ComplaintsforBelmont Family Dental, PLLC

• Initial Complaint

  07/18/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  3/16/2003 went to dentist for a cleaning, they claim that they did a periodontal cleaning. Before they began I told them that I only wanted what my insurance would cover (Medicare) they told me I was due for x rays and I asked if it was going to be covered, the hygienist went to the office and said that they were not sure so we skipped the x rays and they did the cleaning. I received a bill for $166.80. I called and talked to the office manager on or about July 10th to complain about the bill, the office manager would not listen to me and talked over me and told me that they don’t do what the customer wants but what the doctor tells them to do. I offered to pay for a general cleaning but she would not tell me what that cost would be. I since then have received another bill for $192.00 I would be happy to pay for the service I requested not what they insist on what the doctor tells them to do. I tried to explain to the office manager that if she took her car in for an oil change and they did an engine job and demanded that she pay for an engine job that she would not pay it. She had no reply

  Business response

  07/24/2023

  Patient had scaling and root planning done in 2018 (ADA code 04342) 
  Patient had been coming to our office ever since for periodontal maintenance (ADA code 04910) 
  Patient’s insurance changed towards the end of last year. Patient failed to provide his new insurance prior to his most recent visit. 
  Patient’s new insurance does not cover 04910 code. 
  
  During his visit, patient requested a “regular cleaning.” 
  Regular cleaning is prophylaxis cleaning (ADA code 01110) 
  Prophylaxis is a preventative code. 
  We cannot bill a preventative code where there is history of periodontal disease and use of 04342 code. You have to bill a maintenance code, not a preventative code. 
  
  We explained to patient on multiple occasions that we cannot bill what his insurance covers just because it covers it, that is considered insurance fraud. Patient’s insurance also covers dentures, we cannot bill it just because a patient requests it. 
  
  Patient did agree to our fee policy when he signed up as a patient. It specifically states that a balance is the patient’s responsibility should an insurance claim gets denied. Please see paragraph 2 of attached document. 
  
  

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