Saturday, November 14, 2009

Can a dental office not submit claims to insurance by choice?

I saw a dentist in 2004. I had dental insurance and provided this information to the dental office. I never heard anything after that but changed dentists due to location.

I get a copy of my credit report last month and see there is a collection for this dentists office. I contact them direct and was told my insurance denied the claim. My coverage was active at the time of service conducted.

I called the insurance carrier and was told the dental office NEVER even submitted the claim to them. So, the dental office is going to submit the claim to the insurance now but says they still can charge me the fee that it cost them to turn it over to the collection agency.

i dont feel this is right because the $38 fee would never had to happen if the dental office had submitted the claim like they were supposed to. I was referred to this dental office by the insurance company's website so I know they accepted the insurance.

Is this a violation of the Fair Credit Reporting Act somehow?

Can a dental office not submit claims to insurance by choice?
Many health care professionals file an insurance form as a courtesy to the patient. However, they are not required to do so. If you were referred by the insurance company website, the dentist had an agreement with that carrier to accept their usual and customary fee. It may or may not have had a requirement to submit the forms for the patient. However, that agreement would be between the provider and the insurance carrier. Your best bet is to contact the insurance company, since their website did the referral. They are more likely to refund the fee than the dentist's office. If you took them to small claims court it would cost you more than you would recover and you would probably spend a fortune trying to get the dental office to pay you. The BBB is really a farce. They take reports, but when you call them to find out about a compnay all they will say is they have or have not received reports about them. The BBB will not disclose what was reported- good or bad. You might try your state insurance commissioner.
Reply:Thanks a bunch! Report It

Reply:If they failed to file the claim then they should take care of the fee. Request they remove the charge. If they dont, call the better business office or consumer affairs and see if they can help. I once had a almost 2 yr old computer repaired (motherboard and power supply both fried) at best buys cost because in Maine there is a 4 year implied warranty. Different situation you are in but I still think you have recourse if the dental company wont help.
Reply:it sure is a violation of SOMETHING---the dental office caused you two very big problems---the biggest one being the bad mark on your CREDIT REPORT which is a HASSLE and a half to get removed----(I had mis-information on MY credit report and it took 4 YEARS to get it wiped off... and the paperwork and phone calls and all was SUCH a pain in the BUTT.... It clearly (by what you report here) was the dental office's fault for not submitting your papers IN THE FIRST PLACE....if they admitted to not submitting them then THEY have to absorb that $38 fee. IF, however, they SAY you never left the papers with them---THAT will be hard for YOU to prove that you DID..... so the barrel tightens....Get them to admit FIRST that you DID give them the insurance stuff when you had the dental work and THEN tell them that they need to take care of that $38 fee and if they disagree with them, tell them you will go see someone from the Attorney Generals office of your state... you can file a claim against the dental office THROUGH the AG and the dental office gets investigated....
Reply:In your situation there is certainly a problem as it seems as though they either forgot to file it or chose not even though apparently they normally do since they are filing it now.

In general though they do have the right to not submit claims to insurance by choice. In my experience there are three choices they might make. 1) they take care of the whole process for you and you do not have to do anything but provide your insurance information 2) you make sure the proper paperwork gets submitted and they await payment from your insurance company (generally in this situation you have to show proof of preapproval from your insurance that they will pay) or 3) you have to pay the bill directly to the dentist and submit all the paperwork to your insurance provider for reimbursment.

They should always tell you which way it is going to be. Based on your details though it sounds like they just dropped the ball.

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