the insurance anyway as sometimes they still pay, or at least part of the claim due to the COVID crisis.  Regardless of the insurance and dispute about what was and not discussed, the fact is that $6519.00 for this dental procedure is abusive.  This is the problem with the dental/medical industry today, inflated price gouging of the uninsured.  I did my due dilligence to find the amount that my insurance company would have paid out the dental office.  I offered a reasonable solution based on the prices I was quoted with dentists in similar markets around the country.  I offered 20% premium above what I calculated as a reasonable settlement for the procedure and sent a personal check to pay the remaining balance.  On average, I found similar procedures costing between $2000 and $2500.  I offered a reasonable settlement of $3006.04 for the total cost of the procedure.  

  I reject the offer that the dentist office has countered with and respectfully ask that the office please return my check.  If the office feels the need to send this matter to a collection agency, as it has the right to do, this just reinforces my premise of the abuses the dental/medical fields.  Should the dentist office send it to collection, I will continue to contest this matter through any legal means necessary.
  
  Regards,
  
  *****************************