Dental Fraud

[dabelms]

What is the name of your state? PA

 

[doucar]

Do you have a question?

 

[dabelms]

My dentist Is charging me the write off amount he is supposed to except for participating in the insurance plan. In other words, if his fee for service is $500 and the insurance indicates that the acceptable cost is $300, he bills me for the difference, $200. The total plan only shows his cost and the amount the insurance authorized (no write off amount). This led me to believe i owed him $200. This adds up because the total amount I owed was $8,400 of which I paid $6,000, in installments, before I started to question his work and examined his charges near the end of this 5.4 month fiasco.

 

[quincy]

What has your dentist and/or his billing office said about your concern?

 

[PayrollHRGuy]

What has your dental insurance provider said about your concern?

 

[quincy]

Here are two links, the first to the Pennsylvania Attorney General’s information on insurance fraud and the second to the Pennsylvania Dental Association with information on filing a complaint about a dentist:

https://www.attorneygeneral.gov/protect-yourself/insurance-fraud/

https://www.padental.org/Online/Directory/Complaint.aspx

The first step in resolving almost any dispute is to speak to the one with whom you are having a dispute, to see if there is a simple solution.

 

[Zigner]

My dentist Is charging me the write off amount he is supposed to except for participating in the insurance plan. In other words, if his fee for service is $500 and the insurance indicates that the acceptable cost is $300, he bills me for the difference, $200. The total plan only shows his cost and the amount the insurance authorized (no write off amount). This led me to believe i owed him $200. This adds up because the total amount I owed was $8,400 of which I paid $6,000, in installments, before I started to question his work and examined his charges near the end of this 5.4 month fiasco.

Is the dentist a participating dentist in your plan, or is he simply billing your insurance as a courtesy to you?

 

[dabelms]

Apparently, talking to him did no good. He is ignoring me, so I am preparing a letter with photos, the reason I sought a 2nd opinion and asking for most of my money back by a specific date. If he ratio ignores me, I need to know my rights before taking further action,
At the time I hired him, I was searching for a dentist that used NOx and he was only one in the area. However, it did not make me feel the same. I kept asking him and offered to have my husband come over and look at the tubing, etc. That is when he admitted it was on low and turned it up. I have a low threshold of pain. Somewhere around the 4th visit, it felt like the novacain wasn’t working. When I screamed and pulled his arm away, he said he did not think I needed the full dose.
Turns out he is a real character. His staff does most of the work, he pops in and does the drilling, etc. and leaves again. Saw him picking up sticks in the yard. It seems he has a reputation for focusing on cash flow.

 

[dabelms]

Is the dentist a participating dentist in your plan, or is he simply billing your insurance as a courtesy to you?

We have the blue cross/shield Met Life dental plan. When I first contacted his office, I was told he accepts it, otherwise I would not have gone to him.

 

[Zigner]

We have the blue cross/shield Met Life dental plan. When I first contacted his office, I was told he accepts it, otherwise I would not have gone to him.

I understand that he accepts it, but is he participating? There is a difference. If he is a participating provider, that means he's signed a contract with the insurance company, if he's not, that means that he'll bill them on your behalf and accept their payment with you paying the balance.

 

[dabelms]

Here are two links, the first to the Pennsylvania Attorney General’s information on insurance fraud and the second to the Pennsylvania Dental Association with information on filing a complaint about a dentist:

https://www.attorneygeneral.gov/protect-yourself/insurance-fraud/

https://www.padental.org/Online/Directory/Complaint.aspx

The first step in resolving almost any dispute is to speak to the one with whom you are having a dispute, to see if there is a simple solution.

Thank you. I am 77 and just want my money back at this point. I have Interstitial Lung Disease and my time is limited, so I don’t want to go through a long law suit. If he ignores my request, I will post complaints against him (to help other people) and file a fraud case, once u find out I have a right to do so.

 

[adjusterjack]

We have the blue cross/shield Met Life dental plan. When I first contacted his office, I was told he accepts it, otherwise I would not have gone to him.

Agree with Zigner. You have to call the insurance company to see if he is a contracted dentist. You're supposed to do that before you engage any medical or dental provider.

 

[PayrollHRGuy]

We have the blue cross/shield Met Life dental plan. When I first contacted his office, I was told he accepts it, otherwise I would not have gone to him.

It is your responsibility to make sure that your doctor is in-network. While the doctor may accept payment from your insurance provider it does not mean that he is in-network and has accepted their cost structure.

 

[dabelms]

I understand that he accepts it, but is he participating? There is a difference. If he is a participating provider, that means he's signed a contract with the insurance company, if he's not, that means that he'll bill them on your behalf and accept their payment with you paying the balance.

I’ll check with insurance company today. Problem is he never filed a claim with the insurance company. I thought he was filing at the end of the service, but only received 1 for another unrelated to the bridge. I was paying him on the installment plan, giving him $2,000 payments, til the Novacain and NOx incidents.

 

[dabelms]

Agree with Zigner. You have to call the insurance company to see if he is a contracted dentist. You're supposed to do that before you engage any medical or dental provider.

His office when I called said he accepts my ins. Did not even think to call to verify.