ComplaintsforPrisma Health Dentistry–Richland

• Initial Complaint

  05/21/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  This complaint is filed for the following reasons: 1. Using the term "estimate" to justify dramatic increases in the final cost for services; 2. Knowingly giving bogus misrepresentations that they were; a, in the network of insurance providers; b That the insurance provider would directly reimburse me. 3 Taking over 7 months to inform me that the "estimate" was incorrect and that my share increased by $750. 4. Adding addition charges of over $168 eight months after the original service. 5 Retaliation for confronting her with my concerns and involving Patient Advocate (see email chain). My problems began in August of 2023. I had a toothache and sought help from Prisma Dentistry It was determined that I needed an extraction on a tooth located in the front of the mouth. I didn't want that empty space so they attempted to fabricate a replacement which was installed but didn't last a night. The next day I went back and because I had been charged for this service, they agreed to apply the cost to red**e my bill by this amount. I was told that Aetna (my primary insurance) would pay @ $1900 and that the balance of $1800 was due prior to installing the permanent replacement and that I would receive a refund from ****** ********* (my secondary insurance). After a month, I called ****** *********, I found that they were not a part of their preferred providers, didn't not have an agreement to pay me directly and had not received a claim from they months after the procedure I confronted the office about this and the fact the ** had not received my claim. This went nowhere so I contacted the Patient Advocate who relied on facts provided by the dentist office and only after several conversations was the claim filed, Almost 7 months later, I receive a bill for $756 and then after I paid that, they sent another for $168 which I have not. (email chain available).

  Business response

  05/28/2024

  Dear Sir/Madam,

  Thank you for bringing this to our attention. This matter was thoroughly reviewed in November 2023 following standard procedures. A follow up explanation was provided along with an apology for any confusion/inconvenience regarding the billing process. Additionally, in-depth discussion occurred that included a review/description of estimates and claims. Once EOBs were received, payment was applied accordingly.  We sincerely regret any ongoing dissatisfaction, however appropriate actions were taken to address the concerns, and communicate the outcome. 

  Customer response

  05/28/2024

  
  Complaint: ********
  
  I am rejecting this response because:
  Sorry isn't enough in this incidence.  There was no reasoning why it has taken nearly seven months to receive a bill for $756 and another for charges they say were made last August 2023, Dentist have nearly daily contact with insurance companies they work with.  They know exactly how m**h they will pay and how m**h the patient will pay out of pocket.  I think that this practice is not a one out of a million. but routine.  It is too easy to just fall back on the defense that the original cost was an "estimate".  An "estimate" has to be in good faith.   In addition, if they were actively seeking additional monies from Aetna, is there evidence that this was the case?  What is the explanation for why charges for $168 were added 7 months later.  Not mentioned in original complaint is the number of attempts I personally made to get the correct claim info from their office (4).  Each time I would call ****** ********* in an attempt to recover my prepaids (This can be verified by contacting them).  Each time I was told that the info was incorrect.  Eventually ****** ********* had to call the office directly and still that was not enough.  I can't believe that they are offering s**h a flimsy excuse for over charging me and expect me to just roll over.  I won't!!
  Sincerely,
  
  ***** *******

  Business response

  05/30/2024

  Thank you for making us aware of this patient’s dissatisfaction.  We aim to meet all patient’s needs (both in terms of outcome and service value) and regret that we did not do so in this situation.

   

  An internal investigation by our patient accounting team yielded the following re: his BBB complaint #********.

   

  Date of Service 08/28/23, patient services estimate was $177.00.

  Date of Service 09/12/23, patient services estimate was $1,815.00.

  Total service estimate was $1,992.00, which equals the anticipated patient out of pocket financial responsibility/obligation. To date the patient has paid $2739.41, but he was then reimbursed $927.67 by ****** *********.  It was confirmed with ****** ********* that the patient did cash the check they mailed him at the end of March 2024.  The amount the patient paid, $2,739.41 minus the amount ****** ********* paid directly to him, $927.67 equals a total patient out of pock payment of $1,811.74.  His account has a remaining balance of $166.80.  Current net out of pocket payments of $1,811.74 plus the outstanding balance of $166.80 equals a total out of pocket payment for services of $1,978.54.  Again, the dental estimate provided him which he agreed to prior to administering treatment was $1,992.00, which means the payments made (plus that still owed) was off by $13.46 to his favor.

   

  Our accounting team left the patient a message with a call back number of 864-522-8716.  We look forward to explaining this to him again and hopefully winning back his trust.

   

  Best regards,

  Matt

   

  Matthew H. F****, MS, OTR/L

*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. ↩