Complaints

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• Initial Complaint

  Date:12/05/2022

  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.

  I went in last month to evaluate a particular tooth that my dentist determined had a crack in it. I was told that it was a consultation and covered by my insurance. The dentist looked at me for 5 minutes and tapped on my tooth and agreed that it needed pulled. They referred me to another dentist office. I then received a bill for $135. My insurance company said that they charged it as one of my 2 dental visits that I am allowed a year. That was not a cleaning and check up! When my wife asked about it they said they couldn't resubmit the claim in any other way. I loved their office and staff but very upset that nothing was done and now I have an extra bill.

  Business Response

  Date: 12/06/2022

  While are sorry to hear you are upset about your bill, it sounds more like a lack of understanding.  Yes, the tooth was cracked and referred out for extraction.  Our office billed you and bills the Dental evaluation code for all evaluations.  You came for an evaluation which was rendered, and billed to insurance appropriately; code 0140.  The evaluation code is not a cleaning code - this I believe is your confusion.  At time of scheduling, insurance was checked to see if the evaluation code was covered, which it was and so you were quoted it being covered.  It appears, just as in the case of insurance, other dentists can be billing it at a similar time which is unseen by other providers resulting in maxing out your frequency limit for that particular code.  While we cannot bill codes that are un-rendered, in this case the billed codes are appropriate and standard for the service given. 

  Customer Answer

  Date: 12/07/2022

   
  
  Complaint: ********
   
  
  I am rejecting this response because:
  
  I spoke to my insurance company and that is the same code used for dental cleanings/exams.  I am only allowed 2 per calendar year.  He mentioned that a consultation could have been done to first determine if they could help me or not.  That is a different code.   It is very frustrating to receive a bill after being told it was covered and I assumed it was a consultation to see if I could be serviced at this office.
  
  Sincerely,
  
  
  
  ***** ******

  Business Response

  Date: 12/08/2022

  We billed ***** for your evaluation, this can be confirmed with your insurnace and EOB. The ADA description for ******”Limited Oral Evaluation” which was rendered.  This is  NOT a cleaning.  We cannot be held liable for another provider billing for an evaluation; it appears your insurnace only allows 2 limited oral evaluations per year.  As frustrating as it is to deal with insurnace we face the same challenges.  Ultimately we rendered service, billed your insurnace, and they didn’t pay because another provider also billed for the D0140 evaluation.  All patients, sign an agreement to cover what insurnace dictates that they will not, which we have on file.