Am I Liable for overpayment paid to Dentist

[kennethcarver]

What is the name of your state (only U.S. law)? TN
A few months ago I received a copy of the letter sent to my old dentist from MetLife stating that they overcharged the insurance company by submitting non negotiated prices. Around $190. I go to a different dentist, not associated with the first, for a routine cleaning. Charges were submitted to MetLife, however metLife refused to pay because they never received their overpayment back from the original dentist. My new dentist called MetLife and they were told that since they did not receive payment from my old dentist that I am liable and any charges made would go toward the $190. I did not receive anything from MetLife stating this; only a payment statement to the new dentist as though it was paid. The payment was for $80 and my new dentist received nothing. When they called MetLife they were told that this was to come off the $190 that they overpaid. My dentist told MetLife that they are a different dentist and have nothing to do with the overpaid dentist; MetLife said that don't matter that they were going to get their money back through me because of a failure to pay by the original dentist. My dentist thinks it's a load and so do I. I have not called MetLife yet. Just wanted to get a little info as to what you folks with better knowledge on this thought. Thanks KC

 

[ecmst12]

Doesn't sound right to me. The overpayment is between the insurance company and your former dentist. You should talk to your insurance company about it.

 

[justalayman]

Leave the current dentist out of the picture. Pay him whatever is owed and fight this out with the insurance company.

While I don't necessarily agree with what MetLife is doing I understand it. They are putting op in a position of seeking a refund from the previous dentist if it actually should be a refund. Whether it is proper or not is going to be determined by the insurance contract involved and the facts of the situation with the previous dentist. I can think of a situation where what happened could be appropriate. If the $190 was actually due the previous dentist but was the op's responsibility, that would mean op would have owed the $190 MetLife paid so making the offset as they have would be appropriate.

 

[ecmst12]

The overpayment had nothing to do with OP and would not have been his responsibility.

 

[justalayman]

The overpayment had nothing to do with OP and would not have been his responsibility.

How do you know it would not have been his responsibility? Do you have a copy of his policy? Do you have a copy of his claims to date against the policy co-pays or max out of pocket?

If so then you must have posted the original thread under a pseudonym.

If it isn't you posting under a pseudonym you can't have any knowledge of whether the overpayment amount would have been the op's liability or not.

 

[ecmst12]

Because it was related to the contracted rate for services. Amounts billed over the contracted rate are never the member's responsibility.

 

[justalayman]

Because it was related to the contracted rate for services. Amounts billed over the contracted rate are never the member's responsibility.

Many policies have a simple schedule of payment for a given service with the remainder being owed by the patient. Do you have a copy of the op's policy so you know what it covers and what it pays for any particular service?


I have seen similar situatons where a dentist billed in a manner so the patient paid less than they should have. It is insurance fraud.