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:09/18/2023

  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.

  Deceptive sales practices and billing for braces.Was lied to by ****** regarding the braces billing with ******** then cheated because the billing to insurance was not processed properly.

  Customer Answer

  Date: 09/20/2023

  Adjustment of the ****** balance they claim is owed. 

  My daughter needs her braces off and aligners placed as soon as possible. 

  Business Response

  Date: 09/26/2023

  We have carefully reviewed the full history of our patient, the daughter of ******************. Our findings show that during the consultation for orthodontic treatment, the patient was covered under ******** benefits. Her records indicated that the patient would not qualify for ******** coverage for *********** care, and ****************** wanted to start treatment for her daughter as soon as possible.
  Because they did not have insurance benefits to help cover the cost of treatment, we offered the patient a reduced case fee of $3500 for comprehensive *********** treatment. We offer patients affordable payments and ****************** chose to pay $100 down and $100 per month. This would mean 35 equal payments. Due to treatment time being ***** months,  this would leave a remaining balance at the completion of treatment which is outlined in the orthodontic contract. Payment plans and treatment time often do not run parallel in order to make treatment affordable. 
  
  ****************** made fairly regular payments, however has missed the occasional monthly payment, resulting in a slightly higher remaining balance at the end of the treatment time. 
  
  After starting treatment, the patient obtained insurance with MetLife. We submitted a claim for active treatment / work in progress, which is a standard process for the dental industry billing. MetLife prorated the available benefits and paid $125, denying any additional benefits towards *********** care. The plan shows it was termed soon after coverage was in effect, reducing the total applicable benefits. ****************** would have received a copy of the Explanation of Benefits sent to the provider and patient upon payment of any benefit outlining the payment and why.
  
  
  Patient has completed orthodontic care and is scheduled to have the appliances (Braces) removed and retainers delivered.  Any remaining balance on an ortho case is typically due (per the orthodontic contract) at the time of retainers. Generally, we work with patients to continue their monthly payments until the remaining balance is $0 if they are unable to pay the remaining balance at debond. 
  
  A conversation with ****************** was completed by our orthodontic team on 09.16.2023 regarding her questions about the remaining balance. ****************** did make a payment of $200 on that day, indicated she understood where the balance was resulting from, and that the total remaining after all patient and insurance payments was $875. 
  
  We have not been contacted by ***************************** with any questions or concerns she had regarding the remaining balance on the account since her in person conversation on 09.16.2023.
  
  We are happy to discuss with her the balance and review the payment history and contract in order to assist her. 

  Customer Answer

  Date: 09/27/2023

  I have spoken with the person in charge of the ortho billing several times. 

  Delta Dental has also spoken to her regarding the billing seveal times. Please have her upload the *** from Delta Dental .

  As I stated before this was supposed to be taken care of a year ago. I understand that they feel there should be a balance , but the Delta Dental *** clearly states a write off amount which they have failed to adjust. 

   

  Customer Answer

  Date: 09/27/2023

   
  Complaint: 20615065
  
  I am rejecting this response because:

  Consumer

  Most Recent Message

  Date Sent: 9/27/2023 2:49:17 PM
  

  I have spoken with the person in charge of the ortho billing several times. 

  Delta Dental has also spoken to her regarding the billing seveal times. Please have her upload the *** from Delta Dental .

  As I stated before this was supposed to be taken care of a year ago. I understand that they feel there should be a balance , but the Delta Dental *** clearly states a write off amount which they have failed to adjust. 

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

  Business Response

  Date: 10/03/2023

  Please find the *** from MetLife attached, per Ms. ******** request. The Insurance plan we have on file is MetLife, not Delta Dental. Please find the attached *** received for Work in Progress claims submitted on behalf of the patient. There is no statement from the insurance plan to provide an adjustment or write off for *********** Services. This plan appears to have been in effect for less than 3 months total. 

  Patient started with treatment without this plan in effect. We provided a reduced fee based on the patient's lack of benefits to help cover the cost of treatment. Our office contracted rate with this plan is $4750, and the patient total fee for treatment is $3500. We received a payment of $125 from MetLife and applied that to the total fee of $3500, reducing Ms. ******** remaining balance by that amount. 

  When we reviewed the remaining balance of $875 on 09.16.2023, ****************** stated that she understood her benefits from MetLife, and acknowledged that she owed the remaining balance of $875. 

  In order to appease Ms. ******** we would be happy to provide her a 20% discount on the remaining balance if she is able to complete the final payment of $700.

  Due to the fact that the patient Averie started treatment without benefits available for her case from ********* and without any other plan in effect, we extended a discount to her at the start of treatment. Our office then billed the plan provided to us by ****************** for Work In Progress as soon as it was in effect and applied the allowed benefits to her balance. The plan would only pay benefits for active treatment while it was in effect and we have no ability to enforce payment by the insurance plan on her behalf beyond the scope of the plan.

  Please advise if there are any other documents or additional information you may need to close this concern. 

   

   

  Business Response

  Date: 10/03/2023

  Regarding the *** from MetLife for ***********************, the patient in this complaint:  We billed for work in progress with the Comprehensive Orthodontic Treatment code D8080 as per usual billing processes for orthodontic treatment. In order to apply any benefits to the claim, MetLife paid on an alternate code D8670,which is the Monthly Orthodontic Treatment code, and denied any benefit. We appealed this denial on behalf of the patient. This resulted in the benefit of the $125 towards the total fee.

  I previously attached the original denial ***, and have requested a copy of the payment *** from MetLife showing the payment of $125.00, which includes 2 payments. One for July 2022 and one for August 2022, at $62.50 each. These are the only months the patient was eligible for benefits with this plan. 

  The MetLife reference number for that insurance contact is #********* and *******'s name is *******. 
  

   

  Customer Answer

  Date: 10/03/2023

   
  Complaint: 20615065
  
  I am rejecting this response because:
  
  Sincerely,
  
  *************************

  Customer Answer

  Date: 10/03/2023

  I explained this to the billing person several times. 

  If you look at the eob she billed the charge for the original date my daughter got braces. 

  That doesn't make any sense. 

  I did not have metlife at that time. 

  I instructed her to bill it the way that metlife asked her to. 

  She was asked to bill it for July and August 2022. 

  I also need documentation that shows ******** denied the braces before this payment plan was set up. 

  Like I stated before the entire process from day was misleading and deceptive. 

  Business Response

  Date: 10/04/2023

  I have attached the *** from ******** Standard billing practices for billing insurance companies that become effective after patient started treatment, is to bill the original start date, with the entire treatment plan and fee, as well as the *** billing code associated with the treatment. The insurance plan pays based on that information. We must provide the insurance the information regarding the original start date, the total case fee and the estimated treatment time. This plan was in effect for July and August 2022, and paid benefits based on the effective coverage dates. 

  There is no other way to bill the insurance plan than what has been explained here and in previous responses. The plan pays based on the coverage, effective dates and total case fee. We present the required information and MetLife determines their benefit accordingly. 

  MetLife originally denied any benefit and we appealed on behalf of the patient which resulted in the 2 months of benefits applied to treatment but their claim payment. The denial *** has already been submitted to this complaint for review. 

  I have also attached a copy of our letter sent to the insurance plan MetLife in appeal of the denied claim.

  Medicaid has very strict guidelines for approving benefits for orthodontic treatment which require medical necessity and a qualifying condition. This patient did not have a qualifying condition which would have resulted in benefits from ****** ********* This was discussed and explained at the consultation appointment, prior to the patient entering into treatment and any financial arrangements and starting that day. 

  Again, we have provided substantial discounts for treatment due to a lack of benefits to reduce the patient's cost, we billed MetLife for Work in Progress according to standard insurance billing practices for all dental offices and plans. We are willing to provide an additional discount of 20% of the remaining $875 balance if mom is willing and able to complete payment of $700 on the treatment balance.

  Business Response

  Date: 10/05/2023

  Following the extensive review and our continued review and responses with this process, we are unable to determine what actions would satisfy the complaint outside of a complete write off the entire remaining balance for the contract for Orthodontic treatment. 

  In the initial complaint, ****************** states that she was lied to by ******. We do not and have not had an employee by that name.

  All financial expectations and billing of treatment has been shared and clarified to ****************** from the start and throughout. We have extended significant work to ensure that any and all benefits available to the patient were received, including appealing the original denial by her insurance company. 

  Please advise as to recommended solutions in order to resolve this issue and move forward. 

  We will continue with completion of case, debond and delivery of retainers. Patient has not scheduled for any future appointments at this time.

  Customer Answer

  Date: 10/05/2023

   
  Complaint: 20615065
  
  I am rejecting this response because:
  
  Sincerely,
  
  *************************

  Customer Answer

  Date: 10/05/2023

  All they are doing is repeating the same things over and over.Were not resolving anything. My child needs her braces removed. If your not going to do it then we need a refund of the balance owed of ******. I will then go elsewhere to finish services. 

  Business Response

  Date: 10/11/2023

  Per earlier responses, we are happy to remove the braces and have explained that to the patient's mother. The $875 is the balance owed to us for the complete treatment and is not an overpayment of any kind on the account. No refund should be provided as the contract has not been paid in full, and treatment has been completed in full. 

  We have billed the insurance appropriately, applied all payments to the account and have a remaining unpaid balance of $875.

  We will give an adjustment to the account of $175 reducing the balance to $700 as a courtesy to the patient. 
  
  They may contact our office to schedule to have the braces removed. 

  Business Response

  Date: 10/11/2023

  Please find attached the Orthodontic Contract / Agreement for treatment signed by ****************** for the patient. This document provides the information regarding the total case fee and payment agreement for the treatment of her daughter for orthodontic conditions. We have completed all treatment and are pending her final appointment which has not been scheduled by ******************. We have left messages on several occasions to make the appointment with no response.

  We are requesting recommendations for how to fully resolve this issue and close the case. 

  Customer Answer

  Date: 10/12/2023

   
  Complaint: 20615065
  
  I am rejecting this response because:
  I called to schedule the appointment that I was told to make. I scheduled for the 27th of this month at 10am. I was told again that I have to pay ****** to have her braces removed. 

  I am perfectly fine wth paying my balance but I need my daughters braces removed. I will continue to pay as expected, but I do not intend on keeping her braces on for 6 to 8 months if they need to be removed. 

   

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

  Business Response

  Date: 11/09/2023

  We scheduled the complaintant's daughter for removal of her braces. The team again explained that the balance was owed of $875. If she wants to clear the remaining balance and pay that in full we are happy to provide an adjustment of the balance to $700 saving her $175. She could also continue to make a monthly payment towards the balance. ****************** cancelled the appointment on 10.27.2023.

  We requested that she continue to make her monthly payments to our office, which she has not done and has not made a payment on her balance since 09.16.2023 the last time her daughter was seen in our office.

  This letter appears to be a duplicate of previous notices. 

• Initial Complaint

  Date:08/30/2023

  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.

  Hello, My Daughter ***************************** Was Scheduled For Her Monthly Orthodontist Appointment **day. And, Was Turned Away, Because They Hadn't Realized From 6 Month's Ago They Did Not Collect Two $80.00 PAYMENT'S From Several Month's Back. How Is That My Daughter's Fault? They Are, A Business That's Supposed ** Keep ************** Records Than This. I Want My Daughter's BRACE'S REMOVED EFFECTIVE IMMEDIATELY. We Drove 30 Minutes Out ** Their Place Of ************** **ld ** Come Back When You Have The Money From 6 Month's Ago. She Had Her $80.00 **day As, She Has For The Last 4-5 Month's. They Still, Should Have Seen Her Regardless Of Missing Past Payment's That They Should Have ************* Attention **. And, It's Way Past The 2 ************ ******** Having Her Braces On. Iv'e PAID $4,500 In The Last 2 Year's Since, May '2021'. People Have BILL's ** PAY Besides Braces. Our RENT Is $1800.00 Per *********** CAR NOTE IS: $655.00. I Would NEVER NOT PAY OUR HOUSEHOLD ****'S Just ** PAY ON BRACES That Are, Almost, Completely, PAID OFF. I Would Like A RESOLUTION BY NEXT WEEK AS, FAR AS, THE REMOVAL OF THE BRACES. SINCE, THEY WERE RUDE & UNPROFESSIONAL! THANK YOU!

  Business Response

  Date: 09/14/2023

  To whom it may concern, 

  In response to a complaint from the mother of our patient *****************************, we have carefully reviewed the situation and have found that we have failed to live up to our standards of customer service. Our records do not reflect  payment of $4500, however, and our contract with **************** shows a total case fee of $4000.
  
  On behalf of our team and our doctors, I apologize and understand that ******** and her family members understandably feel like they were let down by our actions.
  
  In regards to resolving this matter, I am happy to remove the braces if that is the desired outcome. I understand that with the recent frustrating experience, this may be the case. If there is any consideration for a second chance, however, I would love the opportunity to make it up to ******** and her family. 

  Sincerely, 

  ********************, Director of Operations

  Celebrate Dental and Braces *********