So 1 year ago I went to a dentist, I had insurance coverage at the time, before setting up the appointment I contact the dental office made sure they took my insurance, they said yes. I scheduled the appointment and was seen for cleaning and fix a filling. At the time I did not have my insurance card with me, so the person at the desk who checked me in and dealt with the insurance went to my insurance carriers website, printed off my insurance card for me, kept a copy and gave me a copy. 2 weeks later I received a denial notice from the insurance company stating the office was out of network. (the plan I had only paid in network). Then 2 weeks later I received a bill from the office for over 300.00. I contacted them and told them I refused to pay it as I was told 2 times before setting up the appointment, and when I got there that my insurance was ok. They stated to email them my position and they would have the dentist look at it. I emailed them a week later and heard nothing back. About 1.5 months ago I received a collection notice. I sent them a cease and desist/debt validation letter, advising them that the address they had was invalid and to not send any correspondence there. About a week later they sent a computer printout of a statement. I sent them another C&D and another debt validation along with the email I sent to the dentist office. Today I get a phone call from my friend who resides at that address, and starts yelling at me for getting more mail there. It's now from a law firm that the collection agency has ''retained''. Am I wrong for not feeling I owe this? What do I do... ?? Isn't the CA in violation for not removing the invalid address per my dispute letter/cease and desist? Is the law firm in violation?
Also in the law firm's notice they have the normal, attempt to collect......unless you notify this office.... but then it says while your right to dispute the validty of this debt continues for a full 30 days, I am permitted by federal law to proceed witht he collection efforts, including filing suit against you during this same period or until I receive notice of dispute from you. this may be your last opportunity to resolve this debt prior to suit. is that legal!?
Sounds pretty boiler plate to me. Send them a DV letter. Whether or not you actually owe them will probably have to be settled in court if you haven't been able to come to an agreement. In all likelihood, if you don't have anything in writing saying that says you don't have to pay, but you did sign something that said you do have to pay, you'll probably have to pay.
Did you check with your insurance company prior to your dentist appt to verify they would cover this? I'm assuming not... Be careful here, there are often "liability clauses" in medical forms that state you are liable for any charges the insurance company will not cover. Just do some homework, and perhaps go back at the dental insurance company. Often, insurance comapnies go out of their way to not pay.
The only thing the collection agency provided to me was the computer printout of the charges. I never received a copy of any of the forms from the dr's office, so I dont know honestly, it was all on their computer, everything was electronically signed. When I called the insurance company they stated that the dr had only inquired about being a member of the plan I had. No I didn't call them prior, I assumed the dr's office was competent enough to give me correct information 3 times . Guess I'm stupid. I've filed complaints against the dr's office with the BBB, local dental society, and the state dental society. We'll see if they respond to me now.
Finally got a response to this from the attorney's office via the Attorney General. The attorney said that he was going to file suit, then received the AG letter, then waiting prior to suing and obtaining judgment to collect the monies owed. He included a copy of the account history from the dr's office, and a note by their office person says that they will hold off any attempt to collect until dr makes a decision. I've never heard back from their office. Am I to just assume the decision was made and that they don't to advise me of it?
Insurance is a contract between the patient and the insurance company. It is the patients ultimate responsibility to make sure that he/she goes to an in network doctor, before the appointment is ever made. Best way is to call up the insurance company and they will tell you. When a patient calls me and they ask me if I take Aetna, the answer is yes and no. Thee are so many plans under Aetna that I do not even know half the time if I am in or out of that network. You might be able to sweet talk a judge about he said she said, but I believe that you are the one responssible for paying for the services rendered. Oh, just remembered. About 7 years ago there was a patient who owed me $200. We wrote letters and called him to at least pay $10 a month. Never talked to us once. So I took him to small claims courts. Do you know why? Because he lived in a $400K house !!!!!!! That pissed me off so I took him to court. The $200 he owed was for the deductible which is part of the insurance for which the patient has to pay before insurance kicks in. He complained that at other doctors he never pays more then a $10 co -pay and that he didn't know that there was a deductible. The judge told him that he should have known before the visit what insurance pays and also asked him if services were rendered or not? When the patient said yes-the judge told him to pay up. Good luck
I tend to side with the above on this topic. We've been backed into a corner in this respect a time or two. Sometimes it's worth making someone pay up just on principle alone.
I agree completely with chiroman95 and Apex. You need to determine what your insurance will or won't pay. You are responsible for the amount of the service, and if the insurance doesn't pay you do. I just make an appointment with a doctor and they asked what insurance I had. I said Blue Cross. They asked if it was PPO or HMO. I didn't even know BC had an HMO! So yes, every company has a multitude of plans.
Well they attempted service at my parents house yesterday, which they told them that I do not live there, which is correct. With respect to the above replies about it's the patients responsibility, I understand that, and did contact both the insurance company and the dental office, and both said it was ok. It wasn't until after I had the services done that I found out the dentist had only talked about joining the plan I was in, the insurance rep. that I spoke with didn't tell me this, only that they were a member of the plan I had. So with that information, I made the appointment with the dental office. I guess I will contact the attorney tomorrow and see if I can pay the principal alone, since he doesn't have good service and will have to hunt me down and find me to get service, I would think he would be inclined to accept the offer, since he isn't allowed attorneys fees. Any other suggestions?
Usually if it's out of network they pay a much lower payment and you pay the rest your insurance should have a appeal process did you try that you can go to them and say that the rep,ok'ed it was it your rep.i would pay then take on your insurance and try to get aportion of it.
