1/5 -- Extremely Concerning Billing Practices and unnecessary treatment…read more
. My negative review is not about the quality of her dental care. Unfortunately, my experience with the front desk and billing practices has been completely different and has left me extremely disappointed and concerned.
The front-desk employee was extremely aggressive about collecting large amounts of money upfront rather than charging what would ultimately be my appropriate patient responsibility under my insurance. What makes this even more upsetting is that she specifically represented to me that the amount she was collecting was the amount my insurance company told her I had to pay. I trusted that statement because I believed the dental office had verified my benefits with Anthem.
For my crown, I was required to pay $960.60 upfront -- $460.60 electronically and $500 in cash. I was also charged $208.80 for deep cleaning service. With information from the dentist that I need because of unhealthy gums ( find out with other dentist that I don't have infection or disease in my gums)
When I later received my Anthem Explanation of Benefits, I was shocked. According to the EOBs, my responsibility for the crown and core build-up was $493.50, and my responsibility for the deep cleaning was $151.20. Those amounts were substantially less than what the office had collected from me.
When I questioned the office about why I had been required to pay so much upfront when my insurance showed a much lower patient responsibility, I did not receive the refund I requested. Instead, I was told that the crown cost more because a "stronger material" had been used and that I had signed treatment documents.
I want to make something very clear about those documents.
Some treatment plans I signed involved future proposed treatment, including two implants and replacement of some veneers. I specifically told the front-desk employee, Joan, that I could not afford those treatments at that time. I even asked her, "Why do I have to sign these treatment plans when I already told you I cannot afford to do them right now?"
She explained to me that my signature was only to document that she had explained the proposed treatment and how much it would cost if I decided to proceed in the future. I never proceeded with the two implants or the proposed veneer replacements.
What happened afterward concerned me even more.
Approximately three months after the original service, I received another Anthem EOB showing a separate $1,155 claim involving the same tooth and the same original date of service, this time coded as D6999 -- "Unspecified Bridge Procedure." Anthem showed $0.00 patient responsibility for that claim.
I find the timing of this additional claim extremely suspicious, especially because it appeared after I had questioned the office about why I was charged so much more than the patient responsibility shown by my insurance.
I cannot state why that additional claim was submitted or conclude that it was submitted to cover up an overcharge. That is precisely why I have asked Anthem to investigate the provider's billing, coding, payment collection, and complete claim-submission history.
My advice to anyone using this office is simple: do not assume that an upfront amount quoted by the front desk is necessarily your final insurance responsibility just because you are told that your insurance company provided that amount. Ask for everything in writing, request an itemized estimate, keep every receipt, obtain copies of everything you sign, and carefully compare your payments against your EOB when it arrives.
based on my personal experience with the front desk's aggressive upfront collection practices, the refusal to resolve what I believe is a substantial overpayment, and the subsequent additional claim that I am now asking Anthem to investigate, I cannot recommend this office.
