I had a few visits with Summit Dental and I am deeply troubled at the billing departments lack of adherence to the ADA code of ethics, the Golden Rule of medical billing or any other rules or guidelines I have come across that may pertain to a patient rights to truthful communication and transparency. My daughter and I had one routine cleaning each, both were supposed to be covered at 100%. I went to the appointment fully anticipating 100% coverage, for both of our visits. However, Summit opted to use an Xray with higher frequency limitations but they did not feel they had to inform me of this. I attempted to clarify that I was not asking them to inform me of the frequency limitations in my policy, but the equipment used in Summit Dentals facility. I asked how a patient, without any dental training, would know which Xray Summit requires for the visit. They responded that while they do not expect their patients to know the names of the Xrays, they are “always happy to share that information…if our patients ask”. They would also not clarify, so I can only assume that the same would hold true then for any other dental equipment they might use. A patient’s insurance policy will not inform the patient which equipment is selected for each procedure and Summit Dental will not properly inform or educate the patient, unless the patient asks. They did not take a minute to say something along the lines of “the Xray required for todays visit may have increased frequency limitations. Would you like to review your policy before proceeding?” They don’t even have to offer to check for the patient, just give a friendly FYI, especially if the patient has no reason to suspect there will be any charges for a visit anticipated to be covered at 100%.
The most serious issue, however, is regarding a crown replacement. The claim form submitted by Summit Dental was incomplete, causing it to be rejected by my insurance. Even though Summit Dental is aware that all insurance companies have different requirements and different frequency limitations, they failed to provide complete and accurate information in order for my insurance to calculate coverage based on my individual plan. I was told by Summit that insurance did not ask for the date, Summit did not have the date, so they left it blank. I do not know which claim form they used but the ADA dental claim form states all fields must be completed and the full claim form lists the instructions for this specific date field. I was also told by my insurance that this specific date field is required for a replacement crown. When the claim was partially rejected by my insurance, Summit did not contact me to explain, they just sent me the bill. During Summits attempt at defending their actions after the fact, I was told since they did not have the date they left it blank “due to it being a guess or estimate” and because they want the insurance to make decisions based on “facts not guesses”. Again, as Summit Dental has stressed that all insurances are different, Summit Dental still opted to take a chance at guessing whether or not the date field needed to be completed. There is also a concern that filing an incomplete claim could have caused extreme undue financial hardship as it may have affected my out of pocket expense for the estimate. And a patient receiving a bill 8 months after a procedure, may pay out of pocket an amount that should have been fully covered by insurance, for fear of getting sent to collections.
I feel very strongly that the actions of the Summit Dental billing department are unethical, suspicious and potentially fraudulent. Based on my experience, I do not trust Summit Dental to initiate any communication or have any transparency regarding billing methods that would allow a patient to make an informed decision regarding their health care. As they do not seem to have an obligation to inform or educate their patients, I do not recommend...
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