ComplaintsforChad N. Webster DDS, PC

• Initial Complaint

  07/25/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Prior to the procedure (implant with crown) being scheduled and accomplished, I provided the office manager with two (2) forms of insurance (TRICARE and Delta Dental) and requested whether the aforementioned procedure would be covered (paid for in full) by insurance. I asked on two (2) different occasions. Both answers were the same: that the procedure would be covered in full and no out of pocket payments by the patient would required. After the procedure was accomplished with the crown installation and after a discussion whether my night guard would need to be adjusted, Dr. *******'s assistant (Ashlee) offered to determine whether a new night guard would be covered by insurance. She did the research and said, "yes" enough time has passed *** my insurance would cover the expense of the night guard. She performed the molds. I then received a bill for both aforementioned procedures and made several inquires to a new office manager, Tami. She would not discuss the matter, so I asked to speak with Dr. ******* and she refused to allow me to speak with him. I called again on Veteran's day last year after receiving text that my teeth cleaning appointment was coming ip. I asked her if I would have the opportunity to discuss the matter with Dr. ******* and she cancelled the appointment. She then mailed a copy of the patient financial responsibility form I had signed many years ago. I assert but for the representation by the dental office that the procedures were covered I would have selected a different course of action. I relied on their promise to my detriment. The bill have been sent to collections and has negatively affected my near perfect credit rating.

  Business response

  01/04/2023

  Business Response /* (1000, 11, 2022/09/13) */ Mr. ****** had a limited exam at our office June 1, 2020 and was in pain. Tooth # 31 had a vertical fracture with a periapical abscess and was non-restorable. He was referred to Dr. Johnson an oral surgeon for extraction and Bone Augmentation on June 9, 2020. The Implant was placed October 19, 2020. Implant restoration was done in our office on November 30,2020 and was seated December 17, 2020. This procedure was an ongoing restorative process that spanned over seven months. Mr. ****** stated he would have chosen a different course of action. However, by the time he saw us in November there was no other course of action. ***** provided two insurances to our office, Primary/ Delta Dental of Oklahoma, and a Secondary/ United Concordia. Once both insurances paid and contracted adjustments were made, his out of pocket, as dictated by his insurance company was $1,086.59. A night guard was discussed at his December 17,2020 appointment, he approved, and impressions were done. Due to the lengthy treatment done at the oral surgeons the majority of his benefits were used. Mr. ****** received two statements prior to his April 12, 2021 appointment, his balance was discussed with Tamy. I did not have all the information needed so Tamy requested explanations of benefits from both of his insurances. Once those were received, Tamy reviewed his account, it was determined that the balance is his in accordance with his insurance. Our New Patient forms state: Please be aware that we cannot guarantee this estimate and that there may be a balance after insurance pays. Any Balance remaining is your responsibility. Which ***** signed when he became a patient of record on January 12, 2016. Mr. ****** was sent two more statements with no contact. A collection letter, voicemail and a text were sent September 1, 2021 with no response till September 16, 2021. Mr. ****** and Tamy had a very lengthy conversation on September 16, 2021 at that time she explained to him, what his insurance reimbursement and, network adjustments. She advised him during that conversation, that your insurance policy is a contract between you and your insurance company. We are not a party to that contract. It is physically impossible for us to have the knowledge and keep track of every aspect of your insurance. It is up to you to contact your insurance company and inquire as to what benefits your employer has purchased for you. Mr. ****** asked to speak with me during that conversation; I was with a patient at that time. I reviewed the ledger/notes and insurance information. I advised Tamy, I performed a service that was agreed upon by Mr. ****** and that as office manager she takes care of all aspects of the office, that there was no need for me to contact him. A statement was sent on October 12, 2021, a final collection letter on October 14, 2021, with a final voicemail on October 28, 2021 for Mr. ****** to contact her prior November 1, 2021. November 4, 2021 Mr. ****** was turned to collection and a voicemail and text was sent advising that his November 11, 2021 appointment has been cancelled due to collection. Mr. ****** had from January 14, 2021 when the first statement was issued to November 4, 2021 when he was turned to collection to remit payment. I can provide a copy of his signed new patient forms including our financial policy with any other forms needed to provide we did everything in our power to get as much insurance benefit as we could. Consumer Response /* (3000, 13, 2022/09/23) */ (The consumer indicated he/she DID NOT accept the response from the business.) The timing of the conversations are inaccurate and as a result continue to prove that the customer service/care is not a concern to the office, particularly to Chadwick *******, the owner/operator. The statement is false that Tamy requested I speak with Chadwick *******. She did not pause the conversation long enough to check his availability. Why provide false statements and not address that the office made a mistake on the ability to process the insurance claims as they promised x 2. Beware of the new office management due to lack of integrity and service. Business Response /* (4000, 17, 2022/10/11) */ ***Document Attached*** Responding to Mr. ******'s denial of accounts: Tamy was hired as office manager with one of her responsibilities being, cleaning up outstanding insurance and past due patient balances. Regardless of whether or not Mr. ****** agrees with my last statement, the fact remains his insurance had dictated the balance of $1,086.59 to be his responsibility. Mr. ****** received his first statement January 14th 2021, and then a second statement February 25th 2021. When Mr. ****** was present for his April 12th 2021 appointment the account was discussed. Due to lack of information on her part she investigated into his account and collected all the insurance information. I was aware of every conversation Tamy had with Mr. ******, she did her job in accordance with her job description and title. Mr. ****** was aware of his balance as far back as January 2021. The account didn't go to collection till November 2021. Many offices would not have held an account open for 11 months. All of my new patient forms and any treatment plans given state that we can only provide Estimates. We advise all of our patients that insurance is a contract between the patient and their insurance and that as a courtesy we file insurance to help with the cost of their treatment. Whatever benefit insurance may or may not provide, the patient is still responsible for all fees associated with their treatment. I provided a service to Mr. ****** and expected to be reimbursed for that service. If I adjusted everyone's balance when insurance doesn't pay, I would be out of business.

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