Anonymous on BBB
8 years ago
06/20/2013, 14:18 PM
My husband Daniel was given an extra service without his knowledge or consent.
I have group dental insurance through my employer, *********************, and my husband is on my plan. As part of the plan, we are each allotted two free, non-deductible, maintenance-related teeth cleanings annually. My husband scheduled his appointment as such. When he went into the office he received what he believed to be a regular teeth cleaning. We later received a statement from BCBS informing us that we would owe a $56 deductible on the teeth cleaning. The hygienist had apparently coded it incorrectly.
When we contacted Shemen to correct the error, we were informed that the cleaning had apparently been "upgraded" without our knowledge or any notification to the one indicated on the BCBS statement, which required the deductible to be paid. We are unclear why the hygienist would feel the need to provide a different service than the one requested, and why, even if it was necessary, she did so without informing her patient or obtaining any consent from him. We are now stuck paying the deductible we wouldn't have otherwise needed throughout the year for services which should have been free under the dental insurance plan we pay the premiums for monthly.
We would like the refund of $56 and a refiling of the claim with our insurance for the service expected. Either the hygienist did code the service incorrectly, in which case we should not have to pay for the error as it would be paying for a service not actually received-- or she dealt in a dishonest manner with us, "upgrading" the service without permission.
All future appointments we have with Shemen are also requested to be scheduled with **********.
Business' Initial Response
We will refund the $56.20 as a courtesy, per the patient's wife's request. We will not re-file the insurance claim for the "service expected" as Mrs. ****** requested, because that would be insurance fraud. We have already filed and received payment for the procedure that was completed. The service was coded correctly, and was what the hygienist deemed to be the appropriate procedure, based on the patient's periodontal condition and history. We regret that there was a misunderstanding about the procedure that was performed.
We will do our very best to accommodate Mrs. ******'s request that she and her husband be scheduled with *********** for all future appointments. If, in the future, Mr. or Mrs. ****** refuses a recommended treatment in favor of one that is covered 100% by insurance, this will be noted in the patient's chart with his/her signature so there is no confusion.