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Linda S | Help!! Caught in a 3-way with my dentist, finance company, and insurer!? |
This is very complicated. Can anyone help? I was informed by my dentist that I needed 4 bridges and that my insurance would not pay for it. So he had the financing coordinator come in and she filled out a financing form for me and got me financing during the visit. the bill was $7,500 which was paid by an outside financing company. well come to find out my insurer does cover the procedure. But the dentist office is refusing to help (since they have already been paid) even when contacted by my insurer. And I am having to pay for this unessesary financing which I can't afford. Anyone have advice or information that could help I am only 22 and I feel like I have been taken advantage of!
Additional Details
Hot Legs:
yes, I spoke with the financial coordinator three different times, even brought in my schedule of benefits and pointed out the exact number and description that matched the number for the needed procedure! But the lady kept telling me the same thing that no hmo or ppo covered bridges, EVER! So I felt like I had no choice You know, I thought "why can't lie about that kind of thing"! |
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Over The Rainbow
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Sounds to me that your dentist told you that your insurance company would not pay for this reason: When an insurance company pays, it is the insurance company that decides the price based on their own research of usual and approved charges for the procedure. The dentist probably wanted his full fee at his chosen price so he steered you toward the finance option. So that way he got paid immediately and at his chosen price.
Now what I want to know is, did you ask the dentist office to check with your insurance and were you told by the staff there that your insurance would not cover it? If that is the case then you have been a victim of fraud.
I would send them a certified letter that you are now aware that you are covered and you want their help in resolving the situation. Don't use the word fraud or acuse or be nasty for now becasue you want to give everyone involved a chance to resolve with dignity.
They may respond better since you are sending a certified letter and asking for a written response. Tell them you want a reply in writing.This also alerts them that you are not going to go away and that you are serious about collecting legal data in writing. (without actually saying this in the first letter).
If you do not get anywhere with them then, write one more time to let them know you are contacting the Better Business Bureau. Very important...get your work completely done before you tell them about the the BBB. Go to BBB.org online. |
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Suzanne: YPA
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If the dentist is a participating provider with your insurer, then it's up to the dentist to file the claim -- the insurer would just issue payment to the dentist anyway (they have to according to their contract with the dentist), so it won't help if you file the claim yourself. If the dentist is participating and refuses to file the claim, you should send your insurer a written complaint asking them to enforce their contract with this dentist.
However, if the dentist is non-participating, you'll have to complete the form. You will need codes from the dentist, though, that tells the insurer what was done. Once you receive payment, send it to the financing company. The balance is yours to pay via the agreement you set up prior to treatment.
Either way, I suggest you contact your state's Consumer Protection Division and request its assistance. If this dentist is participating and uses a dishonest technique so he or she will get full price via financing (instead of the reduced price paid by your insurer), then the CPD should be able to do something about it. Your state's insurance commissioner's office can provide some assistance in dealing with your insurer, but will have no authority over the business practices of your dentist. |
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fitzovich
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I would work with both the dentist and the insurance. It might be nice to remind the dentist's office that the possibility of a complaint to a licensing board is always possible, so they can either help you resolve this issue or they can spend an equal amount of time explaining the situation to their State Board. Do not pay anyone anything immediately and you may need to seek legal advice.
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mbrcatz
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This isn't hard. YOU just fill out the claim forms yourself, and submit them to the dental insurance company yourself. Then when you get the money, you send it off to the finance company.
This isn't really a three way - it's three different deals. You have one deal with the dentist, which is closed. You have one deal with the finance company, which is ongoing until you pay them off. Then you have a third deal with the insurance company, which you haven't started yet. |
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Sadie C
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First of all drop your insurance. Don't have insurance, its not worth it. The don't pay for anyting! Second of all, drop your dentist! It shouldn't cost 7500 for 4 bridges. I have never heard of such a thing. Go to Sears Dental, I know they are no where near that price |
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DTB
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Yup, you're boned. |
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