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:05/14/2024

  Type:Service or Repair Issues
  Status:

  ResolvedMore 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.

  There are several dates involved in my complaint. However, Nov. 20, 2023 is the only one that can be addressed with a resolution at this time. I will attach a detailed statement that includes all of my concerns along with supporting documents. I will start with March 20, 2024 to provide some insight and clarity.March 20, 2024, I went for a routine cleaning and paid at the conclusion of my appointment for the services. I received the statement from MetLife, Dental Insurance Provider, a week later at which time I reviewed that statement as well as the billing statement from Daytona Elite Dental. I noticed that I had been charged for a full mouth irrigation that I knew I had not received but had paid for. This prompted me to also review the statement from my Nov. 20, 2023 visit where I also found an error. I immediately contacted Daytona Elite Dental in person to advise them of my concerns. It took 3 weeks and 2 additional in person visits but they did correct this situation and refunded that cost associated with the March 20, 2024 visit only. This left the Nov. 20th matter still unresolved. This situation was different as it involved MetLife paying for the topical application of fluoride varnish in full, and I was also charged fully for the same service and had paid for it. However, after several calls along with in person visits, ********** Manager advised me that I was not being reimbursed for this. I repeated that Daytona Elite Dental had been paid for this service by both MetLife and me and they were not entitled to be paid by both of us. I was then informed that they were having issues with MetLifes carrier and being paid. I was then told I could contact ******* regarding being reimbursed. This did not make sense to me as MetLife had met their responsibilities as far as I knew in paying Daytona Elite Dental and if there were issues in Daytona Elite Dental being reimbursed by MetLife that is their problem and not mine to pursue.

  Business Response

  Date: 05/30/2024

  patient was informed about the situation about the insurance metlife processing the November 2023 and march 2024 claims using the wrong network (dentemax) and not the careington network which is the network that we are participating with.  Dentemax network fees are lower than the careington fees therefore the explanation of benefits (EOB) was stating the patient owed less than what he had paid for during his visits. Resulting in the patient asking for a refund. Patient was informed of the situation and unfortunately it was something that neither the patient nor the office could control. It took almost a year for the network situation to be resolved by metlife. Starting on May 2024, we have been receiving payments and adjustments of old claims that were processed incorrectly and Metlife has been paying the difference between the two networks. We received a payment from Metlife today for both the November 2023 claim and march 2024 claim for this patient. I have attached a scanned copy of the old explanation of benefits along with the adjusted claims we received today showing the proper amount that was due by the patient and by metlife insurance. I also attached a screenshot of the patients account for those two days of service to show he was charged properly. In regards to the fluoride being charged to the patient and paid by insurance on November 2023 was by mistake. Insurance usually doesnt cover fluoride on adults so the patient was charged accidently. However, due to the network processing issues,once the payments and claims were completed, it showed the patient had a balance instead of a credit after the insurance payment (balance was written off since it wasnt the patients fault that the insurance paid less than estimated) therefore the extra amount for the fluoride was not reflecting on the account for us to correct and refund. The patient did mention the fluoride at the beginning when he spoke to the office manager but he mainly focused on the irrigation $30 charges and the explanation of benefits saying he overpaid each time for the cleaning each they spoke causing the office manager forget about the double payment with the fluoride and focus on the irrigation and the claims which were the main concerns of the patient (progress notes are attached to show the office manager notes after interacting with the patient). We have no issues with refunding a patient when it is necessary. We refunded the patient the $30 for the irrigation to give the patient a peace of mind even though it was completed according to the hygienist. The office manager said she did indeed mention to the patient that we could not refund him anything else apart from the $30. However, she was speaking in regards to a May 24th 2023 date of service for another cleaning that included an irrigation procedure as well that was indeed completed but the patient didnt think it was. The office manager also meant that we could not refund him the difference of the cleaning copay since the explanation of benefits was incorrect. Now that the fluoride has come to our attention again we can gladly refund him of the $19.55 that he paid originally for the fluoride procedure. 

  Business Response

  Date: 05/30/2024

  patient was informed about the situation about the insurance metlife processing the November 2023 and march 2024 claims using the wrong network (dentemax) and not the careington network which is the network that we are participating with.  Dentemax network fees are lower than the careington fees therefore the explanation of benefits (EOB) was stating the patient owed less than what he had paid for during his visits. Resulting in the patient asking for a refund. Patient was informed of the situation and unfortunately it was something that neither the patient nor the office could control. It took almost a year for the network situation to be resolved by metlife. Starting on May 2024, we have been receiving payments and adjustments of old claims that were processed incorrectly and Metlife has been paying the difference between the two networks. We received a payment from Metlife today for both the November 2023 claim and march 2024 claim for this patient. I have attached a scanned copy of the old explanation of benefits along with the adjusted claims we received today showing the proper amount that was due by the patient and by metlife insurance. I also attached a screenshot of the patients account for those two days of service to show he was charged properly. In regards to the fluoride being charged to the patient and paid by insurance on November 2023 was by mistake. Insurance usually doesnt cover fluoride on adults so the patient was charged accidently. However, due to the network processing issues,once the payments and claims were completed, it showed the patient had a balance instead of a credit after the insurance payment (balance was written off since it wasnt the patients fault that the insurance paid less than estimated) therefore the extra amount for the fluoride was not reflecting on the account for us to correct and refund. The patient did mention the fluoride at the beginning when he spoke to the office manager but he mainly focused on the irrigation $30 charges and the explanation of benefits saying he overpaid each time for the cleaning each they spoke causing the office manager forget about the double payment with the fluoride and focus on the irrigation and the claims which were the main concerns of the patient (progress notes are attached to show the office manager notes after interacting with the patient). We have no issues with refunding a patient when it is necessary. We refunded the patient the $30 for the irrigation to give the patient a peace of mind even though it was completed according to the hygienist. The office manager said she did indeed mention to the patient that we could not refund him anything else apart from the $30. However, she was speaking in regards to a May 24th 2023 date of service for another cleaning that included an irrigation procedure as well that was indeed completed but the patient didnt think it was. The office manager also meant that we could not refund him the difference of the cleaning copay since the explanation of benefits was incorrect. Now that the fluoride has come to our attention again we can gladly refund him of the $19.55 that he paid originally for the fluoride procedure. 

  Customer Answer

  Date: 06/05/2024

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  

  Although I disagree with the amount of the refund as it does not take in consideration of the $6.90 balance forwarded on their 11/20/23 billing statement, I have reviewed the documentation supplied by the Elite Dental and accept closure of this matter as in the best interest to both parties. This will only pertain to the complaint filed with the BBB.
  

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