March 9, Physician's StatementI initially examined the patient on November 25, with a chief complaint of fractured retained roots of the mandibular lower left third molarThere are typically roots with this toothIt is the last molar in the arch and her roots were broken off below the gingivaI explained to the patient that to remove the roots of the tooth I would need to section the remains of the tooth and take the roots out individually and most likely need to make an incision of the tissue to gain access.I gave her the option to havethe procedure performed under local anesthesia or sedation After discussing her options, she elected to have the procedure performed under sedationThis was thoroughly explained and the patient was given exact instructions if we performed sedationThese were third molar roots - multiple rooted tooth, not a single rootAlso we could have waited for a predetermination but the patient was symptomatic and wanted the procedure performed soonerWe work with insurance companies every day and we appealed to her insurance carrier in an attempt to help her.Physician: Michael KB**, DMDOffice Manager StatementIn our office benefits for this particular insurance are looked up on the insurance website and we are given a summary of benefitsIn the patient's case we looked specifically into the dental oral surgery benefits for her root extraction which covered at 50%; and also looked into anesthesia, which stated that it was covered at 100%They do not show under the anesthesia that anesthesia is not covered if the patient has a root removedTypically, In the past this insurance did not pay for anesthesia if the extraction was routine, which means there is no cutting or removal of bone to get the tooth out.Unfortunately, only recently has there been an issue with this insurance company not covering anesthesia if a root removal is involved and there was no way for us to know this ahead of timeWe did our best to help the patient out by appealing that decision, but the insurance company did not see it that wayThey don't cover for anesthesia period if a root is involvedInsurance is becoming increasingly complex in deciding what they will cover and will not coverIt is not always possible for us to know this ahead of timeWe were just as surprised as the patient was when they did riot cover the anesthesia for that reasonThe patient was not given a bill for our full anesthesia charge, the service was provided for her and we deserve to be paid for services rendered*Office Manager: Laurie F*
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below.Unfortunately, this has turned into a he-said, she-said scenarioAs much as I like DrB**, his memory of my exam is incorrectI was not given the choice between local and full anesthesia with pros and cons of both explained to meIf I had been given the option of local anesthesia I would have definitely accepted that option due to being able to drive myself home that day and knowing that the price would be lessHe very clearly told me that he'd be completely putting me under, and I'd need to make sure I had someone with me to drive me home In addition, in all of my discussions with his office's business manager, that version of the story was not mentioned until the very last conversationYou'd think an important detail like that would have been something that was brought up immediately, months agoIf the business is going to stand behind this untruthful version of the events- that I chose full anesthesia with all knowledge of the pros and cons- future customers of DrB**'s need to know that that is a lie so that they know to ask for options in their careIn regards to my insurance company changing their coverage between the dates of the estimate and the procedure, [redacted] Insurance has stated that that is also a lieFull anesthesia for a root removal is never covered unless it is proven medically necessary and hasn't been for as long as the representative could rememberDrB [redacted] and his staff can continue to stand behind the legality of what they didYes, I did sign that what they told me was an estimate and that I was responsible for the remainderHowever, that does not excuse the morality of their actions At best, they were negligent in providing me options and negligent in reviewing my insurance accurately to provide a realistic estimateHowever, due to the lies they continue to state, it seems like this was not negligence but a purposeful deceitful actFuture customers do need to be made aware Regards, [redacted]
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear belowUnfortunately, this has turned into a he-said, she-said scenarioAs much as I like DrB**, his memory of my exam is incorrectI was not given the choice between local and full anesthesia with pros and cons of both explained to meIf I had been given the option of local anesthesia I would have definitely accepted that option due to being able to drive myself home that day and knowing that the price would be lessHe very clearly told me that he'd be completely putting me under, and I'd need to make sure I had someone with me to drive me home In addition, in all of my discussions with his office's business manager, that version of the story was not mentioned until the very last conversationYou'd think an important detail like that would have been something that was brought up immediately, months ago If the business is going to stand behind this untruthful version of the events- that I chose full anesthesia with all knowledge of the pros and cons- future customers of DrB**'s need to know that that is a lie so that they know to ask for options in their care In regards to my insurance company changing their coverage between the dates of the estimate and the procedure, [redacted] Insurance has stated that that is also a lieFull anesthesia for a root removal is never covered unless it is proven medically necessary and hasn't been for as long as the representative could remember DrB [redacted] and his staff can continue to stand behind the legality of what they didYes, I did sign that what they told me was an estimate and that I was responsible for the remainderHowever, that does not excuse the morality of their actions At best, they were negligent in providing me options and negligent in reviewing my insurance accurately to provide a realistic estimateHowever, due to the lies they continue to state, it seems like this was not negligence but a purposeful deceitful actFuture customers do need to be made aware Regards, [redacted]
March 9, Physician's StatementI initially examined the patient on November 25, with a chief complaint of fractured retained roots of the mandibular lower left third molarThere are typically roots with this toothIt is the last molar in the arch and her roots were broken off below the gingivaI explained to the patient that to remove the roots of the tooth I would need to section the remains of the tooth and take the roots out individually and most likely need to make an incision of the tissue to gain access.I gave her the option to havethe procedure performed under local anesthesia or sedation After discussing her options, she elected to have the procedure performed under sedationThis was thoroughly explained and the patient was given exact instructions if we performed sedationThese were third molar roots - multiple rooted tooth, not a single rootAlso we could have waited for a predetermination but the patient was symptomatic and wanted the procedure performed soonerWe work with insurance companies every day and we appealed to her insurance carrier in an attempt to help her.Physician: Michael KB**, DMDOffice Manager StatementIn our office benefits for this particular insurance are looked up on the insurance website and we are given a summary of benefitsIn the patient's case we looked specifically into the dental oral surgery benefits for her root extraction which covered at 50%; and also looked into anesthesia, which stated that it was covered at 100%They do not show under the anesthesia that anesthesia is not covered if the patient has a root removedTypically, In the past this insurance did not pay for anesthesia if the extraction was routine, which means there is no cutting or removal of bone to get the tooth out.Unfortunately, only recently has there been an issue with this insurance company not covering anesthesia if a root removal is involved and there was no way for us to know this ahead of timeWe did our best to help the patient out by appealing that decision, but the insurance company did not see it that wayThey don't cover for anesthesia period if a root is involvedInsurance is becoming increasingly complex in deciding what they will cover and will not coverIt is not always possible for us to know this ahead of timeWe were just as surprised as the patient was when they did riot cover the anesthesia for that reasonThe patient was not given a bill for our full anesthesia charge, the service was provided for her and we deserve to be paid for services rendered*Office Manager: Laurie F
*
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below.Unfortunately, this has turned into a he-said, she-said scenarioAs much as I like DrB**, his memory of my exam is incorrectI was not given the choice between local and full anesthesia with pros and cons of both explained to meIf I had been given the option of local anesthesia I would have definitely accepted that option due to being able to drive myself home that day and knowing that the price would be lessHe very clearly told me that he'd be completely putting me under, and I'd need to make sure I had someone with me to drive me home In addition, in all of my discussions with his office's business manager, that version of the story was not mentioned until the very last conversationYou'd think an important detail like that would have been something that was brought up immediately, months agoIf the business is going to stand behind this untruthful version of the events- that I chose full anesthesia with all knowledge of the pros and cons- future customers of DrB**'s need to know that that is a lie so that they know to ask for options in their careIn regards to my insurance company changing their coverage between the dates of the estimate and the procedure, [redacted] Insurance has stated that that is also a lieFull anesthesia for a root removal is never covered unless it is proven medically necessary and hasn't been for as long as the representative could rememberDrB [redacted] and his staff can continue to stand behind the legality of what they didYes, I did sign that what they told me was an estimate and that I was responsible for the remainderHowever, that does not excuse the morality of their actions At best, they were negligent in providing me options and negligent in reviewing my insurance accurately to provide a realistic estimateHowever, due to the lies they continue to state, it seems like this was not negligence but a purposeful deceitful actFuture customers do need to be made aware Regards, [redacted]
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear belowUnfortunately, this has turned into a he-said, she-said scenarioAs much as I like DrB**, his memory of my exam is incorrectI was not given the choice between local and full anesthesia with pros and cons of both explained to meIf I had been given the option of local anesthesia I would have definitely accepted that option due to being able to drive myself home that day and knowing that the price would be lessHe very clearly told me that he'd be completely putting me under, and I'd need to make sure I had someone with me to drive me home In addition, in all of my discussions with his office's business manager, that version of the story was not mentioned until the very last conversationYou'd think an important detail like that would have been something that was brought up immediately, months ago If the business is going to stand behind this untruthful version of the events- that I chose full anesthesia with all knowledge of the pros and cons- future customers of DrB**'s need to know that that is a lie so that they know to ask for options in their care In regards to my insurance company changing their coverage between the dates of the estimate and the procedure, [redacted] Insurance has stated that that is also a lieFull anesthesia for a root removal is never covered unless it is proven medically necessary and hasn't been for as long as the representative could remember DrB [redacted] and his staff can continue to stand behind the legality of what they didYes, I did sign that what they told me was an estimate and that I was responsible for the remainderHowever, that does not excuse the morality of their actions At best, they were negligent in providing me options and negligent in reviewing my insurance accurately to provide a realistic estimateHowever, due to the lies they continue to state, it seems like this was not negligence but a purposeful deceitful actFuture customers do need to be made aware Regards, [redacted]