Consumer Complaints and Reviews
On June 17, 2009, my wife had an appointment to get her teeth cleaned, x-rayed and examined by Dr. Marie **. My health insurance company, Blue Cross Blue Shield, covered all this work 100% minus a $20 co-pay. After her examination, my wife was given an estimate on further work that needed to be done in the amount of $2,094 that Blue Cross Blue Shield does not cover. She brought home the estimate and I immediately called the dentist to inquire as to whether they accept MetLife, which we have as a secondary dental insurance. The customer service representative, Elsie, told me that they do accept MetLife. I called MetLife and verified that they were an in-network dentist provider and MetLife told me that Dr. ** is an in-network provider. After verifying with both parties that we were covered, I went ahead and scheduled my wife’s appointment for June 29 which later was changed to June 23. At the same time, I scheduled a June 22 appointment for my daughter to have her exam, cleaning and x-rays. My daughter was diagnosed by Jeffery **, associate dentist of Dr. **, as having 1 cavity, so I scheduled her to have that filled on June 24 by Marie **, along with my other 3 children to have their cleanings, x-rays and exams done.
My wife had her work done on June 23. The following day when I took my daughter in to have her filling done on the 24th, I was told by Dr. ** that her initial exam was misdiagnosed and that there were an additional 12 cavities (so instead of having one cavity, now she has 13). I thought that was a little suspicious and considered having her examined by a different dentist, but she was already in the chair and Mrs. ** told me that she would fill 3 of them that day and the rest would be scheduled for a later date. While prepaying for all the dental work that still needed to be done, totaling $5,147.00, I inquired about how to file the claim with MetLife. Theresa, the office manager, told me that they would help me file their part of the paperwork and she took my MetLife card and entered the information into the computer. It was then that I was given a paper to sign which turned out to be a letter saying that they no longer accepted MetLife’s in-network fee schedule.
Now, after having $2,491.00 worth of Dental work done, they present me this letter which was the first and only time I was informed that Mrs. ** does not honor her contract with MetLife and their in-network fee schedule. Obviously, I cancelled all future appointments and asked them why they did not inform me of this when I called on June 17 to ask if they accepted MetLife Insurance. Their explanation to me was that there are signs in the office that states “We do not file secondary insurance claims.” I did see that sign and understood that to mean that I had to pay first and file the claim myself in order to be reimbursed by the insurance company.
During a private meeting with Theresa on June 29, she told me that the sign also means they do not accept the terms of secondary insurance companies. I don’t believe that any average consumer (outside the dental industry) would understand that sign to mean that. I called MetLife and inquired about the sign’s hidden meaning that Theresa told me about and they told me that the dentist is still under contract to accept the negotiated fees. The dental office led us to believe that our insurance was accepted, but we would just have to pay up-front and file the claim ourselves. That was acceptable to us. However, her fees are much higher than what is agreed upon in her contract with MetLife, making our out-of-pocket expense astonishingly higher than we were led to believe. I feel we were intentionally blind-sided, and completely misled by the information we were given by the employees at this dental office. It was blatant dishonesty and misrepresentation. We took measures, as a consumer, to insure that we were attending a dentist that took our insurance, and though we were told they did, we were lied to until after the work was done. In reality, they do not comply with the contract they have with our insurance company and that should have been made clear before all the dental work was done. That is clear misrepresentation.
At the time I first called the office and asked if they accepted MetLife, I should have been told no, they do not accept MetLife’s in-network fees. The answer I got was a simple “Yes, we take MetLife.” Since I was not told this until after treatment was done, it has cost me $831 more than I expected. Of course if I'd have known this in the beginning she would not have received my business. Mrs. ** 's methods of attracting new customers is not very honest and in fact unethical.
Marie Basco DDS Company Profile
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- Marie Basco DDS