Feeling Extremely Deceived

Updated on June 21, 2012
M.G. asks from Fairfield, CA
11 answers

Recently my husband and I have decided to take care of our dental health. We've had quite a few appointments. Prior to the first appointment I spoke with someone at the dental office informing them that the dentist I was to see is not a participating provider with our insurance company - though many doctors at this office are. She told me not to worry because they'll bill it under one of the participating dentists and if/when we get bills to bring them in or give them a call and everything will be worked out. I've paid out of pocket what they(the dental office)said I had to pay. I return yesterday for a different visit expecting to pay $145. I get into the chair and the hygenist starts probing around - I was there for a cleaning. She then quits and goes up front to talk about the cost and bring me what it would be. No joke, it is over $500. I immediately call that visit to an end and discuss things with the billing woman up front. Come to find out the office has billed my prior visits(2)with the non participating provider to my insurance company. Now I owe for the % not covered AND the difference between what the insurance did cover and what the approved amount is.

I feel beyond ashamed that I believed what I was told by the office initially. Had I not been told that I would've kept the one appointment, paid out of pocket in full and been done with that doctor. I'm trying all I can to see if there's a way I can change what is. I doubt there is. The office has not even put forth any money I have paid towards the dentist's bill. What was I paying for?! I'm honestly just frusterated and feeling like I was duped. Has anyone else been in this type of situation, and if so what did you do about it?

What can I do next?

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L.B.

answers from Biloxi on

What the dentist's office did was promise you that they would commit insurance fraud in order to accommodate your desire to use a practitioner outside of your insurance plan.

I am not surprised that they did not go through with filing false insurance claims. How dishonest of them to even suggest it to you, and honestly, dishonest of you to accept.

I don't know that there is anything you can, or should, do but pay your bill and switch to a dentist that is in your insurance program. I mean, do you want to call the insurance company and complain that the dentist's office did not commit fraud for you? My Granny used to say, what a tangled web we weave when first practice to deceive.

Sorry you got into this :(

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S.H.

answers from St. Louis on

well, I worked in the dental field for 7+ years....& this technique is pretty standard. Some consider it fraud, most offices just consider it a part of "group" practice. This happens most frequently when a new dr joins the practice & is not yet a part of the PPO.

Regardless of the fraud issue, just as a good rule of thumb....as consumers we should always get a written confirmation of all dealings. If the other party is not willing to put the terms in writing, then walk from the deal. In your case, I would have asked for written confirmation of their proposal & subsequent agreement to "bill under another dr's name, thus ensuring your PPO co-pay".

& in the case of your cleaning...what happened was the hygienist determined that you required additional treatment, well beyond that of a standard cleaning. This happens every single visit for my DH! He thinks he's going in for a regular cleaning.....& every time, he ends up with a deep scaling - with anesthesia, & by the quadrant to boot! A Heck of a lot more involved/expensive than just a cleaning. This is the price he pays for neglecting his dental care....you'd think he'd learn. Aaaargh.

Anyway, the odds are ....that she walked to the front to check on the % covered for the procedure....so she could accurately quote you your portion of the expenses.

Soooo, next step should be: write a letter to the head of billing, CC to the office/business manager & senior partner of the practice. Explain what the verbal committment was & how you are requesting compliance to their promises. Do not focus on feelings. Make it very straightforward & request a written response. Attach copies of your insurance EOBs. & I'm also not above mentioning contacting the insurance co, the BBB, the Attorney General's office, the Chamber of Commerce, & the ADA.

Stick it to them in a very non-emotional manner, & I believe they'll comply with their original agreement. If you're overly emotional, then I do believe they'll just ignore you. Good Luck....

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K.M.

answers from Denver on

I am sorry that happened! It seems like what the dentist office was trying to do is insurance fraud, maybe you should take it up with the insurance company? Maybe they can cut you a deal?

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N.B.

answers from Minneapolis on

Sounds like the dental office wanted your business and perhaps to confuse you in this whole process. Sounds like they inferred they would do insurance fraud (billing it out under a preferred provider covered under your policy).

I would certainly ask for itemized statements of what was done to you, what you paid out and compare that with your credit card or check copies/bank statements. Talk to your insurance company and see if there is anything they can do, but might not be?

I would also find another dentist office, who is a preferred provider under your policy (look online once you know some places, look for personal review sites). Perhaps even consider a report to whoever a governing body is that can sanction or investigate the office for such deceptive practices?

All of this stuff is confusing at best to all of us...certainly to me! I know I rely on my medical, dental and eye clinics to best advise me on doing things all on the up and up and legal for my reimbursement account (federal tax junk) and insurance needs as best they can. But to outright suggest or SAY they will do it fraudulently, like this is very normal...then flip on it as well. ALL of it is shady and suspect.

Best of luck.

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C.O.

answers from Washington DC on

To me this sounds like insurance fraud. There is NO WAY one provider can bill under another provider. That would have given me red flags...

did you get the name and number of the W. who told you this? Did you document this conversation or have anything in writing from her?

if not. The onus is on you and you will be responsible for out of pocket expenses for going to an out of network doctor. I'm truly sorry this happened. I would talk to the dentist IN PERSON as well as the billing department W. and have them work with you on payments, etc. I would also consider reporting her for insurance fraud and tell the doctor you plan on doing so. The fear of reporting incidents will most likely spur them into action for you.

In the future. Only use NETWORK providers. If someone tells you they will work with you - and what they will do for you - GET IT IN WRITING AND SIGNED BY THEM!!! Then you will have your proof!!

GOOD LUCK!!

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R.J.

answers from Seattle on

Like Sue said... this is really common in healthcare, esp when individuals are working on becoming a single entity/taxcode/group OR there's a new doc and the paperwork hasn't gone through, yet. On the opposite end, insurance companies are so used to this that they often just look at the office instead of individual practitioners.

I've billed insurance, and goofs on codes or data entry are VERY common (Ummm... I didn't have my arm amputated). Insurance coders are literally just imputing strings of near random numbers hundreds of times in an hour (fortunately I was just the subber when our billing person was out, I'd go starkers). Just go in and talk with the office billing department and see if they will rebill for you.

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K.M.

answers from Chicago on

I am sorry, but you agreed to have work done by Dr. Smith to be billed under Dr. Jones? In what world is that acceptable? Now you are upset that they decived you when you were planning on deciving the insurance company? Sorry, but I think this is Karma telling you your choice was not the best and I would also go with a different dentist from now moving forward.

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C.J.

answers from Dallas on

I am dittoing all the responses about insurance fraud. The second they said that - Red Flag!
Regardless, you could talk to the dentists office and find out if they have a discount for "cash" customers and pay it off. If you need, ask about a payment plan and

Oh, and I'd report them to their licensing or billing organization (ADA??)!

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J.S.

answers from Hartford on

It sounds like you were trying to commit insurance fraud. You SHOULD be billed for the doctor doing the work. Ah, and I see below that others agree with me.

Pay your bill because YOU OWE IT. Then I would hightail my butt out of that office because they sound extremely shady if they would dare to operate that way. I've never, ever heard of this being "standard practice" and in fact if I came across any medical office that did this I would report them for fraud.

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J.H.

answers from San Francisco on

Sorry Mama! I would take my business elsewhere. Tell them before you do and they can keep you as a patient if they are willing to fix this. I recently had an issue with my dentist office... they billed me more than they quoted but they resolved it partly because of another mishap. I showed up and a different dentist started working on me (I let it go because I am not that particular) but she was awful... the appointment culminated with her dropping a bur (sp?) down my throat. But back to your post, try to resolve it. I needed a couple days to cool off. If they don't adjust your bill, write them some bad reviews about a wrong quote and inability to work with you. Good luck!

Love Sue H.'s answer!

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D.N.

answers from Chicago on

Okay, I won't say anything about insurance fraud since everyone else has. I wil lsay though that it sounds like the office is also double dipping. There is an approved amount. Is that the agreed amount that the insurance has with the dental office? My dental insurance has agreements with the dental offices for what they will pay for and the amount to be charged for services. I have a co-pay percentage. If the charge for the service is $180, my co-pay is 10% and the agreed amount for insurance is $120, I so not have to pay the difference. I was told my co-pay once and when I got the EOB, Igot a refund from the dental office. I have had bills from my husband;s doctor about $$ due. The insurance paid the agree amount. We ahd already reached our out of pocket (busy year) so should not have had to pay anything. The hospital tried to make me pay the difference. They even threatened to send to collections. I would look into this issue. It may be possible you do not owe for the difference between the agreed amounts and the paid amount.
Also, demand an account record for the amounts you have paid and how it was billed.

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