Towards the end of February I sought the services of a local dentist that accepted my Insurance. After a short search, and confirming this particular dentist accepted my plan, I went into their office to be evaluated. They took a couple of X-rays and made the determination that I needed a triple bridge and crown. At that time, the Office manager (Doctors Mother) said they would come back in a moment with a quote. A minute later, the O.M. told me the work would be $3600. I asked if she had taken my insurance reimbursement into account. I called the Dental Insurance co the day before to confirm my benefits. It is $1000 off the top and 50/50 of allowable services. The O.M. said they know how these things work and it would be more expensive if I lived in DC, saying that I was getting a deal. There is no way a practice can make a determination without working with an insurance company, unless it was going to be a self pay. It was a short back and forth with her saying that I have insurance and I’m not expected to pay the full price. From many experiences of predetermination of benefits, when there is “work” to be done the doc office sends the info, in this case x-rays and codes to the insurance company, and the I.C. makes a determination on the $$ they pay and the percentage that is my responsibility. Well that wasn’t even brought up by either the doctor or more importantly the O.M. They had no interest in working with the Insurance company since they were complaining to me abt how they never pay their claims, it takes forever to get a reply, etc. I figured that they would straighten that out and I was asked by O.M. to leave a deposit of $500. That’s a lot of money to me, but I knew that the work needed to be done and the final amount would be significantly lower once the Insurance kicked in. I walked out of the doctor's office without any itemized bill of the work to be performed, only a receipt for my $500 deposit. I felt very uncomfortable about how things went down so again, I decided to call my insurance company to confirm my benefits. They said the same thing that they said prior to my visit to the doctor. I gave it a week and half and checked with the O.M. and she said they submitted the claim but didn’t hear back. I then waited another week and she told me the insurance company kicked back the claim because the member (me) information was incorrect and they had no record of me in their system. I believe this to be untrue because the O.M. took a copy of my insurance card and I had called the I.C. twice with the same info and they had no problem pulling up my record. As I’ve done before, calling the doc and insurance company to get things moving is not out of the question, especially when it’s to my benefit. I was informed by the person I was speaking with from the I.C. that they had no record of ever receiving anything from the doc office so she offered to put me on hold while she called them thinking maybe they had the wrong information. They didn’t and I gave it two more weeks. I called the O.M. and explained my dissatisfaction in how things were handled. She said “if you want your money back we’ll just go ahead and do that”. To which I responded, “yes PLEASE”. Finally, I felt that I could get my refund, find another dentist, and put this behind me. A couple days later I get a call from the Doctor and in an accusatory way asks me what seems to be the problem. Of course he knew exactly what the problem was by talking to his Mom. I reiterated the lengthy process and that I wasn’t comfortable with them doing any work on me, so since his Mom offered to refund the $500 I decided that was the best thing. The next thing he says is “we’re not giving you a refund” and hung up on me. Needless to say, I was stunned at this behavior. I have never in my 57 years had such an unprofessional experience with a doctors office and staff. How could he not honor what his mother, the office manager had already agreed to?
Update: 5/20/23- I call