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Aspen Dental / incorrect billing

1 Mount Dora, FL, United States Review updated:

After following up with Amy at Aspen Dental Patient Satisfaction on 5/2/11, regarding being sent a bill for $172.40, she concurred that I do not owe them that amount and stated that I would receive a corrected statement/ledger...and they still have a credit amount for me. Amy today again said she will send the corrected ledger out to me as I have still not received one.
HOWEVER...my question regarding the denial of payment toward my permanent partial took an interesting turn. I was told by Amy on 5/2/10 that the payment request would be resubmitted to Ameritas (although she seemed certain that it would be denied after I told her the insurance company said the wrong code was submitted and there was no indication that they were being billed for a permanent/replacement partial and they received no information from Aspen Dental that I had a temporary partial prior to that and for how long).
After not hearing back from Aspen Dental or Ameritas, I again spoke to Amy at Aspen Dental patient satisfaction today 5/18/11 and she said payment request was resubmitted on 5/3/11 but again she was certain the insurance would again deny the permanent partial charge due to "frequency". I asked her to explain what frequency meant and she said my insurance covers a partial every 5 years. I explained to her that I was specifically told at the Mount Dora, Fl office that the first partial I rec'd was temporary and to be replaced after 6 months with the permanent partial. She tried to tell me that there is no difference between a temporary partial and a permanet partial but that after 6 months one would have to be replaced anyway after the gums have receded...would that not make the first one a temporary then? As a matter of fact Miss Schneider (Mt. Dora office) herself left me a voicemail message in January of 2011 requesting that I come in to get fitted for the PERMANENT partial. I went back in February for that.
In an email from Miss Samantha Fikes with Aspen Dental Patient Satisfaction back in November 2010, she stipulated that the permanent partial would NOT BE BILLED to my insurance company until after it was placed sometime after the 6 month period. I quote Miss Fikes below:
" I do show that you still do have to get your permanent partial. We did not send the charge for this to your insurance carrier yet because it is not placed."
Yet this morning when I contacted my insurance company, I was told that Aspen Dental did not bill for a temporary partial back in August 2010 (when I received the temporary partial) but billed for a PERMANENT partial which I did not get until about April 2011...interesting!
The Ameritas rep Liz said: had Aspen Dental billed for a temporary partial there would have been a different rate for that...ofcourse less than a permanent partial. The insurance rep said if they were to correct their billing to correctly reflect the charges for the temporary partial I received in August 2010, then Aspen Dental would have to reimburse the insurance company as they had overbilled at that point.
I called my insurance company again just to be sure and spoke to Mark and was told that had Aspen dental billed correctly in the first instance for a temporary partial, then I would have been qualified for the insurance payment toward the permanent partial after the 6 month period.
So! here's the synopsis of what Aspen Dental did:
They billed my insurance company for a permanent partial when I only had a temporary and they were paid 50% of $599.00 (eligible PPO charge on a PERMANENT partial) by insurance company...and took payment of 50% from my out of pocket account, then they rebilled the insurance company for "prosthetics" verses what they billed for the first time "denture partial" and when that payment request was denied by the insurance company...Aspen Dental took not $599.00 but $720.00 from my account! And as if that was not bad enough tried to bill me over and above what I should pay...the $172.40 as stated above!
At a time like this, when people are experiencing such economic hardships, is this how Aspen Dental makes its money, by ripping people off? Does this unethical behaviour extend to the Patient Satisfaction department and beyond also? I would like a written explanation/breakdown of all the PPO charges you have applied to the out of pocket account I have with you in the amount of $1412.60 (this I will compare to my insurance statements). Also I as well as my insurance company - Ameritas, would like to know if you are going to make the necessary corrections and ACTUALLY bill them for a temporary partial, since you have already been paid 50% by them for a permanent partial & 50% by myself and have also taken over 100% payment for a permanent partial untop of that from my account because you claim Ameritas denied payment of that permanent partial.
I know your organization has to make money but doing so dishonestly might not be in your best interest. I look forward to your written response.

Jennifer Ebanks

cc Better Businsess Bureau
Pam Bondi - Florida Attorney General

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Comments

  • Th
      31st of Dec, 2011
    0 Votes

    This seems to be a common practice for them. I have just gone something very simular with them. Incorrect insurance codes and overcharging for insurance covered procedures. I was also told my insurance would not cover and yet, 5 calls to the insurance carrier and my coverage outline and handbook all say its covered. I think they call it fraud!

  • Je
      31st of Dec, 2011
    0 Votes

    Unfortunately most people accept dental/medical billing blindly. My discovery was after the fact when I cross referenced my statements (dental statements against insurance statements) but I eventually did get some resolve and for that I am glad. Consumers have to protect themselves because some of these companies, unfortunately, are not completely above board.
    If you are not being unnecessarily charged for something you don't want or need, you might be owed a balance based on what you've paid them and what's been paid to them by the insurance company, and you won't know or be given a credit unless you verify and follow-up. Save emails, voice messages, take notes and follow-up...relentlessly! :)

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