November 1, 2021
BE CAREFUL! Medically UNNECESSARY work being recommended. First, let me say I was pleased with the Ruby Canyon (RC) dental hygienist, and dental assistants. The RC billing department is a different story. Let me explain.
I am a relatively new patient at RC. I moved to the area about two years ago. Shortly before the pandemic started. When I finally decided to look for a new dentist here, I did my research and settled on Ruby Canyon. I scheduled an appointment for a routine cleaning. All of the routine preventative work went fine.
I was told I needed two crowns. I was aware of the broken tooth that needed a crown. However, the dentist told me of another tooth that also needed a crown. The costs seemed high, but I had never gotten a crown before, so I didn't have anything to compare it with.
The procedure was done on 5/20/21 and went fine. However, when I received the Explanation of Benefits (EOB) from my insurance provider, I found out the other tooth was denied coverage. According to the EOB, the cost of the crown was denied because it was deemed medically unnecessary. I would have NEVER gotten the second crown, if I weren't told it was necessary. Or if I had been informed my insurance wasn't covering the procedure.
Upon finding out the procedure wasn't covered on 7/8/21, I called RC. I spoke with Carol, and she told they had already filed an appeal on the denial on 6/10/21. Carol also told me she would call my insurance provider to follow-up on the dispute as soon as we got off the phone.
The next couple of weeks I called a few times to follow-up, and had to leave voicemails, but never received any return calls.
On 8/11/21 I called and left another message at RC. It was at this time, that I decided I would also, call my insurance provider to check on the status of the dispute. This is the first time I found out that they had not ever received a dispute/appeal of the coverage denial. Upon finding this out, I immediately called RC back and spoke with Molly, in billing. She told me RC doesn't actually handle their billing in house, a 3rd party billing company handles it. She said she would contact them to find out what was going on.
This went on for a few months. Being told the dispute/appeal was filed on this or that date, only to find out it hadn't been. Finally, after leaving a voicemail informing RC I was going to write a review about the service I had received, Molly actually called me back. Not only did she call me back, but she has had their 3rd party billing company email me with an update. I actually received an email from Latasha with eAssist Dental Solutions. Latasha apologizes and say that Molly and Carol 'were under the impression that I had already filed the appeal for the claim.' Latasha then goes on to say that she 'just completed all the documents, and the appeal is set to go out today.' So now we have a third date, 6/10/21, 7/10/21, and 9/3/21 that the appeal has been filed.
On 10/7/21 I called my insurance provider and was informed they had received the appeal and it was currently being reviewed. I was informed that a resolution date of 10/18/21 was scheduled.
Of course, the appeal was denied. I called RC and they believe they are being generous by not charging me the amount that insurance 'should' have paid. Even though they knew the tooth was denied coverage when they gave me the quote. As I stated earlier I would NEVER had gotten the crown if I had been informed the procedure wasn't covered by my insurance. Coverage seems like very BASIC info, that should be provided to patients prior to any procedure. BUT RC DIDN'T PROVIDE THAT INFO. This is information the patient cannot find out for themselves, because of all the required coding.
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