Reviews

Review Details

• Review fromVincent F

  Date: 11/15/2024

  1 star

  Vincent F

  Date: 11/15/2024

  I am deeply disappointed with James A. Burden, D.D.S. & Associates of ************* *** due to their lack of transparency and professionalism. Here’s my experience:
  I scheduled my appointment well in advance, providing my insurance information at the time of booking. The staff assured me that they “accepted” my insurance. At no point was I informed that they were actually out of network. During my visit, I was told my balance was fully covered, except for a fluoride treatment, which I paid for on the spot. I even received a receipt showing “Patient Portion: ******* 
  However, a month later, I received a bill for nearly $***, allegedly for routine X-rays and cleanings for both myself and my spouse—charges that should have been largely covered by my insurance. When I called the office to inquire, I was casually informed that they were out of network. This critical information, which directly impacted my financial responsibility, was never disclosed prior to my treatment.
  I have made multiple attempts to resolve this issue, including leaving messages for the office manager, but I have not received any response. This lack of accountability and communication has only added to my frustration.
  Healthcare providers have a responsibility to be transparent about costs and insurance coverage. This practice has failed on both counts. If you value honesty and trust in your healthcare provider, I strongly urge you to avoid James A. Burden, D.D.S. & Associates. Their approach prioritizes profits over patient well-being, and their lack of transparency is unacceptable.

  James A. Burden DDS and Associates

  Date: 11/20/2024

  In response to this patient's complaint, I went through our call recording and listened to the initial call from the patient on 9/18.  He was in fact informed at the time he made the appointments that we were out of network with his insurance.  We explained that as long as he had out of network benefits that we could file his claim.  We further stated that we would verify that he had out of network benefits (which he did).  They were both scheduled to come in on 10/10.

  
  

  When he and his wife came in for their appointment, we had reviewed a treatment plan with him for treatment to be performed that day for him and his wife.  As far as we knew, we did anticipate insurance to pay 100% of their visit and had no reason to suspect otherwise.  Everything on the treatment plan was completed that day.

  
  

  The patient coordinator who reviewed the treatment plans, noted her conversation with the patient and his wife, where she explained insurance to them while they were in the office.  They scheduled the needed treatment after she spoke with them.  Her note read:

  
  

  "went over walkout tx plan with pt and wife, they had a lot of questions about ins and how tx worked. answered both pt questions, and they wanted to sched got the pt on the sched and they will pay day of with their hsa card"

  
  

  Unfortunately, we can not guarantee what an insurance company will reimburse us.  As such, we outline this in our office policy in which he signed and initialed where we state, "we can not guarantee any estimated insurance payments". 

  
  

  Furthermore, it is stated on the treatment plans that were signed by him and his wife the following:

  
  

  (a) Payment for services rendered will be due at the time of service. 
  
  (b) THE INSURANCE PORTION OF THE TREATMENT PLAN IS AN ESTIMATE ONLY AND NOT A GUARANTEE OF COVERAGE.   
  
  (c) Your ESTIMATED portion will be due at the time of service. 
  
  (d) IF YOUR INSURANCE CARRIER PAYS LESS THAN THE ANTICIPATED AMOUNT, YOU WILL BE RESPONSIBLE FOR THE UNPAID BALANCE.  
  
  (e) THIS IS NOT A PREDETERMINATION, IT IS AN ESTIMATE ONLY.
  
  
  
  *** I UNDERSTAND THAT I MAY BE RESPONSIBLE FOR ANY UNPAID BALANCE FOR THE PROCEDURES THAT ARE PERFORMED.

  
  

  When they left the office, their statements did indicate that the "patient balance" was $0 and showed the balance of the visit was "estimated" to be paid by his insurance company.  Once his insurance submitted payment, they were left with a remaining balance, which is the bill he received in the mail approximately one month later.

  
  

  In reviewing our phone records, I see the patient called only once on 11/13 after receiving the statement.  He spoke with our Accounts Coordinator. She said that she will check with the office manager to see what we could do for him.  On 11/18, she had left him a voice mail that she spoke with the manager and we will write off their balances.  We mailed him a statement showing this.

  
  

  Our approach is and always has been to prioritize good patient health and to be as transparent and as informative as we possibly can be with all patients.  We strive to not have surprise billing as we would not want this for ourselves. 

  
  

  The issue at hand is that insurance companies are NOT prioritizing patient's health and well being by not reimbursing dentists at a fair and reasonable rate.  They are clearly putting profit over healthcare not us.  

  
  

  We were as transparent as we could have been with this patient from the first phone call, to our new patient paperwork and on our treatment plans and the one on one conversation he had with our patient coordinator while in the office. 

  
  

  If you would like to see the documentation and hear the recordings, I would be happy to send them to you.