Complaints

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• Initial Complaint

  Date:11/08/2022

  Type:Product 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 May 2022, I was directed by my dentist to have a deep clean at the doc Z***’s office. During the months of April-August I performed what my dentist directed in several visits and always payed my bills in time. I mentioned several times that I needed to know in advance the amount I needed to pay prior to services being performed. I later discovered in October 28/2022 that doc Z*** office had not submitted all the claims from back in April to my dental insurance at the time/or around the time of service and it continued performing unnecessary visits along with respective charges to myself and my health insurance which resulted in causing to me a financial burden. If I knew in advance that not all the claims were covered I would not have had the additional visits that doc Zito and his office kept scheduling me one after the other. This is not only unethical behavior from doc Z***’s office but also I believe properly thought and misleading. It depleted my insurance money that I could have used for other necessary more urgent services (like crowns and fillings I desperately need) and not spending a lot of the insurance allowance money for just mouth cleaning and non urgent procedures/visits. I am looking for them to apologize and refund me for unnecessary services.

  Business Response

  Date: 11/09/2022

  ** ******* was seen in my office for a new patient exam on 4/01/2022. his treatment plan was for scaling and root planing of all four quadrants of the mouth. We did a predetermination with his insurance company (*****) to get an estimate of out of pocket expenses for him. His initial visit with us was not covered because maximum benefits for exams had been used. As per our agreement with ***** the $140 visit was reduced to $63. The predetermination for the four quadrants of came back. His coverage was at 90% and his co-pay for his treatment according to the predetermination was going to be $75.20. He was seen on April 21st and April 28th 2022. Both dates were submitted to ***** on the day of services rendered. The problem was that ***** paid us for April 28th and not for April 21st. We spent 6 months trying to get this claim paid by *****. After numerous phone calls and resubmits they finally paid the claim on October 13th but payment was only for $79.60 not for the $338.40 which was what the predetermination had stated would be paid. The bottom line is that *****, not us held up paying our claim for 6 months and during that time ** ******* had other dental work done at other offices where he maxed out his dental benefits. Patient was called and explained what had happened but felt we were at fault. It was explained to him that the hold up was from ***** as we had tried NUMEROUS times to get this claim paid during the nearly 6 months it was outstanding. It was explained to him that he used his benefit money elsewhere for dental work and unfortunately he had a balance at our office of $296.40.  l us why here...

  Customer Answer

  Date: 11/10/2022

  [To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
  
   Complaint: ********
  
  I am rejecting this response because:
  The doc Z***’s office has not provided any evidence of contacting the insurance company repetitively other than stating they did. I had quite a few visits at their office which gave them the opportunity to see how much money was left for them to claim and they kept scheduling me visits after others. When i asked at the front desk what I had to pay each time at the checkout they often told me nothing, for then sending me bills afterwards. Once I paid in time they kept using the same method over and over. At this point I am not asking anything from them other than people to be aware of their methods especially people who are not familiar with the way how dental insurances work and dear to trust them to handle the billing process. 
  
  Regards,
  
  ******************