N
njh0021
Guest
What is the name of your state? Texas
(Sorry it's long!!)
In June my husband's wisdom teeth were finally bothering him enough that he went to the dentist to see about getting them out. The dentist said they could schedule him for oral surgery the very next day. I asked the dentist if we needed to do a referral for our insurance. He assured me that it wasn't necessary because the oral surgeon worked for the same dental company and just rotated through all the locations. Since he would be there it was considered "in house" so we didn't need a referral. I thought that sounded logical and I figured that if that wasn't true that the lady who did the final bill would give us the right process. He even joked with us that he hoped I didn't need to have any work done, as this procedure would take all our benefits for the year.
We went to the "treatment counselor" (who is really NOT a counselor in the correct use of the term!) who gave us a bill for EVERYTHING they wanted to do to him in the next couple of years so that we would know what we were looking at. The bill had the list of procedures, a list of insurance co-pays, and what we would pay. The total was $2500 that we would pay for EVERYTHING. We thought that was pretty reasonable for wisdom teeth, root canals, bridges, and fillings. She told us that the prices for the wisdom teeth would change a little the next day once the oral surgeon had a chance to do a consultation and once they got the insurance information in there. That seemed reasonable as well. Not once...EVER...did the word referral leave her mouth, so I assumed that we were in the clear.
The next day, after the consultation, she comes to us with a bill for over $4000 for the wisdom teeth alone!! She told us that the insurance only paid 25% of the bill so we'd be stuck with a bill for over $3000. We just thought that that was what the insurance paid and that was that. At this point it's important to note that this new bill, unlike the previous day's bill, only had the list of procedures and the amount we had to pay. The insurance column was blank except for at the bottom where she had crossed off the total and told us that insurance paid this and we paid the rest.
A couple of days later in the mail, we received the list of co-pays from our insurance. We had ended up paying about $400 a tooth compared to the co-pay of $75 a tooth. We called the insurance company and to our surprise, we were told that they NEVER pay just a flat percentage of a bill - they pay per procedure. Before I went to see her, I called the insurance company. They said that the dentist was only cleared for general dentistry and not oral surgery. She was required to tell us about the referral process, which she never did. I went in to talk to the "counselor" about this and she proceeded to tell me that she had explained all this to me. I told her that she had never told us about the referral option. She said that she had explained that it was a 25% DISCOUNT and then she said that they don't offer the referrals because after all...that would take their business away. So I said, "You might have saved yourself some business but now I'm paying a $3200 bill instead of a couple of hundred!?" She just looked me and said that was how it was.
I called the BBB to file a complaint. The dental people returned the first offer...the guy at the corporate office, without ever talking to me, said that it was his understanding that we had been duly informed and had chosen to go with the DISCOUNT instead of the referral, however, they had found a $453 clerical error that would be refunded. I refused to accept their offer, and I called the man directly. I told him our side of the story and he said he'd look into it. Since then, the only other time that I've been able to get a hold of him, after many, many phone calls, he told me that he was waiting on an employee statement and that he'd have it finalized by that Friday. That was 4 weeks ago. He has not returned any of my calls or the calls and emails from the BBB. The man at the BBB said that there was another case with the same company and same man that opened after mine that has already been closed. Because he still did not respond, the case was sent to arbitration. A day later, he calls me. He says that since there was a miscommunication they wanted to resolve it and asked what I thought a fair price would be. I told him the same thing I had said before – I want to pay what we should have paid had it gone through the referral. He said that was not fair to his company (they lied, but it’s not fair to them!), so I asked him what he thought a fair price was. He responded $1975. As this is still $1000 more than we should have paid, I am not happy with this.
Yes, I know that we did many stupid things to continue this saga; however, I feel like we were violated as both patients and consumers. They were supposed to give us all of our options; they failed to do so to make a few bucks and this is, in my humble opinion, fraud.
My common sense question is this...If we were given the option to spend $3000 or $800 for the exact same thing, why would we have chosen to pay more? What sense does that make?
I would like to know if it goes to an arbitrator or to court, does it look like we have a chance or should we take the latest offer? Do you have any suggestions of things we can do to get this solved? I am prepared to continue with contacting the media, local and state dental assoc., state consumer agencies, the State Attorney General. What do you think?
(Sorry it's long!!)
In June my husband's wisdom teeth were finally bothering him enough that he went to the dentist to see about getting them out. The dentist said they could schedule him for oral surgery the very next day. I asked the dentist if we needed to do a referral for our insurance. He assured me that it wasn't necessary because the oral surgeon worked for the same dental company and just rotated through all the locations. Since he would be there it was considered "in house" so we didn't need a referral. I thought that sounded logical and I figured that if that wasn't true that the lady who did the final bill would give us the right process. He even joked with us that he hoped I didn't need to have any work done, as this procedure would take all our benefits for the year.
We went to the "treatment counselor" (who is really NOT a counselor in the correct use of the term!) who gave us a bill for EVERYTHING they wanted to do to him in the next couple of years so that we would know what we were looking at. The bill had the list of procedures, a list of insurance co-pays, and what we would pay. The total was $2500 that we would pay for EVERYTHING. We thought that was pretty reasonable for wisdom teeth, root canals, bridges, and fillings. She told us that the prices for the wisdom teeth would change a little the next day once the oral surgeon had a chance to do a consultation and once they got the insurance information in there. That seemed reasonable as well. Not once...EVER...did the word referral leave her mouth, so I assumed that we were in the clear.
The next day, after the consultation, she comes to us with a bill for over $4000 for the wisdom teeth alone!! She told us that the insurance only paid 25% of the bill so we'd be stuck with a bill for over $3000. We just thought that that was what the insurance paid and that was that. At this point it's important to note that this new bill, unlike the previous day's bill, only had the list of procedures and the amount we had to pay. The insurance column was blank except for at the bottom where she had crossed off the total and told us that insurance paid this and we paid the rest.
A couple of days later in the mail, we received the list of co-pays from our insurance. We had ended up paying about $400 a tooth compared to the co-pay of $75 a tooth. We called the insurance company and to our surprise, we were told that they NEVER pay just a flat percentage of a bill - they pay per procedure. Before I went to see her, I called the insurance company. They said that the dentist was only cleared for general dentistry and not oral surgery. She was required to tell us about the referral process, which she never did. I went in to talk to the "counselor" about this and she proceeded to tell me that she had explained all this to me. I told her that she had never told us about the referral option. She said that she had explained that it was a 25% DISCOUNT and then she said that they don't offer the referrals because after all...that would take their business away. So I said, "You might have saved yourself some business but now I'm paying a $3200 bill instead of a couple of hundred!?" She just looked me and said that was how it was.
I called the BBB to file a complaint. The dental people returned the first offer...the guy at the corporate office, without ever talking to me, said that it was his understanding that we had been duly informed and had chosen to go with the DISCOUNT instead of the referral, however, they had found a $453 clerical error that would be refunded. I refused to accept their offer, and I called the man directly. I told him our side of the story and he said he'd look into it. Since then, the only other time that I've been able to get a hold of him, after many, many phone calls, he told me that he was waiting on an employee statement and that he'd have it finalized by that Friday. That was 4 weeks ago. He has not returned any of my calls or the calls and emails from the BBB. The man at the BBB said that there was another case with the same company and same man that opened after mine that has already been closed. Because he still did not respond, the case was sent to arbitration. A day later, he calls me. He says that since there was a miscommunication they wanted to resolve it and asked what I thought a fair price would be. I told him the same thing I had said before – I want to pay what we should have paid had it gone through the referral. He said that was not fair to his company (they lied, but it’s not fair to them!), so I asked him what he thought a fair price was. He responded $1975. As this is still $1000 more than we should have paid, I am not happy with this.
Yes, I know that we did many stupid things to continue this saga; however, I feel like we were violated as both patients and consumers. They were supposed to give us all of our options; they failed to do so to make a few bucks and this is, in my humble opinion, fraud.
My common sense question is this...If we were given the option to spend $3000 or $800 for the exact same thing, why would we have chosen to pay more? What sense does that make?
I would like to know if it goes to an arbitrator or to court, does it look like we have a chance or should we take the latest offer? Do you have any suggestions of things we can do to get this solved? I am prepared to continue with contacting the media, local and state dental assoc., state consumer agencies, the State Attorney General. What do you think?