St. Mary's Dental

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this because: Of all the different doctors and dentist offices I've been to, this is the first and only office that has not reviewed my insurance and notified me prior to going back to have any procedure or check up that something has changedAnd this isn't just some minor changeThis is a very big changeAnd it wasn't me who made a change nor was it my insurance company that changedStMary's dental made a changeTherefore I feel it is their obligation to notify individuals that were affected by the changeThey claim they informed me on my previous visit to their office that they were dropping *** but that seems like something I would rememberOr even still, they already had a letter that they supposedly made available in their wait room that they could have simply printed out and sent home with all *** patients on their most recent visit that they were still covered forLike I said in my original complaint, I don't pay for my dental insurance so I can go to a dental office where my insurance is not accepted and have to pay the full amountThat would be absurdI do however feel that it is more likely that a dental office, knowing that they will be losing one of their patients, would not notify one or some of their patients knowing that they will come to the office for a routine checkup and still make money off of them one last time before sending them on their wayThe other possible explanation is that they just forgot to notify meA simple mistake yes, but given that they had so many patients to notify, maybe one or some slipped through the cracks and we're failed to be notifiedEven if none of that is the case, I sat in their waiting room for approximately 10-minutes waiting for my turn to go backHow long does it realistically take to hop into the computer system to verify if or what insurance company the patient is covered by? The last I checked, most if not all doctors offices do this alreadyWhy would a dentists office be any different
Regards,
*** ***

As stated before, we had notification stating we will go out
of network with *** *** as of October 31, The notification went up in our
office in July of 2013, which was months prior to going out of networkThese
signs stayed up through January 2014; they were in our waiting room as well as
on the front desk where patients check out.
We also have a signed document by the patient that states “your bill is
ultimately your responsibility”, which was attached to our prior response We make every effort to let patients know of
changes; however, ultimately it is the patient’s responsibilityOut of all of
our patients that come to us with *** *** this is the only patient who has reported
not knowing. We have many patients with
*** *** that continue to come to our office even though we are out-of-network
We called *** *** and they stated that it is the patient’s responsibility to
check with *** *** prior to each dental visit for coverageMost dental offices
are fee for service which is different compared to medical offices which are
insurance basedRegardless of any of factors it is ultimately the patient’s responsibility which the patient consented to
by his signature of our financial policy page

June 23, Dear ***,Thank you so much for alerting us of the complaint submitted to you by *** *** *** on 6/9/14.I have been in practice for years and this is the first complaint I have ever receivedIn the years of business, we never participated
with *** Insurance (***'s PPO plan) except for the period from 05/24/until 10/30/(when we pulled out of the plan because it became to labor intensive for my staff to service)On or about June we posted a large sign in our reception area notifying all patients with *** insurance that we would not be participating with *** insurance effective 10/30/Every single patient was notified verbally upon check out that in months we would go back to being a non-participating *** provider (as we did since 1994)*** was in our office on 09/09/and was notified at the completion of his visit that, effective October 2013, we would no longer be a *** participating providerThe large sign in the reception room stayed posted until January 2014, It stayed posted for patients to see for over months.In addition, we have almost 6,patients and it is the responsibility of the patients to know their insurance planPlease find enclosed copies of ***'s signed document where he acknowledges that his bill and his insurance coverage is HIS responsibilityAt the patient's first visit with us, this is clearly explained verbally and in writingPatients are also provided with a brochure called "Why doesn't my insurance pay for this" Please reviewPlease also find enclosed a copy of ***'s Explanation of Benefits which details his insurance coverage for date of service 04/07/At that visit he purchased an electric toothbrush in our office and his insurance/deductible was appliedWe made every effort to notify the few *** patients that we have via email as wellFor whatever reason *** was the ONLY *** patient that did not get the message while the other patients we have acknowledged that they knew we are a non-participating provider.Please find enclosed a copy of the letter we sent to *** notifying them on July 30,that we would return to a non-participating provider status effective in daysIn addition, we provide excellent over the top service to each of our valued patients without regard to their insurance coverageWe spent a great deal of quality time with *** providing that excellent careI encourage *** to become acquainted with his insurance coverage since he is accustomed to receiving his medical/dental care in a military setting.If you would like to discuss this matter in greater detail, I would be happy to talk with youMy personal cell phone number is ###-###-####It is unfortunate that *** decided to go the route of the Revdex.com, but I am certain that you realize we did our due diligence of notifying him that we were a non-participating *** providerPerhaps he should consider that his insurance carrier did not properly notify him that StMary's Dental is a non-participating office and seek reimbursement from ***?