In December 2007, my mother entered a dental office located in the La Sierra section of Riverside, California. At the time of her treatments, she was covered under a dental insurance plan. Over the course of two visits, she was informed that she needed to have the crowns/fillings on two teeth replaced.
According to a representative from my mother's dental insurance company, basic fillings and crowns would have been covered up to a total of approximately $305. Thus, depending on the dental treatments she chooses (i.e., basic versus premium materials), her treatments could either be covered 100% by her dental insurance or there may be out-of-pocket expenses for the insured in the event she chooses for the more expensive options not covered under her insurance plan.
Her dentist, however, told her to get the more expensive fillings/crowns at a cost of $850 per tooth, for a total of $1700 for two teeth. Because her dental insurance would not have covered the entire cost of my mother's dental treatments, a credit card account under "Care Credit" aka GE Money, was somehow opened in my mother's name to cover the remainder of the cost of treatment.
As you can imagine, confusion ensued when my mother received her first credit card bill because she had absolutely no idea at which point in time she had allegedly authorized a credit line under Care Credit/GE Money. My mother states that on the day services were rendered, she was never asked for her dental insurance card nor her co-payment. Also, at the time services were rendered, not one person spoke with her about which treatments were covered by her dental insurance and which were not. No authorization or consent was ever obtained from her to pursue the much more expensive course of treatment. In other words, she was never asked to provide consent to services which were obviously above and beyond what her dental coverage would have covered.
Obviously a meeting with the dental office's billing clerk was clearly called for.
Here is a synopsis of the events that unfolded as far as we can understand.
I asked for the following items from the billing clerk:
(1) Any proof of authorization or consent from my mother allowing the dentist to provide the more expensive crowns/fillings that were clearly not fully covered by her dental insurance?
Dental office: No actual form was present in her file that proves she signed for or consented to receive the more expensive treatment. No actual form that reflected that my mother was even informed of the price differential and that her insurance would not cover the much more expensive treatment course. The dental clerk found in her file some obscure hand-written notes that the more expensive crowns/fillings were to be used, and nothing more.
My mother: never once was she approached regarding which treatments her dental insurance plans provides for versus the cost of the treatments being pursued that day.
(2) The application form for Care Credit as authorized by my mother? According to the Care Credit brochure, there are three ways to open a line of credit: (1) ask the dental office for an application; (2) apply online at their website; or (3) via telephone conversation directly with a Care Credit customer representative whereupon a decision can be made immediately. I asked for evidence of any of these means of application.
Dental office: No form or application can be found that shows my mother even consented to opening a Care Credit account. A photocopy of an application back in 2006 for a Capital One credit card in which my mother had signed was found in her file. The very existence of this photocopy as made by the dental office is highly indicative that the office does keep meticulous records of credit cards being opened in connection with dental treatments provided to their patients. In contrast, the fact that no application existed in my mother's file for Credit Care for this past December 2007 speaks volumes as far as the issue of whether my mother indeed consented to it. And it's certainly probative as to whether my mother was even made aware that their recommended treatment course was above and beyond what was covered under her dental insurance plan AND of Care Credit's role and function in providing the supplemental payments for such treatments.
My mother: never once was there a discussion regarding Credit Care being utilized to supplement the difference in the cost of her dental treatments.
(3) A cost itemization of all the treatments provided to my mother.
Dental office: two teeth at a cost of $850 each = $1700, minus 10% discount for use of Care Credit, for a total of $1530.
(4) According to a representative from mother's dental insurance company, they paid $305 towards the dentist's claim for services rendered. I asked the billing clerk to reconcile the figures, i.e., why did they collect $1530 from the credit card company + $305 from the dental insurance company for dental services that they claim totaled only $1530? By all appearances, they were paid an additional $305 by the insurance company! It sounded like a case of "double dipping" to me.
Dental office: no explanation yet. They claimed they needed to call the dental insurance company to confirm whether a claim was filed and if they did collect $305 towards the cost of my mother's dental treatments.
THE BOTTOM LINE: this does NOT pass the sniff test whatsoever!
First of all, my mother is elderly and living on a very limited income. She would not have consented to expensive treatments that her dental insurance does not cover had she been informed of her ALL her options and financial obligations. Her dentist and his staff never informed her of these options and, more importantly, what her dental insurance WILL NOT COVER. Ultimately, her consent was not obtained to pursue the more expensive alternatives.
Secondly, based on other complaints I've read and am now experiencing with my own mother, it appears that some dental offices may be in collusion with Care Credit, aka GE Money. She interestingly "accepted" much more expensive dental treatments rather than the ones that would have been covered under her dental insurance, and subsequently found herself the unlucky subscriber to Care Credit's deferred interest loan at a whopping 22% APR, which conveniently pays the dentist the remaining cost of treatments that insurance companies do not.
I'm in the process of figuring out whether fraudulent activity is involved and whether dentists, such as the one my mother had the misfortune to be treated by, are preying upon vulnerable and gullible elderly people on limited incomes. I AM NOT ACCUSING EITHER CARE CREDIT/GE MONEY OR THE RIVERSIDE, CA DENTAL OFFICE OF IMPROPRIETY, however, I am certainly suspicious of it.
If someone else is out there has a similar experience, please let me know.
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