Complaints

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• Initial Complaint

  Date:01/19/2023

  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.

  December 2022 dentist Bruce KOHEN did s double root canal and charged me 200$ cash on top of my ins payment.stating he knows how to get around my ins denying me root canals and crowns and for 200$ on the side he'll get them approved.i paid him and now he hasn't even provided the insurance company the records they need.and the ins company said they will make a decision on Jan,18 2022 with or WITHOUT the 2 additional X-RAYS they requested.today I spoke to Bruce KOHEN who stated bring me another 200$ and I'll get it taken care of for you.i already paid 200$ and feel he is extorting me.and charging the ins company.because I refused to pay the additional 200$ he sent me the records and said do it myself.i spoke to highmark whole care and they stated DENTIST KOHEN has not sent in the additional X-RAYS needed as of 2pm.

  Business Response

  Date: 02/10/2023

  This patient originally came to us on October 14th
  
  2022 for an evalution on two teeth that needed
  rootcanals. He said he was suing the Allegheny County Corrections Department for 'Neglegence' and
  'Failure to Treat' because they were going to do root canals and crowns on these teeth but he was released
  from their custody prior to them being able to do it and also said the dentist there 'messed up his teeth
  with fillings because he didnt know what he was doing'.
  
  His only insurance at this point was Access, but he said he was also getting Highmark Wholecare at the
  beginning of November and that Access told him we can just bill Highmark Wholecare now using his
  Access member ID since it wasn't effective yet. I informed him that unfortnately that is not possible, they
  are two completely different entities. I let him know that Access does not cover root canals or crowns and
  that only some Highmark Wholecare plans cover those procedures, which we couldn't say for sure if they
  would approve them until his plan actually became effective and we were able send 'pre determination'
  claims for them. The patient got extremely irate, yelling about how this isn't fair and its not his fault the
  Corrections Department didn't do the procedures while he was jailed and reiterated that he was taking
  them to court and making them to pay for it because this is all their fault it's not done already. We told him
  to keep us updated on any progress with this and that we will check coverage with his Highmark plan
  once it's effective. Unfortunately his Highmark plan was a basic one that only covered root canals and
  crowns if you under the age of 21. He once again became irate and was yellling and using profanities. He
  asked which of the Highmark plans did cover rootcanals and crowns so I gave him the names of those
  plans and he told me he was calling them to make them change his plan to one of those ones and he'd
  keep us updated when he gets it changed.
  
  The patient came back to us on November 14th
  
  2022 to have multiple restorations done on several teeth.
  He said he was still in the process of taking the Corrections deparment to court and was also working on
  changing his Highmark plan to one that covered root canals and crowns and he'd let us know when that
  was done. By November 30th. he still hadn't been able to resolve his court case with the Corrections
  department and also was unable to change his insurance to a plan that would provide coverage for these
  procedures. I told him I would fill out a 'Benefit Limitation Exception' (BLE) form with his insurance and
  send along all the xrays/medical documents to see if I could get them to approve these procedures since
  he was at the point where the teeth would start causing infection and abcesses if not treated and they will
  sometimes approve these procedures if there is a valid medical diagnosis such as a periapical abcess.
  
  The claim this patient has made that this was something we 'charged $200 to do on the side' is an absolute
  lie. This is something done for any patient that has a 'Benefit Limitation Exception' (BLE) option with
  their insurance and also has a valid medical diagnosis that meets the BLE insurance guidelines, which up
  unitl this point he had not. He has never been asked to pay so much as a penny for any service at our
  office. Every service that he had done was submitted into his insurance for payment and all payments for
  the services have come directly from the insurance company. I submitted the BLE forms along with the
  patients x-rays to Highmark Wholecare on November 30th.
  
  The insurance company response we received
  the following week requested additional x-rays in order to make a proper determination for the root canal
  approvals, so we had the patient return to the office and take 2 additional xrays to send to them to try to
  get these procedures covered for him.

  
  On December 16th, Highmark Wholecare approved the benefit limitation excepction for coverage to get
  root canals done on both teeth 7 and 8., which the patient returned to the office on December 30th to have
  these procedures done. It had already been explained to him multiple times that just like with the root
  canals, we can not gaurantee coverage for the crowns on tooth 7 and 8 until the insurance approves the
  BLE form for them, which require the xrays showing the teeth have been root canalled to be included,
  which obviously we cant do until after the root canals are actually done. I sent the BLE form requesting
  coverage for crowns on teeth 7 and 8 to the insurance on the same day the root canals were performed,
  along with the required xrays shopwing the teeth were now rootcanalled.

  
  At his appointment for the root canals, we were preparing the scripts for the three medications we
  routinely prescribe after this procedure, which are Naproxen, Augmentin and 8 tablets of Norco. As per
  federal law, we are required to search the Pennsylvania Dept. of Health Prescription Drug Monitoring
  database to review the patient's prescription history to ensure that they are not receiving controlled
  substances from multiple doctors at the same time and there is no 'prescription overlap'. The database
  search alerted us that he was currently being prescribed Subxone and Tramadol which he had never
  disclosed to us. The doctor did prescribe a different type of pain medication due to this, but we did inform
  him that the Pharmacy still MAY NOT fill the prescription unless it is cleared by the doctor who is
  currently prescribing the other medications. The patient seemed fine with this and was not argumentative
  at this point. It was only after this that the patient infomed us he as on Suboxone, due to being mandated
  for his incareration release. He was not allowed to be prescribed Opiod analgesics due to the terms of his
  release from jail. We received a phone call at the office a short time later from the Pharmacy stating that
  the patient tried to fill this prescription but has 'overlapping prescriptions' for controlled substances and it
  was said that when the other prescribing doctor gave clearance, they could fill the script we had given the
  patient. This is exactly what we had told the paitnet may happen. Regardless of the fact we told him this,
  he started making extremely aggressive and increasingly threatening calls saying:
  – we gave him the prescription then we called the pharmacy and specifically told them not the fill
  the prescription for him even though we know how much pain he is in
  – we are liars and his other doctor doesnt NEED to approve anything especially since his other
  doctor will not return his calls and he will now be suing him for 'neglenece'
  – If we don't tell them to fill the script immediately, he is going to start punching people's windows
  out
  – He is going to be taking us to court for 'failure to treat' and 'neglegence' over this and that he is
  going to the marshall's office in the morning to have us served
  
  These messages and calls took place on December 30th
  
  - January 1st.
  
  . The patient then called demanding
  all of his records be given to him immediately because he was going to be filing complaints and he
  wanted all his records to do this. He was informed the doctor was not in the office at the monent but when
  he returned he would scan all his records and we would email them to him as soon as that was done. The
  patient again became irate and started with increasingly threatening calls and messages where he said he
  was going to be coming to the office and dealing with us in person. The staff felt so unsafe and fearful of
  this person's capability of violence that the office doors were actually locked and staff was instructed to
  call the police if the patient attempted to get in. After this, the patients number was not in service and we
  could not reach him to verify his email address but his records were sent to the email address he had listed
  on his patient paperwork.
  
  During this time, the predetermination we had submitted for the crowns for tooth 7 and 8 had been denied
  by the insurance company as they were requesting additional xrays to the ones we had sent along with the
  claim. As the patient had become increasily aggressive and threatening with the staff as well as saying he
  was already taking us to court, the patient was not brought in for additional xrays. All the procedures we
  had been approved to do had been completed and the patient can not continously threatening the
  wellbeing of the staff and also threaten legal action then still be allowed to continue on as a patient with
  the practice. All of these messages have been transcribed and saved as proof of what this patient has been
  subjecting the office to with his inappropriate and alarmingly threateneing and scary behavior. There are
  witnesses who were present for the phone calls with this patient that will attest that money was never
  asked for from him, no 'extortion' ever took place, and that we did everything we could to help him but
  his aggressive and threatening behavior is not acceptable and no health care providers should have to
  tolerate physical threats and have their staff interact with a person they are fearful of due to his incredibly
  inappropriate and alarming behavior.

  
  AT NO TIME DID THE PATIENT EVER PAY US ANY MONEY. NO MONEY WAS EVER
  DEMANDED OR COLLECTED FROM HIM. HIS ALLEGATIONS ARE OUTRIGHT LIES.
  
  - Office Manager