ComplaintsforDayton Dental Collaborative, LLC

• Initial Complaint

  06/12/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Earlier this year, while searching for a dental provider in network, we contacted this firm. We have two dental plans. We provided both to their phone/office people to check on before we set up an appointment. One of ours, Buckeye Health, was not, but the other Anthem, we were told was. Consequently, I decided to set up an appointment. On arriving, I once again spoke with the front desk person to verify that Buckeye was not "in network" coverage with them and Anthem was. She said yes and took my Anthem card. As the service completed the first stage, they had me sign a document guaranteeing payment and made me pay the estimated half that would be the patient responsibility before I could leave, which I did. Fast forward, the service was completed on 3-27-24 and they filed a claim with Anthem on 4-2-24. The claim was denied and marked "out of network". As this company was aggressively trying to collect money from me, I was working with Anthem to figure out what happened. In correspondence (email & text) they tried to justify their claims they made about coverages, and the one that alarms me most, "we do take Anthem, but we are not in network." "We have not been in network with Anthem for about 4 years now". Quite surprising to say the least as they were quick to say they were with Anthem and clearly gave the impression they were an in network provider, to learn this after the fact. Honestly, had they not been grossly misleading in these insurance discussions, I would have went elsewhere. The only reason I chose this firm was because their staff clearly stated my Anthem coverage was taken there. Had they been truthful, I would have contacted others who actually are Anthem in network providers. I cannot blame Anthem for denying, only this firm for misrepresenting. My doctor and hygienists were very professional and provided good care (or at least I think as of now). People need to be warned of their misleading practices. I am 100% sure I am not the first.

  

  Business response

  07/08/2024

  Re: ***** ******

  
  

  July 8, 2024

  
  

  Hello ********;

  
  

  I think what is most troubling about this complaint is the accusation that we intentionally try to deceive our patients. Not only is that hurtful, it is untrue. Our administrative team try to do their very best to clearly explain insurance coverage to our patients and take the time to answer all of their questions. The facts are that we do accept Anthem insurance and have many patients who use Anthem in our practice without issue.

  
  

  In reviewing our conversations with this patient, we explained that we were out of network with Anthem, but more importantly, we explained that the Anthem insurance plan he had chosen excludes major services. We clearly explained there would be no coverage for the treatment he needed due to his plan limitations and lack of coverage for major services. We then set up a payment arrangement for the patient to pay half of his fee at the initial appointment and the second half at the final appointment, which is customary for our practice. He did not seem confused or concerned regarding any of this information.

  
  

  We do not allow dental benefit companies, such as Anthem, to dictate the care we recommend to our patients. We are committed to optimum oral health, candid conversations with our patients regarding their treatment, and preservation of their teeth for their lifetime. Our patient’s health is paramount to us and we are always willing to make comfortable payment arrangements with our patients when treatment is not covered. 

  
  

  We believed this patient understood he had no coverage and that he was comfortable with the 1/2 and 1/2 payment arrangement we made with him. The “in network” vs “out of network” status was not even relevant and he would not have had coverage for this procedure no matter what dentist he saw.  We believed we clearly explained that and he understood. We have a variety of options for our patients and would have gladly discussed this with him had he raised this as an issue. This patient needed this treatment in order to save his tooth and we believed he understood and was comfortable with his payment arrangement.

  
  

  We waited several months for this patient to pay his balance for treatment, even though his treatment was completed.  We have already adjusted off part of this patient’s balance for services totaling $306 in which Anthem only paid $54.60. So in other words, we have already discounted his treatment by $251.40 to try to appease him. 

  
  

  Even though it is not fair, we will provide an additional refund of his recent payment of $1885 (the balance for his treatment). He will receive a check to his home address on file. We are providing this refund as we wish to prove to him that we are sorry for this misunderstanding.

  
  

  We kindly request that this patient refrain from further offensive and defamation statements. We also wish him well and hope that he finds a dental practice that better aligns with his values and philosophy of care. Finally, I would appreciate an apology to my administrative team for questioning their integrity. These individuals work really hard, are sincere and conscientious and do not deserve this ridicule.

  
  

  I hope this helps the Better Business Bureau resolve this complaint.

  
  

  
  

  Sincerely,

  
  

  
  

  ******** *********

  Customer response

  08/05/2024

  Dear BBB,

  I have received access to the business response.  I also received, which I did not ask for, a check in the amount of $1,885.00 and a note to see their BBB response.  I reviewed their response and saw multiple discrepancies in their "facts" and yet, I do not want to waste any more time correcting them.  They are who they are, and, I was only hoping to help others.  After seeing their response, I consider this matter closed as I do not want to involve the BBB to mediate the facts as they actually occurred. I do not want their money as it doesn't change the facts.  I am voiding it and mailing it back to them on 8/6/2024, as it is more important to them than me. . 

  Thank you for giving customers a platform to share the unfortunate experiences that occur within our business community.  Future customers and clients in all areas of business appreciate you.

  Sincerely

  **** ******

*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. ↩