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Discussion Starter · #1 ·
well, i'll try and make a long story short.

Dentist office wanted to take my wizdom teeth. I've had issues with their billing before (they tell you one price and have you pay that at checkout but always send a bill for a little more a month later, saying your insurance didn't pay us what they said they would).

due to previous issues, i asked for a pre-authorization to be done so i knew exactly what i would pay with them or if i should wait to have it done. They told me they did a pre-authorization and i'd owe $200, so, i decided to have the teeth pulled.

fast forward 4 months, and i get an additional bill for 500 more.....

Long story short, the dental office never actually did a pre-authorization, but lied to me and told me they did. since they didn't do a pre-authorization, and were out of network (only dentist in area that was good with the kids), they just assumed that our insurance would pay everything (or the percentages listed for in-network coverage) they billed. they blamed the second bill on "my insurance company not paying them as much as they said they would"

now, i disputed this bill, saying that i provided falsified information by the dentist. basically, the dentist has told me to pound sand, they arn't budging on the bill, and say that the person who said they did the pre-authorization doesn't work there anymore. Now, they are threatening to add $250 to my bill and send me to collections.

This feels like i was frauded into getting the procedure done when they lied to me and provided falsified info and now they are trying to extort the money out of me by threatening to increase my bill by 50% and send me to collections.

am i incorrect in feeling wronged?

any thoughts on how to report them or courses of action? i've looked into reporting them to the BBB or filing a fraud complaint with the dental licensing board as well as the department of health but so far come up with "we don't deal with billing issues"...

anyone have any ideas? i feel like i'm getting the shaft and theres nothing i can do...
 

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I had a dentist pull that on me...I was a cash customer!!! I previously had a $100 credit had some teeth pulled WAS told $700 for the work Paid them $600. He sent the other $100 to collections.. I sent him a letter demanding he take care of the collections within 30 days OR I would see him in small claims court !!!! dispute settled !!! IF you have any paper work ??
 

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The media is your friend. Tell the doctor you'd be happy to take your case to the local news paper and TV news.

As far as I know the BBB is like a club, not something that actually does any regulation; businesses don't even have to join the BBB or be accredited.
 

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The first thing you should do is review the claim with your insurance company. You should have received an EOB (explanation of benefits) from your insurance company. This will detail the billed amount, negotiated network discount, the amount the insurance paid, and the amount you owe. Legally, you do not owe a dime more than what is listed on your EOB. If the dentist was out of network, then you will definitely owe more out of pocket. If you still think that you were billed fraudulently, then you should contact the state licensing board that licenses dentists in your state.
 

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Discussion Starter · #6 ·
The claim was reviewed with the insurance company. the insureance company paid as they should have. the issues is that the dentist lied to me, telling me they filed a pre-authorization when they actually didn't. they told me i would only owe $200 out of pocket so i had it done there as opposed to finding an oral surgeon or something that was in netwrok.

the issue is, that the dentist billed about double the amount authorized by insurance (they are out of network, so, understandably, they can bill what they want to). my issue is, had they actually done the pre-authorization, i would have actualy known what they were billing and what was covered. since they didn't actually do the pre-authorization, but lied to me and told me they did, they just assumed the insurance was going to cover all that they billed, when, in fact, it only covered about half.

had they not lied and actually done the pre-authorization, i would have known this, not gotten a bill for $600 4 months after the proceedure.

ever since then, all the dentist says, is that this is all my insurance companies fault because they didn't pay what they said they would so because my insurance company lied to the dentist, i owe them money. i've verified call in dates with my insurance company and the dentist definately never called my insurance.

when i asked for a copy of the pre-authorization after we got that 600 bill, they gave me some sheet they filled out 15 months prior to the procedure when we first started going there, some generic coverage sheet. when i called them out on that not being a pre-authorization, they said they gave me the wrong thing, then sent me what they said was actually the correct authorization they got from my insurance company. what they gave me this second time was actually the 15 month old initial paperwork for my wife.....

and if i don't pay it becasue i have issues with how this happened, they say that they will add 50% to my bill and send me to collections....

just seems wrong and i'm trying to find some way to dispute this as this doesn't seem right that they can lie to me about the pre-authorization after i expressed concern about cost and the fact that i have issues with their bills every time we have something done, i wanted to know for sure exactly this time, then they lie about doing what i ask, tell me a really low figure, i have the proceedure, and then they come after me for more than double what i already paid....

i understand the words i have used are serious. however, i do not know a better term when someone provides knowingly false and inaccurate/missleading information to another individual to get them to make a financial decision and elect to pay for a service under false pre-tense.

Then, when called out on the false information and the use of that false information, to force me to pay additional money based on the false information, and if i dont pay, a THREAT that they will increase my amount they say i owe by 50% and send me to collections and report it to the credit companies

also, when i questioned their actions, i was told that i should be lucky they even took my insurance and could just stick me with the full bill and that if i didn't like it, then i wasn't welcome there nor was any of my family and we needed to find a new dentist...
 

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A guy on a scruffy bike
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I don't know if there is anything like this for dentists, but in most states, for many fields (e.g. auto repair) if the provider gives you an estimate, he is legally bound to charge equal to or less than that, unless he has specific permission from the customer to exceed it (e.g. more work is found to be needed, and the provider calls *before* doing the extra work for permission to proceed).

If there is something like that in your state that could apply to him, that's your best bet for not paying. If not, then you're likely stuck with it, and you either pay it, or refuse and resign yourself to the calls from creditors and the hit to your credit rating.

Either way, don't go to that dentist ever again, and advise others the same.

PhilB
 

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It all depends on how much you're willing to fight over this amount of money. Document everything. Send them a letter, with a delivery receipt, requesting the copy of the pre-authorization. Save whatever the dentist sends you. Get a letter from your insurance company stating that the dentist never requested a pre-authorization.

Keep careful records of your phone calls (date, time, who you spoke with) and follow them up with confirmation letters (get delivery receipts).

Then tell the dentist what he can do with his bill.

When they turn your account over to a collection agent, provide the agent with copies of the phone records and letters and mail delivery receipts and tell the agent in writing (again, delivery receipt requested) that you are disputing the legitimacy of the charges. If you are reported to credit agencies for a deliquency (start requesting credit reports), provide the credit agencies with your side of it, again with copies of all documentation.

When all this happens, contact the department of professional regulation in your state, provide them with copies of all documentation, and initiate a formal complaint. Also contact your state attorney's office and ask them to investigate the dentist for fraudulent billing.

Did you pay by cash, check, or credit card? If cash or check, there's not much you can do now. If credit card, call the credit card company and see if there's anything they can do to help (might not be, but if they call the dentist the dentist will know you're going to fight this).

In the future, pay by check and in the "memo" space write something like "Payment in full for services this date" or similar. If they accept and cash that check (and most office clerks won't pay any attention to it) you're done - point to that cashed check as evidence of full payment.

If this doesn't make it go away and they've damaged your credit rating, lawyer up. If you have a buddy who's a lawyer, you might get him to send a letter for you (as always, get a delivery receipt). Sometimes the appearance of a lawyer on the scene will persuade them to back off, or offer to settle the matter for a lesser amount.

If you can't swing a lawyer, there's always the option of carrying a picket sign up and down the sidewalk in front of his business. "Dr. Dipschitz mischarges!" or the like. If he's made a habit of this sort of BS, you might have a few other patients join you.

If you're creative and talented, you might try making a youtube video. It worked for the guy who had a guitar destroyed by United Airlines (google David Carroll, airline, guitar).

Your objective at this point is to become such a jerk, and put so much hassle into the dentist's life, that it's simpler for him to drop the bill and hope you'll just go away.

It all comes down to just how far you're willing to go over a few hundred bucks.
 

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Discussion Starter · #9 ·
at this point, its not as much about the money, i can swing the remaining balance, its more about the principle of the matter and the dishonesty i feel they have.

a google search of their name also brings up a slew of customers who have had the same issues, but not for as much $$ as me, though, exact same situation, told one price, pay a second price on checkout and get a bill a month or two later for an additional amount because their insurance "didn't pay as much as they said they would".....just bs....
 

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So contact several of his other PO'd patients from the postings you've seen and as a group contact the state attorney's office with a complaint. With a dozen or so people complaining, they'll probably at least make an initial investigation. Also contact the newspaper and local TV news; they're always looking for stories like this.

Your objective is to be such a PITA that he'll make you happy just to make you go away.
 

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good advice by all but... you know the history of this place and still go there anyway? I know you said they were the only ones who were good with the kids. I think I would find one in network and tell the kids to man up. Going to the dentist was not my favorite thing as a kid but I survived.
 

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It's mind baffling that healthcare is so damned expensive in the US. I mean, yes, some things get ridiculously expensive here too, but FFS, extractions are simple procedures.
 

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Typically good doctors do not come cheap, cheap doctors do not come good. I would prefer going to a state of the art sterile facility not an old shack with flies and unwashed "medical tools" and a guy with a scar across his face telling me "this is going to hurt" and someone behind me with a hammer aka anesthesia lol.

Some countries have a 1 or 2 week "training" period for their "surgeons" and others require years and years plus ongoing education.

The healthcare system in the US is out of control, you know something is screwed up when the same medicine across the border in Mexico is $2.00 without insurance and is $2000 in the US. Also, isn't it great that welfare bums get 100% free healthcare while people that work their assess off all their lives are lucky to get 80% coverage for $800 a month or more. Got to love scumbag politicians.
 

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Discussion Starter · #15 ·
I didn't know the history until after we we started going. we asked a few times why we would get a second bill a few month or so after a service for an additional $20 or so. they always chalked it up to our insurance not paying them what they said they would.

bad on my part, i never really looked into it at the time because it was only $20 and the dentist was good with the kids (daughter has aspergers, so, finding someone she'll work with and will work with her is a challenge). however, knowing the "extra" bill issue, i specifically asked for a pre-authorization to avoid this for such a big procedure.

it wasn't until after the issues arose after this billing issue that we looked up some other reviews and found others had had the same issues we did, but, by this time, it was to late...
 

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I would just pay it and never go back, it is not worth the stress and headache. be sure to let all your friends and family know on facebook, etc. where it will get spread around like wildfire with the people in your area.
 

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A long time ago I remember reading some advice on exactly this situation. The advice is to do the pre-authorization yourself: ask the doctor for the "code" of the procedure he/she is going to perform, then call your insurance company to verify coverage. The reason is simple: assistants make mistakes; when that happens, you are still on the hook for the bill.

I know it doesn't help you with the current situation, but hopefully you can avoid this type of situation in the future.
 

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The media is your friend. Tell the doctor you'd be happy to take your case to the local news paper and TV news.

As far as I know the BBB is like a club, not something that actually does any regulation; businesses don't even have to join the BBB or be accredited.
and all the office has to do to get rid of your complaint is pay the bbb to remove it.
that's how the bbb makes it's money. they're a b***** scam than the places people file complaints about
 

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Preauthorization doesn't guarantee payment. Ask your insurance, they will you this


How the doctor codes things is critical for getting things paid. If things are coded wrong, the insurance claim gets rejected

We've had this happen many many many times, just work through it
 

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This dude supposedly didn't trust the dentist to begin with, knew he was out of network, and is now surprised by a $700 bill for Wisdom Teeth extraction.

First of all, $700 would probably be a normal copay for wisdom teeth pulled from an IN NETWORK dentist.

Second, if I didn't trust a dentist to begin with... I wouldn't trust them with preauthorization, and I certainly wouldn't trust them with my surgery.

Third, how hard is it to call YOUR insurance and ask THEM yourself about cost and payment? If you were SO concerned, you certainly weren't prudent.

Seems like you knew their history, knew they were out of network, and now you want to complain because you were too lazy to pick up the phone and do your own research.
 
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