Complaints

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• Initial Complaint

  Date:02/08/2023

  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.

  This involves Parkway Dental at Northview Street location. They have been paid by ********** and Ameritas Dental, the 2 insurance coverages I have. There is an overpayment, as Ameritas is a non coordination of benefits policy and they have been instructed to refund to me the overpayment, which is the standard procedure when this happens and was always done by my previous dentist. I only visited Parkway two times, 10/17 and 10/31. I contacted both ********** and Ameritas about this, but Parkway is not refunding the overpayment as instructed, stating that they are "waiting for the "hold" through **********." There is no "hold" through **, as I have talked with them about what was said. Just another story by Parkway. They have received over $700 for a $353 charge for the two combined visits. The only invoice I ever received from them was blank, other than a "balance forward" and then asking for an additional $100. They are balance billing and that is not allowed for a contracted in-network provider. Could you give any assistance with this? Thank you. *******************

  Business Response

  Date: 02/21/2023

  See attached response. Please let us know if you have further questions. Thank you!

  Customer Answer

  Date: 02/22/2023

   
  Complaint: 19365152
  
  I am rejecting this response because:  I have not received anything from the company other than a letter telling me to find another dental office.  Believe me I did, way before they "instructed" me to find another dentist.  Their practices are unethical and they have not shown me that they have taken any steps to resolve the overpayment they received.  They keep putting the account on "hold", which in their case....to "hold" the overpayment they received.  Their practices are to "balance bill" the customer and unless the customer understands that this isn't allowed after they received the maximum allowable charges as paid in full, as they are a contracting provider, I'm sure that a lot of this goes unchallenged by customers.  This hasn't been resolved and I have not received any information from them, or ********** that this has been done.
  
  Sincerely,
  
  ******************************

  Business Response

  Date: 03/08/2023

  Please see attached 

  Customer Answer

  Date: 03/08/2023

   
  Complaint: 19365152
  
  I am rejecting this response because:  They are trying to make me look like an idiot in this matter and this is just their way of deflecting.  I worked in **************** for 22 years and I am quite aware of how things are done.  Also, the statement that ********** didn't know I had another insurance coverage is completely wrong.  I filled out a form and sent to BC (that BC sent to me, and they have that in their notes) about my other insurance coverage information.  I sent it back to BC and they investigated my coverage with ****************** and found, as I told them, that Ameritas does not coordinate benefits.  I also just spoke to ********** today, 3/8 and the person I spoke with informed me that Parkway Dental was sent and accepted full payment of the contractual adjustment that was allowed under their contract.  Therefore, any other payment that was made over and above this amount is considered an overpayment.  I also talked to Ameritas today and they told me that the $72.66 that was sent to Parkway by them was an overpayment.  They can only accept full payment on a contractual adjustment per their contract with **********, as payment in full and they cannot accept more money over and above what ********** has paid them.  They mention legalities....they are actually not adhering to their contract with ********** by accepting more money from another insurance carrier and are supposed to refund any other payments.  They love to twist things....check further and you may find a lot of others they have done this to.  Their little letter sound wonderful, but entirely incorrect.  I will again call BC and read their letter they submitted.  I will ask their customer relations at BC to get involved.  This is out and out not following their contract with BC.
  
  Sincerely,
  
  ******************************

  Customer Answer

  Date: 03/17/2023

  This updated information is in regards to the issue with Parkway Dental.  I received more information today from ********** of ************** Advantage personnel.  I was informed that ********** made another payment to Parkway Dental because there was an error in processing the claim.  Evidently someone at BC told Parkway Dental (as Parkway mentioned in their last letter, a "***", which did not do his job correctly) to resubmit a claim to coordinate benefits that had already been paid by Ameritas.  Ameritas does NOT coordinate benefits and ********** didn't pay the total plan share that was to be paid.  On March 13th, ********** paid another $206.00 for a total of $227.00 they have paid for the date of service of 10/17/2022, therefore paying the total contractual adjustment that was due Parkway Dental.  They have been paid in full, which is the contractual adjustment (Plan's Share) that their contract allows them to be paid by **********.  As a participating provider they are required to accept the amounts the plan approves as payment in full.  ********** ********** has paid a total of $410.00 for the dates of 10/17 and 10/31/2023 combined.  Also, Ameritas has paid Parkway Dental a total of $253.66 ($181.00 for 10/17 and $72.66 for 10/31).  There is an overpayment of $191.66 because ********** has paid the total amounts for both dates of service.  I will be contacting Ameritas tomorrow 3/16 to inform them that their Provider ******************** needs be in contact with Parkway Dental that there is an overpayment that needs to be refunded.  I cannot contact Parkway Dental because of the animosity between them and I and their refusal to accept that they have been over paid.  I'm waiting for a new EOB from ********** showing the additional payment they have made.  I have the EOB's from Ameritas showing all that they have paid.  Parkway Dental needs to address this issue voluntarily, otherwise the two insurance companies will be contacting them informing them that they cannot "Double Dip" and receive money from both places and keep it.  Any resolutions you can help with will be appreciated to get this account closed and the money refunded.  They can refund it to Ameritas if they wish and Ameritas will take it from there. 

   

  Thank you,

   

  **************************************

  Business Response

  Date: 04/17/2023

  Tell us why here...Hello, 
  All of the insurance as of now has come back now for ******'s account. She has a zero balance. According to the insurance, the patient does not have any money coming back to her. They gave her a zero balance. . As stated before to ****** from the *********** they has overpaid her account, due to they pay as a secondary insurance. Which that is their choice to do, even without coordination of benefits.  ********** have taken back their over payment , and corrected it with the correct amounts. After they were complete with all the billing corrections they wished todo, it left ****** with a zero balance. 
  Attached is the account ledger, as well as the explanation of benefits showing what insurance paid, what they refunded themselves and corrected. 
  This has taken a little while to correct for them. Each time they rebilled claims, they take 3-4 weeks to process any new claims. Refunded, or charged accounts. 
  ****** stated she did medical billing for over 20years. Medical, and dental billing are two totally different billing.  They do totally different things. They do not compare at all, as these explanation of benefits show. ******'s account is now with a zero balance, and I am mailing this patient ledger, and explanation of benefits info that is attached here to her as well.  Again, we billed everything correctly, and the insurance companies also agreed to this. 
  At this point with this zero account, we have completed our part of this claim. Thank you