Complaints

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• Initial Complaint

  Date:12/02/2024

  Type:Billing 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.

  In Nov. 2023 I renewed Humana Advanced for 2024, which included dental coverage to a maximum of $4.000.00.
  In Sep. 2024, while I was vacationing in Colorado, I started having a severe toothache. I contacted my dentist's office (*** ****** ********, in the office of *** ***** ** *******) in Hutchinson KS, asking for help. An antibiotic prescription temporarily took care of the problem.
  After coming home, on Oct.9, 2024, I visited *** ********* office. *** ******** determined that a root canal and crown was really the only way to fix the tooth that had caused pain earlier.
  Before I left the dentist's office, I paid $1985.00, with the understanding that $818.00 would be submitted as an insurance claim.
  Later I went back to the dentist's office and asked question about my insurance coverage of $4,000.00. I was told that my insurance maxed out at $1,000.00. I asked the person handling the payment at the dentist's office to refile, asking for reimbursement for $1,985.00
  On Nov. 7, 2024, I was told that Humana paid only $872.00 instead of covering up to $4,000.00
  The total bill was $2,803.00, Humana paid $872.00 and I paid $1,931.00.
  When I signed up with Humana Advanced with dental coverage of max $4,000.00, nothing was mentioned about reduced coverage in certain cases.
  If the business practice of *** ********* office severed my right to receive full compensation of $1,931.00 I would like a refund.
  The Dr.’s office knew that Humana is my insurance provider. They likely knew that my coverage is reduced to $1,000.00 which meant that the balance wouldn’t be paid by Humana but myself.
  It was not an emergency case; they could suggest shopping for a less expensive alternative to their service. For the dental practice, it may not matter whether payment comes from the insurance company or the patient, but it sure matters to patients like me, who find payment of $1,931.00 a huge problem.
  In this negligence of consumer protections issue, I would like a refund of $1, 931.00.

  Business Response

  Date: 12/30/2024

  To whom it may concern-

  We seen ******** wife ****** in our office on October 9,2024 with a severe toothache that ** ******** had called in an antibiotic for her to take when she was in CO, ** ******** tested and diagnosed *** *** ** Crown due to patients symptoms and an abcess at the root tips. Pt was given a quote for *** *** ** Crown and another option of extracting the tooth. If patient wanted to save the tooth it was going to cost her $2520.50 and if she wanted to do the extraction instead it would have been $197.00. Pt chose *** *** ** Crown and waited for pts husband to return to make sure she could stay for treatment. Pt elected to stay for treatment. Pt paid $1985.00 on this day for the above treatment. The $93.00 was payment towards an appt ****** had on August 7th, 2024. Humana Insurance actually paid more than we estimated them to pay ( we estimated $384.50 from Ins ) and the quote reflects that but Humana actually paid $872.00. 

  When ******* called originally he inquired about why he was charged $250 for a cone beam that he didn't feel was necessary, I the office manager credited that amount back to his account.

  We always call on Insurance for our patients to verify their benefits and then we quote treatment based on what the insurance company gives us, it is also based on if we are providers for that company. If they are out of net work the patient does pay more. ****** was aware since it was a policy supplement to Medicare they would under pay. We do not take Medicare benefits unfortunately.

  Thank you,

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

  Office Manager

  [email protected]

  Grant D Ringler DDS

   

   

   

  Customer Answer

  Date: 01/04/2025

  I, ******, am writing here instead of my wife, ******.  It turns out that
  there was a lot of confusion and controversy about the events
  surrounding ******’s root canal and crown.
  
  I did not understand several things:
  
  1.  That the provider was not in-network for Humana, our Medicare Advantage policy provider.
  2. 
  That we were not promised nearly as much reimbursement as what was the
  case last year. Based on how things stood last year, I believed that we
  had coverage for anything up to $4,000, so I had told ****** ahead of
  time that it was OK to go ahead with whatever treatment the dentist
  recommended.
  3.  That ****** had signed a paper giving approval for
  the work to be done at the price given.  ****** also misinterpreted the
  figure that we were to pay, believing wrongly that it included both the
  insurer’s share and the patient’s share.
  
  We have never had any
  complaints about the care we received at *** ********* office (and ***
  ********** work was very effective and ****** always does a good job),
  and if it were more affordable, we would gladly stay.  As it stands now,
  we simply can’t afford to go to a dentist that is not in-network for
  Humana.  In this case alone, the cost amounts to six months wages for my
  part time job.
  
  I would have liked more clarity about this
  dental office’s relationship (or lack thereof) with Humana, and about
  how insurance coverage or your policies had changed over time.  I
  understand that it’s not a pleasant task to be the bearer of bad news,
  and it’s not pleasant to hear it, but the best possible decision
  requires knowledge of how things stand.  It’s clear to me now that we
  should never have agreed for the root canal and crown work to be done in
  this office because of the cost.  Awkward as it might have been to walk
  away at that point, it probably would have been less awkward than
  dealing with the fallout of this major misunderstanding and unexpected
  expense.  We regret having to part ways, but it seems that we have
  little choice.

  Business Response

  Date: 01/23/2025

  We have already responded to this complaint on 12-23-25. 

  Do you need more info other than the pdf and written response?

  Thank you

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

  Office Manager