[Resolved] Loose Tooth Pediatric Dentistry / Dental
Date of service 5/25/2016 Patient: Raymond Forbes, Jr. dob 04/30/2009
Two teeth were pulled from my 7 year old grandson and they used nitrous. MetLife Insurance did not cover the nitrous, but the negotiated fee was $41 and they charged us $101. They said they could charge whatever they wanted to by state law. I would like to request a refund, and ask that they be held to negotiated charges. They also charged us $40 for a missed appointment with no forgiveness for first time. We did show up, but were a day late. Husband wrote it down wrong. We live an hour away, and they provided no reminder the day before. They seem like they are trying to milk every dollar they can from you.
Misunderstanding of how charges are determined.
The Loose Tooth Pediatric Dentistry Customer Care's Response, Jan 17, 2017
Thank you for allowing us to address your complaint, although, we were trying to do this over the phone yesterday when you verbally abused our front desk employee, swearing at her several times, and hanging up on her twice. We have listened to the calls in their entirety.
As she was trying to tell you yesterday, MetLife does not cover nitrous, as such, under Illinois state law SB3242 which was amended in 2013 to add section 355.3, the insurance companies are not able to impose their fees on an item that is not covered. When something is not covered by the insurance company it falls to our office fee, not "whatever we wanted". The pertinent text is as follows:
"(b) No company that issues, delivers, amends, or renews an
individual or group policy of accident and health insurance on
or after the effective date of this amendatory Act of the 97th
General Assembly that provides dental insurance shall issue a
service provider contract that requires a dentist to provide
services to the insurer's policyholders at a fee set by the
insurer unless the services are covered services under the
applicable policyholder agreement."
With regard to the $40 missed appointment fee with no forgiveness: this is absolutely inaccurate. We always wave the fee the first time, which we did for you, however, when you missed the second appointment, we imposed the fee. When you decide not to show up for an appointment, not only is there an opening in the schedule, there are also other patients who would have like to have been seen at that time, but were unable to come in because we had blocked that time for you.
No refund is warranted, nor will one be offered.
As you know, you signed a treatment plan acknowledging the fee for nitrous. If you waive your Hippa rights we would be happy to post it for you.
Updated by Linda Daniel, Jan 21, 2017
There was one missed appointment. We just came to your office this past spring when we got custody of our grandchild. Your receptionist has a superior air, and I dont appreciate being talked down to. If I hung up on her, I guess we were done talking. No use beating a dead horse. We thought we would be getting superior care for our grandson, which is why we drove an hour to get there. I go by what was submitted to the insurance company, and what they say I owe you. This is also what I use for tax purposes. If that is wrong, then maybe you need the insurance companies to change that.
The Loose Tooth Pediatric Dentistry Customer Care's Response, Feb 09, 2017
We are a small practice and unfortuntely can not change the process, and laws, in place that are backed by a big cooperation like Metlife. However, we did have Metlife call you and write you a letter explaining the law to you. There is no equivication between the law, which we followed, and the level of care we provide to each and every one of our patients.
Lastly, in order to avoid any confusion, we could email you the two missed appointment dates with your reasoning.