ComplaintsforPure Smiles

• Initial Complaint

  08/22/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  A tooth extraction on November 20 of 2023 at pure smiles Lima, Ohio that is covered by my dental insurance IF the employees at pure smiles insurance and billing department would submit the correct paperwork. After 8 months and over 4 hours on the phone, nothing is being done. Need help asap

  

  Business response

  08/22/2024

  on 11/22/2023 ******* had a dental service completed in office. ******* later found out all was not covered under his dental insurance. He responded by asking us to bill to his medical insurance. He was informed we do not normally bill medical insurances for services as we only do dental insurance and he can submit to his medical on his own. He was very persistent through multiple calls to the office and during his post op visits  that we provide this service for him even though we told him we do not typically offer this. On march 15, 2024 He was told as a courtesy we would send this to his medical insurance for him. On May 8, 2024 ******* followed up saying his Insurance company informed him the claim was sent back to us because they needed more information. Our billing department asked ******* what other information did they need because we had not received any information from his insurance company and asked for a copy  of his explanation of benefits. He replied he had not received a copy from his insurance company. We explained to him we needed to see a copy of the EOB to forward any more information they desire. Our billing department then called his medical insurance (again as a courtesy for the patient.) They informed us that we need to register our doctor with them as she was out of network with the "medical" insurance. Our doctor is in network with the Dental insurance since she is a Dentist. We then submitted all required info to the medical insurance. He was informed of this on 5/14/24.

  7/25/24 Will left a message saying we sent in an incorrect code.

  7/25/24 ******** from billing left a message with *****s mom since he was not available to call back. 

  7/25/24 Will called back . Documented notes from his conversation with ******** in billing Follows...

  07/25/2024 - Will called back. I explained that our office has sent his claim to dental and to medical. He kept telling me that "it keeps getting kicked back". I explained that he would need to call his medical ins. and ask them about it. He said when he does that he gets sent to dental and when he gets to dental he gets sent back to medical. I let him know that the claim was sent to medical and **** did register Dr. Mayers so we have really done all that we can. He threatened to make this legal if he has to and I let him know it sounds like he needs to get his answers from medical ins. mr

  07/29/2024 - I returned a call from Medical Mutual. Rep told me I need to update our provider contracting online. She said it could take 30-60 days to update. I let her know this has already been done. **** said she already did this. I checked notes and it was updated on May 13. I was then transferred to provider contracting to check on update. NA so I LM for them to call me back. mr

  8/21/24 Patient called office demanding to have an in person meeting with our billing team. I informed the patient our billing dept does not have "meetings" with patients. They can handle everything with a phone call or message. He said our billing department was incapable of doing their job and filling out a "simple" paper so he could have his extraction done. He then said he would just come sit in the office until the met with him. I told him he would do no such thing. He then finished giving me his date of birth so I may check his acct. I checked his account and read off last notes. He said he would call his insurance company back and he's taking a day off of work to do this.

  8/22/24 We received the complaint from the better business bureau. 

  At this time the patient's quarrel is with his insurance company not Pure Smiles. He has taken the courtesy service we offered him and has been very demanding, rude, and nasty toward our staff because we offered to help him after he insisted with his billing opportunity.

  ******* has a credit on his account for $318.90. He was informed on 7/25/24 of this credit. We can refund the credit and he is welcome to use it as he pleases at another dental office.

  Customer response

  08/22/2024

  
  Complaint: ********
  
  I am rejecting this response because:
  It’s not entirely true and mostly because it centers on disparaging a customer that has spent thousands of dollars over a decade at pure smiles over a claim dispute of less than $500. 
  Sincerely,
  
  ******* *****

• Initial Complaint

  02/26/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  My dispute is with Pure Smiles Denistry .Their address is 2115 Allentown Road Lima Ohio 45805-1749. Their phone # is ************. I had a crown procedure done on January 24,2024. Before I had the procedure done Pure Smiles estimated that my portion of the bill would be $496.00 . They required that this fee be paid up front. At this point I did know the amount that my insurance company ,which is Delta Dental would determine what my out of pocket expense would be. I assumed that with Pure Smiles being a PPO and Pure Smiles being in my network with Delta Dental that I would be reimbursed the difference if there was an overpayment.. When I received my statement from Delta Dental they determined my out of pocket expense was $211.20. I have never had an issue with any medical provider that if I overpaid the patient portion that I was not reimbursed the difference. Delta Dental has informed me that I should be reimbursed the difference. When I called Pure Smiles about this their office manager stated #1) I had no credit and no balance . She stated that I signed the estimate (which I did ) therefore I had no legal ground to stand on. #2) she also stated that certain procedure codes would not be sent to insurance provider because those codes would not be recognized by the insurance provider. I believe a fair solution would be for Pure Smiles to reimburse me the difference of my payment which was $496.00 and the amount that Delta Dental determined was the patient portion which was $211.20. I also believe that Pure Smiles should not be recognized as a in network PPO for Delta Dental if they are not going to accept as paid in full the amount Delta Dental determines is the patient portion . Any overpayment should be credited or reimbursed.I greatly appreciate your help in this matter.

  

  Business response

  04/29/2024

  We sent the patient a refund check on 4/12/24 for $284.40 (not insurance.)

  Customer response

  04/30/2024

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ***** ****

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