I took my daughter to this dental place on 6/5/2024 to get dental braces and they gave me an estimate that was way too expensive. The amount is $7,200. However, this provider is contracted with Delta Dental Insurance (my insurance) and Insurance only allows them to charge $4,086 or premier amount of 5360. The insurance pay $3027 or $3500 and I just need to pay $1024 or the $1860. During the visit, I told Dr. Julia about my insurance coverage and I told her the estimated cost that I think that is going to be. Then she said you also have to pay a certain amount for the dentist's knowledge as well. I said well it should all be covered in the treatment plan that is going to be authorized by the insurance.
So, I requested the service coordinator to request the pre-authorization from the insurance, and when they request the pre-authorization, dental insurance will limit the amounts that they can charge. Then the coordinator told me that insurance will not cover the expanders, and I checked with the insurance company and they told me expanders are included in the treatment plan, and it is not a separate billable charge. Their estimate also had a fee for the records but did not specify the amount. The insurance company also informed me that record fees are covered in the treatment plan, and it is not a separately billable charge. During the visit, they took several pictures and I requested those pictures. Then the coordinator Eran told me that those pictures were not free and that if I accepted the treatment plan of $7,200 she would send those pictures.
On 6/6/2024 Eran told me that they requested the pre-authorization (she said that over the phone) and I was waiting for the pre-authorization. Since I did not hear back from Delta Dental, I texted her on 6/12/2024 and asked when she requested the pre-authorization. Then she called me the same day and said the Doctor no longer takes any orthodontic patients.
I sent an email explaining that since the doctor is contacted with the insurance provider there are limitations and Eran did not submit the pre-authorization. Then they sent me the below email. In the below email, they said they are a premier provider and the fee is $5,360, and initially they told me it is $7,200. For a premier provider Delta Dental contracted fee that provider can charge is $5,360. The provider cannot bill separately for an appliance fee of $532, a retainer fee of $397 per arch, a fixed retainer fee of $500, and an ortho record fee of $587. All these fees are included in the treatment plan, and I already verified this with Delta Dental.
On 6/17/2024 Dr. Julia Lee called me and told me that she is a premier provider and her charges are higher than a regular dentist's, and then I told her I am willing to pay what is legitimate to pay according to the insurance guidelines. Thus, I asked her to send a pre-authorization request to the insurance. Then she said it is too much work for them, and she refused to do that. Then she said my daughter's situation is complicated and she feels that it is a lot of work, and she is unable to do that treatment. She also said she is just a regular dentist, not an orthodontic specialist. This also concerns me because her website advertises that she is a specialist in orthodontic treatment. Even when I took my daughter to Dr. Lee on 6/5/2024 she went over the details and explained to me the treatment plan she was going to do. Then I asked Dr. Lee if you are a premier provider then why you don't feel confident to do the treatment on my daughter? She did not have a good explanation. Also, I asked Dr. Lee "if you were not confident enough to do the treatment, how come you gave us a treatment estimate?" Then she said, "Even if you sign that treatment estimate, I can decline to treat". Then I also asked her why her treatment coordinator did not submit the pre-authorization, and Dr. Lee said she did submit on 6/6/2024, but she put the wrong date of birth for my daughter. This Doctor is not credible at all. Dr. Lee is making up stories because she does not want to treat my daughter because she does not get enough money through the insurance.
They never requested the pre-authorization but lied to me by stating that they did, and then they refused to treat my daughter because they realized that they could not overcharge me since I knew the rules.
I am sure this dental place is overcharging many other people. This business is acting in bad faith to overcharge customers. It is a very common ripe-off that nowadays what some dentists do is to refuse to run the pre-authorization through the contracted insurance company(because when they do patient finds out how much they can charge), and bill you for certain covered services out of your pocket without running through the insurance. This is a big scam. Julia Lee DDS basically wants to charge me $3700 but the actual amount i should be paying is $1,860. This is a big scam. read more