Ripped Off by a.... DENTIST! What should I do?

[Rockasilly]

I hope somebody may have some experience in a situation like this and might have some ideas as to what to do.
I got stuck needing some dental care recently so I check with my insurance company and go to someone that was listed as one of their in network providers. The dentist office goes to verify my insurance prior to my appointment and the first insurance idiot on the verification line couldn't find me but I did get them back on a call with a different insurance representative to verify that I am indeed in network... Despite this the lady doing the biling insists that I will have to be billed/treated as OUT of network(I pay 100% upfront) and they would submit a claim and that I would get a check directly from the insurance company. BAD DECISION

I pay the 1088.00 on my credit card up front for a couple of pulp caps and a few weeks pass so I check on the claim to see it was processed as IN NETWORK and the claim check would be only $450.00!?!? To complicate my disappointment the check was not going directly to me like the billing lady at the dentist office claimed but back to the dentist office. The insurance company is kinda jammed at this point as I am thinking I need to file an appeal and a grievance but they are looking at it as I SHOULD have NEVER been charged in the first place by an in network dentist. A general agent claims rep called the office to explain that they should refund my money but the billing lady gave her a claim of "Yes we accept your insurance companies plans, but not this one!" After the insurance company gets ahold of the dentist office the billing lady at the office calls me irritated and blaming me saying hey this is what we agreed on, we just dont accept your insurance plan etc,... I explain to her hey I am stuck in the middle here, you swear you are out of network but the reps say you are in network and the claims process as in network so I am stuck to accept a check at your agreed upon rates and have to wait for you to get it so you can write me a check? She wouldn't budge though as she wasn't going to refund me a dollar. I had a couple of other calls with customer insurance reps throughout the day and they tried calling the dental office to better explain as they were from the actual dental claims department itself and the billing lady wouldn't take their call at all. Eventually she took the call towards the end of the day and an agent read her the riot act stating they were very much IN NETWORK and they should refund my money. The billing lady said she would have to talk to the dentist and will decide what to do.

What should I do? Should I initiate a chargeback NOW or should I wait for this billing lady to decide what she wants to do with the dentist? Is this legal or simply unethical at best? How do I get this made right? I really need to dig deep and find my inner Todd Witteles because I feel I got screwed and should never have thought this would work out nice and neat.

[limitles]

I hope somebody may have some experience in a situation like this and might have some ideas as to what to do.
I got stuck needing some dental care recently so I check with my insurance company and go to someone that was listed as one of their in network providers. The dentist office goes to verify my insurance prior to my appointment and the first insurance idiot on the verification line couldn't find me but I did get them back on a call with a different insurance representative to verify that I am indeed in network... Despite this the lady doing the biling insists that I will have to be billed/treated as OUT of network(I pay 100% upfront) and they would submit a claim and that I would get a check directly from the insurance company. BAD DECISION

I pay the 1088.00 on my credit card up front for a couple of pulp caps and a few weeks pass so I check on the claim to see it was processed as IN NETWORK and the claim check would be only $450.00!?!? To complicate my disappointment the check was not going directly to me like the billing lady at the dentist office claimed but back to the dentist office. The insurance company is kinda jammed at this point as I am thinking I need to file an appeal and a grievance but they are looking at it as I SHOULD have NEVER been charged in the first place by an in network dentist. A general agent claims rep called the office to explain that they should refund my money but the billing lady gave her a claim of "Yes we accept your insurance companies plans, but not this one!" After the insurance company gets ahold of the dentist office the billing lady at the office calls me irritated and blaming me saying hey this is what we agreed on, we just dont accept your insurance plan etc,... I explain to her hey I am stuck in the middle here, you swear you are out of network but the reps say you are in network and the claims process as in network so I am stuck to accept a check at your agreed upon rates and have to wait for you to get it so you can write me a check? She wouldn't budge though as she wasn't going to refund me a dollar. I had a couple of other calls with customer insurance reps throughout the day and they tried calling the dental office to better explain as they were from the actual dental claims department itself and the billing lady wouldn't take their call at all. Eventually she took the call towards the end of the day and an agent read her the riot act stating they were very much IN NETWORK and they should refund my money. The billing lady said she would have to talk to the dentist and will decide what to do.

What should I do? Should I initiate a chargeback NOW or should I wait for this billing lady to decide what she wants to do with the dentist? Is this legal or simply unethical at best? How do I get this made right? I really need to dig deep and find my inner Todd Witteles because I feel I got screwed and should never have thought this would work out nice and neat.

Try living in a country that regulates profit based health care.
Land of the free jackals. Don't care, zero sympathy.

Write it off. You live in the freest nation of all times. Enjoy



Buy a pair of flag embossed shorts, that may help.

Fuck you btw and you're wall of sadness

[Dan Druff]

Don't listen to limitles.

Don't just write it off.

The story was complicated, and I had to read it twice to understand it, but here is my take:

First off, the insurance "in network" shit is awful, and often very tough to verify. The problem is that it's impossible to trust anyone. You can't trust what the office tells you, you can't trust what the phone rep for the insurance company tells you, and you can't even trust what the insurance website search tool tells you. Only when the claim is processed do you find out the truth, and by then it's too late.

I have battled with this before. In the 2000s, I needed an MRI on a shoulder injury, was told the facility was in-network, and then I got an out-of-network bill for $3800! When I called the insurance company, they said there was nothing they could do, and the hospital gave me the wrong info. When I called the hospital, I got an obnoxious rep who repeatedly ignored my point and kept repeating, "We can break the $3800 down into $200 payments for you, if that would be easier and you can handle that." Fucking pissed me off. She completely understood I was objecting to a billing error, and thought that the "breaking it into small payments" thing would shut me up, and wouldn't address the issue. Ultimately I just refused to pay, and pressed the insurance company to re-investigate. They did, and laughably found they WERE actually still in-network, and processed it properly. LO fucking L.

More recently, a provider I took Benjamin to was listed as "in network" on the insurance website, but actually wasn't. After filing a grievance (where I showed the info was STILL incorrectly listed), the insurance company agreed to cut a check for the difference. However, I hadn't paid anything yet, so the power was in my hands.

But back to you...



Dentists are different than doctors, in that they often require payment up front, whereas doctors usually don't. This is because dentists get fucked on bills more often than doctors, especially because dental visits are more urgent than doctors visits in many cases. Also, fewer people have dental insurance than medical insurance.

I have had to pay up front (or the same day as the procedure) many times in dentistry, even at places which have known me for years, and should be confident I wouldn't fuck them. Nothing personal to me, just their policy. Whatever.

However, you should NEVER overpay ANY medical or dental office up front, with the expectation that insurance will reimburse you. There are many ways you can get fucked in this situation. I once posted a story here about a situation from 2010 in Las Vegas, where a shady eye doctor forgot to call my insurance in time before closing, and by the time my 4:45pm appointment came, they couldn't verify my insurance was valid, despite my giving them the info 3 days early like they requested. They demanded I pay $150 up front on my credit card, even though the co-pay was $40. I refused. Many shenanigans were possible. I walked out, and my eye got better on its on in the coming days, so it was just as well. (It wasn't an emergency -- just a mild concern at that point.)

When a place says they can't verify in-network status, you should dig your heels in and tell them that this has to be verified one way or another, as you're never supposed to pre-overpay in an in-network place. This is true for both medical and dental. If necessary, reschedule the appointment, go to a different dentist, or (as you eventually did), call the insurance company, ask for a supervisor, and ask for them to compel the dentist to take you at in-network patient rates. Insurance can compel them to do this, due to their contract.

With that said, don't charge back yet. Wait to see how the dentist responds. He might agree to refund your money in the meantime. If he doesn't agree, charge back, but make sure to get something in writing from the insurance company that you're in network, before doing so. Then tell the credit card company that you have this in writing, and offer to send it to them.

If you do charge back, don't ever go to that dentist again. Among other reasons, he could get the money BACK by simply making up fake problems that don't exist, or even by causing them.

Oh, and let's say you charge back, win, get a refund, and the insurance company sends you a check anyway. Just quietly deposit it and keep it. Why? Because you've been put through hell over this matter, which isn't your fault at all. There were errors on both the parts of the dentist and the insurance company. Consider it a payment for your time and stress, and only send the money BACK if they come asking for it.

I once had a customer service matter (not involving doctors/dentists) where a billing fuckup cost me $650. It took about 20 infuriating hours, spread over about 4 months, to resolve this over the phone. Extremely tilting and stressful. When it was done, they accidentally double-credited me the $650. Do you think I called to inform them of this? I think you know the answer.

[Dan Druff]

Also if you charge back, do not write up a story like your post above. They'll never understand it.

Just make it simple.

This was an in-network place. Here is the proof. Dentist unreasonably demanded I pay out-of-network rate up front, which I did. Now they won't refund me, despite verifying with insurance that they are indeed in-network.

[limitles]

I hope somebody may have some experience in a situation like this and might have some ideas as to what to do.
I got stuck needing some dental care recently so I check with my insurance company and go to someone that was listed as one of their in network providers. The dentist office goes to verify my insurance prior to my appointment and the first insurance idiot on the verification line couldn't find me but I did get them back on a call with a different insurance representative to verify that I am indeed in network... Despite this the lady doing the biling insists that I will have to be billed/treated as OUT of network(I pay 100% upfront) and they would submit a claim and that I would get a check directly from the insurance company. BAD DECISION

I pay the 1088.00 on my credit card up front for a couple of pulp caps and a few weeks pass so I check on the claim to see it was processed as IN NETWORK and the claim check would be only $450.00!?!? To complicate my disappointment the check was not going directly to me like the billing lady at the dentist office claimed but back to the dentist office. The insurance company is kinda jammed at this point as I am thinking I need to file an appeal and a grievance but they are looking at it as I SHOULD have NEVER been charged in the first place by an in network dentist. A general agent claims rep called the office to explain that they should refund my money but the billing lady gave her a claim of "Yes we accept your insurance companies plans, but not this one!" After the insurance company gets ahold of the dentist office the billing lady at the office calls me irritated and blaming me saying hey this is what we agreed on, we just dont accept your insurance plan etc,... I explain to her hey I am stuck in the middle here, you swear you are out of network but the reps say you are in network and the claims process as in network so I am stuck to accept a check at your agreed upon rates and have to wait for you to get it so you can write me a check? She wouldn't budge though as she wasn't going to refund me a dollar. I had a couple of other calls with customer insurance reps throughout the day and they tried calling the dental office to better explain as they were from the actual dental claims department itself and the billing lady wouldn't take their call at all. Eventually she took the call towards the end of the day and an agent read her the riot act stating they were very much IN NETWORK and they should refund my money. The billing lady said she would have to talk to the dentist and will decide what to do.

What should I do? Should I initiate a chargeback NOW or should I wait for this billing lady to decide what she wants to do with the dentist? Is this legal or simply unethical at best? How do I get this made right? I really need to dig deep and find my inner Todd Witteles because I feel I got screwed and should never have thought this would work out nice and neat.

Try living in a country that regulates profit based health care.
Land of the free jackals. Don't care, zero sympathy.

Write it off. You live in the freest nation of all times. Enjoy



Buy a pair of flag embossed shorts, that may help.

Fuck you btw and you're wall of sadness

Exactly, you were born into the unreal world of freedom. Revel in this unique life experience.
Also, write about your experience and profit via any medium available.
And wear any flag related clothing available.
lol

How many retarded Americans donning flag related clothing does is take
to realize there are too many morons in this world?

The number of idiots flying the American flag equals the number of idiots in the shit hole of a country known as the U.s/a.

[Entropy]

I can tell you what you should have done, vote for Bernie.
The results are in, for profit healthcare has evolved into an unbelievably massive scam which is now starting to threaten our existence.

For profit HC has brought us such gems as the opiate epidemic and maybe even the pandemic itself. It'll def be the source of future pandemics.