Complaints

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• Initial Complaint

  Date:05/04/2023

  Type:Service or Repair 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.

  ********************, a contracted provider with GHEA Connection Dental, is performing services on patients that are not medically necessary and in my case, where decay is not present. He is billing for 4+ surface fillings with no evidence of decay per GHEA's review. After a clinical review by GEHA for restorations, no evidence of decay was noted and entire service was denied. **** states on EOB that member is responsible. Furthermore, the provider is recommending unnecessary treatment like root canals and crowns that he makes it sound like you will loose your teeth unless you receive treatment. He doesn't advise patient that the services will not be covered by insurance until you receive the bill. Unfortunately, patients have no option but to trust the providers recommendations. The provider is falsifying a patients diagnosis to justify procedures that are not medically necessary. This is considered fraud. In addition, the provider has offered a discount on these services if I pay balance today, which is considered waiving patient co-pays, coinsurance or deductibles.

  Business Response

  Date: 05/22/2023

  May 22, 2023
  H363**73932383**831H
  PO Box 1191279
  *****, ** *****
  
  To whom it may concern,
  
  I am writing with reference to complaint ID ******** that was submitted on May 4, 2023.
  
  Patient presented for a Comprehensive Oral Evaluation, radiographs, and a cleaning on March 01, 2022. My findings during this exam included the following:
  Tooth #5 had an existing alloy restoration, which presented broken in half due to stress on filling. Decay was also present under the broken filling, which was shown on the x-ray.
  Tooth # ** showed evidence of decay under existing alloy restoration, which was also shown on the x-ray.
  Tooth #** and #** showed internal resorption of the roots, meaning the actual inside of the tooth (dentin) is being resorbed within itself.
  
  The standard of care for reoccurring caries under existing restoration is to remove the failed restoration, and caries and replace the tooth structure. In this patients case, tooth #5 and #** required 4+ surface composite fillings due to the previous large alloy restorations and caries.
  
  Internal resorption of the root if left untreated can cause the tissue to become inflamed and then resorbed all together, leaving the inside of the tooth completely hollow. This may also result in the tooth becoming weaker and eventually break.The standard of care for internal tooth resorption is treatment with a root canal to stop/slow down the internal resorption. Tooth #** and #** were treated with root canal therapy to stop the process, and crowns placed to protect tooth from further breakage.  
  
  We do our best to provide patients with a good faith estimate prior to their H3**532343**937303032H treatment, reflecting our office fees and estimated insurance and patient copays. Patients are informed of treatment costs and are notified that they are responsible for all charges whether or not they are covered procedures by their insurance plan. If needed, we also assist our patients in submitting appeals to their insurance plans should they deny a procedure that we believe was incorrectly denied, however we cannot change any guidelines or rules set forth by a members insurance policy. We will also not falsify a diagnosis in order to get insurance or patient reimbursement.
  
  Thank you,
  
  Dr. *****************, DMD
  Canby Family Dental