Insurance company overpaid dentist, dentist said, "No they didn't."

[Anonymous]

Anonymous wrote:are you in MD? contact maryland insurance administration.

Or the attorney general. File a complaint.

[Anonymous]

Such an easy to resolve this dispute. Tell the dentist to either: 1) pay back the insurance company what they overpaid or 2) he will get a visit from members of MS-13 if does not do the first option .... LOL....

[Anonymous]

BBB post a review there

[Anonymous]

Anonymous wrote:Dentist mistakenly billed my insurance in the beginning of Oct. '17 for someone else's procedure. I emailed the dental office and told them they've billed incorrectly and they called to tell me they put in my insurance info by mistake instead of the other person's. They said they'd correct it. 5 months later I'm getting a letter from the insurance company that they overpaid on my insurance and the dentist is not restoring that payment to them. The consequences of that fall on me -- they'll withhold payment on any procedures I have done until the bill is paid.

I have proof that they billed insurance incorrectly, proof that my insurance company paid them by mistake, but now what? Do I have to sue the dentist? It's only $500, but I shouldn't have to pay that when the dentist owes it back to the insurance company. Anyone have experience with this?

But, maybe what they mean by this is that they'll withhold payment to the dentist up until the $500 mark (or whatever the amount is he owes back to them) because they consider that already paid (erroneously of course). It may not mean that the dentist will charge you. Dentist may be on board with just doing the payback this way.

I.e. they overpaid dentist by $500. You go in and rack up $120 in charges for cleaning, xrays, whatever. Dentist files a claim with your insurance, insurance says "okay, we'll subtract the $120 from the $500, now your total owed is $380." This continues until the full $500 credit is used and then everything returns to normal. Think of it as your dentist being pre-paid $500 for future services and he'll use up that credit first before billing you anything further.

[Anonymous]

Anonymous wrote:Send a letter in writing. Personally I would send it certified.

Document the situation including the date of the erroneous procedure. Include a copy of the EOB that was sent to you by the insurance company. Explain that the insurance company is withholding benefits from you due to his clerical error and that you need it to be remedied immediately. If it is not remedied by X date, you will file a claim in small claims court for the amount that you need to reimburse the dentist, any premiums that you are paying for the period from when you were notified benefits were suspended until resolution (since you are paying for a service you are not being provided and it was caused by his accounting error). Additionally, should you require any additional dental work in the interim and have to pay full price for it, you will also require him to fully reimburse you for all dental work that was supposed to be covered by your insurance but is not due to the suspension. You will also charge for your hourly time lost in trying to resolve the situation including any time that will need to be taken off work to attend court proceedings. Additionally, you will contact the police to report a case of insurance fraud.

People and businesses often try to bully customers in situations like this because they think you are powerless to change anything to do anything to them. However, with the documentation that you have, it is clear that any court would rule in your favor. He has the option to pay the insurance company (or you) back for the money he has fraudulently taken or get himself into a whole lot of bigger problems including a lot more money, a potential criminal charge and the potential loss of ability to practice.

+1

And what are the names of the sketchbag dentist and insurance company?

[Anonymous]

Anonymous wrote:BBB post a review there

Are you 90?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Dentist mistakenly billed my insurance in the beginning of Oct. '17 for someone else's procedure. I emailed the dental office and told them they've billed incorrectly and they called to tell me they put in my insurance info by mistake instead of the other person's. They said they'd correct it. 5 months later I'm getting a letter from the insurance company that they overpaid on my insurance and the dentist is not restoring that payment to them. The consequences of that fall on me -- they'll withhold payment on any procedures I have done until the bill is paid.

I have proof that they billed insurance incorrectly, proof that my insurance company paid them by mistake, but now what? Do I have to sue the dentist? It's only $500, but I shouldn't have to pay that when the dentist owes it back to the insurance company. Anyone have experience with this?

But, maybe what they mean by this is that they'll withhold payment to the dentist up until the $500 mark (or whatever the amount is he owes back to them) because they consider that already paid (erroneously of course). It may not mean that the dentist will charge you. Dentist may be on board with just doing the payback this way.

I.e. they overpaid dentist by $500. You go in and rack up $120 in charges for cleaning, xrays, whatever. Dentist files a claim with your insurance, insurance says "okay, we'll subtract the $120 from the $500, now your total owed is $380." This continues until the full $500 credit is used and then everything returns to normal. Think of it as your dentist being pre-paid $500 for future services and he'll use up that credit first before billing you anything further.

NP here and that's what I assumed would happen as well. Sounds like an issue between the dentist and the insurance company.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Dentist mistakenly billed my insurance in the beginning of Oct. '17 for someone else's procedure. I emailed the dental office and told them they've billed incorrectly and they called to tell me they put in my insurance info by mistake instead of the other person's. They said they'd correct it. 5 months later I'm getting a letter from the insurance company that they overpaid on my insurance and the dentist is not restoring that payment to them. The consequences of that fall on me -- they'll withhold payment on any procedures I have done until the bill is paid.

I have proof that they billed insurance incorrectly, proof that my insurance company paid them by mistake, but now what? Do I have to sue the dentist? It's only $500, but I shouldn't have to pay that when the dentist owes it back to the insurance company. Anyone have experience with this?

But, maybe what they mean by this is that they'll withhold payment to the dentist up until the $500 mark (or whatever the amount is he owes back to them) because they consider that already paid (erroneously of course). It may not mean that the dentist will charge you. Dentist may be on board with just doing the payback this way.

I.e. they overpaid dentist by $500. You go in and rack up $120 in charges for cleaning, xrays, whatever. Dentist files a claim with your insurance, insurance says "okay, we'll subtract the $120 from the $500, now your total owed is $380." This continues until the full $500 credit is used and then everything returns to normal. Think of it as your dentist being pre-paid $500 for future services and he'll use up that credit first before billing you anything further.

NP here and that's what I assumed would happen as well. Sounds like an issue between the dentist and the insurance company.

Can you two not read?

He/she already said the insurance company said they're not paying for any of OP's procedures until this this resolved, and that this applies to any dentists in the future.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Dentist mistakenly billed my insurance in the beginning of Oct. '17 for someone else's procedure. I emailed the dental office and told them they've billed incorrectly and they called to tell me they put in my insurance info by mistake instead of the other person's. They said they'd correct it. 5 months later I'm getting a letter from the insurance company that they overpaid on my insurance and the dentist is not restoring that payment to them. The consequences of that fall on me -- they'll withhold payment on any procedures I have done until the bill is paid.

I have proof that they billed insurance incorrectly, proof that my insurance company paid them by mistake, but now what? Do I have to sue the dentist? It's only $500, but I shouldn't have to pay that when the dentist owes it back to the insurance company. Anyone have experience with this?

But, maybe what they mean by this is that they'll withhold payment to the dentist up until the $500 mark (or whatever the amount is he owes back to them) because they consider that already paid (erroneously of course). It may not mean that the dentist will charge you. Dentist may be on board with just doing the payback this way.

I.e. they overpaid dentist by $500. You go in and rack up $120 in charges for cleaning, xrays, whatever. Dentist files a claim with your insurance, insurance says "okay, we'll subtract the $120 from the $500, now your total owed is $380." This continues until the full $500 credit is used and then everything returns to normal. Think of it as your dentist being pre-paid $500 for future services and he'll use up that credit first before billing you anything further.

NP here and that's what I assumed would happen as well. Sounds like an issue between the dentist and the insurance company.

Can you two not read?

He/she already said the insurance company said they're not paying for any of OP's procedures until this this resolved, and that this applies to any dentists in the future.

No, I can't read. You caught me.

Of COURSE the insurance company wouldn't pay for future procedures if he/she moves to another dentist because they would not, at that point, have recouped their money from this one. So the OP needs to stay with this dentist until those charges are cleared (by way of subtracting future work from the current excess money paid).

I think it would be worth the OP's time to contact insurance again and ask for clarification on their intent not to pay any more claims. OP needs to find out if this means the ONLY recourse is for the dentist to pony up the cash or if their threat of "not paying any more claims" means that all future claims will count toward the overpayment (with OP NOT being charged instead) until that overpayment is cleared.

[Anonymous]

I don’t get it. Does the dentist say they’ll fix it and then just not do it, or are they saying they don’t have to/won’t do it? I agree with the PPs advice involving a certified letter. At that point, being on notice and not fixing the problem, they’re fraudsters and crooks. It would be helpful if you shared the dentist’s name at some point, if they continue to drag their feet. Most of us don’t need the hassle, and a shady dentist makes me wonder where else they’re shady (ex. selling me on procedures I don’t actually need).

[Anonymous]

Dentists are almost always crooks. It's just part of life.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Dentist mistakenly billed my insurance in the beginning of Oct. '17 for someone else's procedure. I emailed the dental office and told them they've billed incorrectly and they called to tell me they put in my insurance info by mistake instead of the other person's. They said they'd correct it. 5 months later I'm getting a letter from the insurance company that they overpaid on my insurance and the dentist is not restoring that payment to them. The consequences of that fall on me -- they'll withhold payment on any procedures I have done until the bill is paid.

I have proof that they billed insurance incorrectly, proof that my insurance company paid them by mistake, but now what? Do I have to sue the dentist? It's only $500, but I shouldn't have to pay that when the dentist owes it back to the insurance company. Anyone have experience with this?

But, maybe what they mean by this is that they'll withhold payment to the dentist up until the $500 mark (or whatever the amount is he owes back to them) because they consider that already paid (erroneously of course). It may not mean that the dentist will charge you. Dentist may be on board with just doing the payback this way.

I.e. they overpaid dentist by $500. You go in and rack up $120 in charges for cleaning, xrays, whatever. Dentist files a claim with your insurance, insurance says "okay, we'll subtract the $120 from the $500, now your total owed is $380." This continues until the full $500 credit is used and then everything returns to normal. Think of it as your dentist being pre-paid $500 for future services and he'll use up that credit first before billing you anything further.

NP here and that's what I assumed would happen as well. Sounds like an issue between the dentist and the insurance company.

Can you two not read?

He/she already said the insurance company said they're not paying for any of OP's procedures until this this resolved, and that this applies to any dentists in the future.

No, I can't read. You caught me.

Of COURSE the insurance company wouldn't pay for future procedures if he/she moves to another dentist because they would not, at that point, have recouped their money from this one. So the OP needs to stay with this dentist until those charges are cleared (by way of subtracting future work from the current excess money paid).

I think it would be worth the OP's time to contact insurance again and ask for clarification on their intent not to pay any more claims. OP needs to find out if this means the ONLY recourse is for the dentist to pony up the cash or if their threat of "not paying any more claims" means that all future claims will count toward the overpayment (with OP NOT being charged instead) until that overpayment is cleared.

No, you clearly cannot read. Maybe because you're too busy rolling your eyes, but that doesn't explain the slow.

Because you clearly missed all the parts where it's already been covered that the insuarance company is not paying anymore claims until the charge is recouped. The insurance company will "withhold payment." Not "apply the current costs they paid toward future claims by dentist." They are not paying any more claims and they told op it's his/her problem. Does that sound like "we're taking it out of future claims by this dentist?" Maybe just to you.

[Anonymous]

Anonymous wrote:Dentist mistakenly billed my insurance in the beginning of Oct. '17 for someone else's procedure. I emailed the dental office and told them they've billed incorrectly and they called to tell me they put in my insurance info by mistake instead of the other person's. They said they'd correct it. 5 months later I'm getting a letter from the insurance company that they overpaid on my insurance and the dentist is not restoring that payment to them. The consequences of that fall on me -- they'll withhold payment on any procedures I have done until the bill is paid.

I have proof that they billed insurance incorrectly, proof that my insurance company paid them by mistake, but now what? Do I have to sue the dentist? It's only $500, but I shouldn't have to pay that when the dentist owes it back to the insurance company. Anyone have experience with this?

This isn't your problem, the insurance company should contact the dentist.

[Anonymous]

Can you get the insurance company on the phone, then have them conference in the dental office. They can speak directly with you on the phone. I have had good luck with getting a lingering billing issue resolved this way.

[Anonymous]

I would skip all the niceties crap and let the dentist know you'll be reporting them to the appropriate authorities for insurance fraud unless they get this worked out with the insurance company in the next 30 days.