Complaint Review: Denville Oral & Maxillofacial Surgeons

I was having an issue with recurring, multiple mouth sores. My dentist advised me to see an Oral Surgeon. My dental office referred me to Dr. Scott Cohen in Denville, NJ. I asked if Dr. Cohen participated in my insurance and was told yes. I was advised they refer many patients to him. I called his office to make an appointment. I advised them that I had multiple recurring mouth sores, and was referred there by my dentist. I told them who I was insured by, and asked if they participated in my plan. I was told yes. The woman took my information and also asked for my medical coverage. I gave her the information, and she proceeded to make my appointment. my appointment was on November 3, 2015.

When I arrived at the office, I was given a clipboard with a bunch of paperwork to fill out. While filing out the paperwork, the receptionist asked for both my dental and medical insurance cards. I asked again if they were a participating provider and was told yes. A few minutes later, I was called in to see the Dr. Cohen. He verified the fact that I had mouth sores. He told me that since they were in the process of healing, I had to wait until a new one started. He told me when I saw a new sore starting, to call and come in right away. He said they would biopsy it to see if it was a viral or autoimmune issue. He told me to follow up with him in three weeks. I went out to make my follow up appointment and was handed a piece of paper by the receptionist. It was an estimate for surgery, and I was told I needed to sign it. She told me if I came back for a biopsy, it was $500.00 and they did not accept any insurance.

I was totally caught off guard. I was very confused and stated that I asked three times if they accepted my insurance and was told yes. She told me they don't accept any insurance and today's visit was also $200.00. I was completely blind sighted. I asked if my next appointment was going to cost another $200.00? She looked at me exasperated. She told me my next appointment was a follow up, and was included with today's $200.00 fee. If I came back for the biopsy, it would cost $500.00. I would be responsible because they don't accept any insurance. I was very confused and asked for an explanation. I told her that I asked three different times if they accepted my insurance and was told yes. She advised me they accept my dental insurance, but my issue was a medical nature. She told me as a courtesy, they file the medical claim on my behalf, but do not accept any medical insurance. I had to pay the bill and get reimbursed by my insurance. Frustrated, I paid the bill and left.

The next day, I called my referring dental office and advised them what occurred. They said they would call and speak to the Office Manager and get back to me. A few days later, I received a call back saying they were also confused. Dr. Cohen's office told them it was a medical, not dental issue and that is why it was not covered. They didn't understand how they arrived at the $200.00 fee, because that wasn't an amount on the fee schedule. They said they would follow up and get back to me. I didn't hear back, so I called Dr. Cohen's office myself on November 12th. I spoke to the Office Manager and explained my situation to her. She was insistent that I was charged the $200.00 correctly, and I was responsible for the bill. I asked repeatedly, why I was not informed of this before I went in to see the doctor. She told me they don't know if its a dental or medical issue until after I'm seen. They have to wait for the diagnosis from the Doctor. At that time, it was determined that it was a medical issue and they do not take insurance. I told her that I advised them exactly what I was coming in for when I made the appointment. I also asked if they accepted my insurance and was told yes. We kept going around in circles. I told her to cancel my follow up appointment. She told me the follow up was included in my initial visit. I advised her that I felt the office was shady in their business practices and I didn't want to return. She put me on hold for a bit and then came back on the line. She tried to explain again about the dental/medical issue. I advised her the same way they informed me after the fact, that a biopsy would cost $500.00, they should have notified me that they do not accept insurance for my issue.

I was referred to this Dental Office by my Dental Office. I advised at that time, exactly why I was being referred there and what insurance I had. I should have been told, we accept your dental insurance, but if the Doctor determines your diagnosis is a medical issue, we do not accept any medical insurance, and you will be fully responsibe. At no time was I advised of this. Had I known this upfront, I would not have made the appointment. It was my understanding, that I was referred to a Dental Specialist by my Dentist, and he was a participant in my insurance. Now I was duped with a $200.00 consultation fee. The claim was denied by my medical insurer, because he was not a participant in my plan. I had no idea this would be considered a medical issue, nor was I advised by anyone that it may be. The receptionist handed me an estimate for surgery after the fact, and hand wrote Today's Visit $200.00 under the estimate, I was told I had to sign it after I was already seen by Dr. Cohen.

I feel this office has unethical business practices. I'm very disappointed that they will not budge on their billing decision. I will not return to their office or recommend them to anyone. I have attempted to work this out with Doctor Cohen's Office, but my attempts have proved fruitless. I filed appeals with both insurance companies, but did not get any satisfaction. I disputed the charge with my credit card company, but they ruled in favor of the Dental Office. Since I signed the the form, although it was given to me after the fact, it was my word against theirs. I filed complaints with the Better Business Bureau, ADA and NJ Attorney General's Office. I know that I'm beating a dead horse, but what this Dental Office did is wrong. I want to get the word out, so that this Dental Office doesn't have the opportunity to do this to someone else. While I was on the BBB Website, I found another negative review for this business from another consumer. It was dated December 17, 2014. Basically, they did the same thing to another consumer that they did to me. They informed the consumer that they accepted insurance. After they saw the Doctor and was about to leave, they informed them the did not accept insurance, and told them they were responsible for the bill. Apparently, this is common practice for Dr. Cohen's Office. They are dishonest, deceptive and unethical. Consumer's beware.