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

[Anonymous]

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?

[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?

Just to clarify- the insurance company says they will not pay any more claims for you until the dentist pays them back?
I would ask the insurance company for a copy of your policy documents and where it is stated that they can do this. It should be on the insurance company to fight with the dentist, not you. They can threaten to drop him as an in network provider which will likely hurt his business as patients go elsewhere.

[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?

Just to clarify- the insurance company says they will not pay any more claims for you until the dentist pays them back?
I would ask the insurance company for a copy of your policy documents and where it is stated that they can do this. It should be on the insurance company to fight with the dentist, not you. They can threaten to drop him as an in network provider which will likely hurt his business as patients go elsewhere.

Yes, the insurance company said that by law they can withhold payments for future procedures until the money is paid back.

[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?

Just to clarify- the insurance company says they will not pay any more claims for you until the dentist pays them back?
I would ask the insurance company for a copy of your policy documents and where it is stated that they can do this. It should be on the insurance company to fight with the dentist, not you. They can threaten to drop him as an in network provider which will likely hurt his business as patients go elsewhere.

Yes, the insurance company said that by law they can withhold payments for future procedures until the money is paid back.

Probably so but only against this dentist as an offset of what they are owed. They should have no recourse against you and if you go to a new dentist this should not impact your coverage.

[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?

Just to clarify- the insurance company says they will not pay any more claims for you until the dentist pays them back?
I would ask the insurance company for a copy of your policy documents and where it is stated that they can do this. It should be on the insurance company to fight with the dentist, not you. They can threaten to drop him as an in network provider which will likely hurt his business as patients go elsewhere.

Yes, the insurance company said that by law they can withhold payments for future procedures until the money is paid back.

Probably so but only against this dentist as an offset of what they are owed. They should have no recourse against you and if you go to a new dentist this should not impact your coverage.

They said the penalty will follow me to whichever dentist I choose. Every time a claim is submitting, they will withhold the benefit.

[Anonymous]

Contact the dentist again and remind them of the problem and that it hasn’t been resolved.

If that fails to get results, contact any local TV station’s consumer helpline. NBC recently did a case that involved a dentist in Va.
https://www.nbcwashington.com/news/local/NBC4-Responds-Consumer-Complaint-Issue-Report-Susan-Hogan-378873701.html

[Anonymous]

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.

[Anonymous]

are you in MD? contact maryland insurance administration.

[Anonymous]

Anonymous wrote:Contact the dentist again and remind them of the problem and that it hasn’t been resolved.

If that fails to get results, contact any local TV station’s consumer helpline. NBC recently did a case that involved a dentist in Va.
https://www.nbcwashington.com/news/local/NBC4-Responds-Consumer-Complaint-Issue-Report-Susan-Hogan-378873701.html

Thanks for this.

[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.

You're hired!

Thank you!

[Anonymous]

Tell the dentist that if you are not reimbursed within one month, in addition to the small claims suit, you plan to leave reviews explaining this situation on Yelp, Google, and other web sites.

[Anonymous]

I'm surprised your insurance company can't just recoup the fees from him from the next in-network claim he submits. That part doesn't make any sense to me. It sounds like he was erroneously paid so I don't see why the insurance company can't simply withhold payment from his next claim.

[Anonymous]

Is this insurance through an employer? I'd involve HR and hopefully, you have a broker representing your firm.

[Anonymous]

where do you live? Send copies of any correspondence to your state’s insurance commissioner (and make sure the dentist’s office knows you are reporting it to the commissioner.)

[Anonymous]

Anonymous wrote:where do you live? Send copies of any correspondence to your state’s insurance commissioner (and make sure the dentist’s office knows you are reporting it to the commissioner.)

"I understand this is frustrating for your department, but the billing is not a patient issue -- that is between you and the dentist. I don't want to have to involve the insurance commissioner or go through small claims court, but you are leaving me no other option. Can't you get it settled between the two parties involved without affecting our dental care, or do we really have to take that next step?"