Please, advice needed about dental bill, long I apologize

We had a dental discount plan, not an insurance, just a plan that offers reduced prices for dental procedures.

My hubby needed extractions done so we called and called until we found a dental provider to accept this plan.

My hubby went to the consultation visit & provided the card and was told someone would contact us to work out getting his procedures done.

I talked several times to the dental person who sets these up. I specifically told her that what we had was a dental plan, not an insurance. She called safeguard (the dental plan) and was advised it we would only be eligible for 25% off the total cost. We knew that ahead of time. I was the one who told her this because we had already had other consults done & they would'nt work with that plan.

A while later I get a call from Monarch dental & I was told that with our plan our cost would be around 3,200. I was never informed of a higher cost. I was agreeable to that and put the amount on our Carecredit account & the procedure was scheduled.

We got the appt & had the work done.

About two monthes later I get a bill for 3,157. I call the office that handled the work & they said they didn't know why we were getting a bill our acct was 0 because I paid with Carecredit. So I didn't think much more about it at that time.

About 2 weeks ago I get a call from a insurance person (one of the main office ins peeps who processes claims) from Monarch dental stating our insurance had denied the claim for 3,157. I was like huh? it was a dental plan, it was supposed to be 25% off the total, no claim was to have been filed. She stated it was obviously filed as a dental insurance claim. She suggested I call the office manager at the location the work was done & I am pretty well steamed at this point.

I finally get ahold of the office manager today, messages left were never returned & she proceeds to tell me that my hubbys work was billed to insurance & was denied and we need to pay another 3000. I am steaming!! I tell her all I wrote above, she said the person must have gotton erroneous info from the dental plan & subsequently it was billed according to thier costs thinking insurance would pay a portion. I said it not our fault y'all filed a claim on a dental insurance that should have never been filed. I was told an original amount and that is what I paid. She said we still owe them 3000 and need to make payment arrangments. She stated she could take 1K off but that was all. I just hung up at that point I was so mad.

Tell me I have some options here, I would have never agreed to a total cost of over 6K, they never stated that. I was told 3200 & thats the amount they submitted to Carecredit and thats what I am paying off.

What do I do? Can they just say oh, we told you wrong so pay up.

Ugggghhh,
Tegleg

 

If I recall correctly, this work was done back in September. I don't recall he ever got a written estimate. And the paperwork he got from the actual procedure visit he has lost somewhere.....men..../groan

When I talked to the lady on the phone who sets up the procedures she stated that our estimate was 3200 and that was the amount she sent into Carecredit, she stated if that entire amount wasn't used we would get the refund back to Carecredit. We recieved no calls whatsoever after the procedure until 2 weeks ago.

I need a plan, I figure I am too angry right now & may not do things correctly. So how do I find out about medical oversight boards? Would that be the Texas State Board Of Dental Examiners? I tried a search & didn't find much.

I think I am going to need to request a validation of sorts, I need copies of the stuff they have. Since hubby seems to have lost everything....grrrr

Oh, they will have a fight for sure. Hubby has already stated they wouldn't get another dime. It's all in his name, my name was only on the Carecredit acct. So we risk damage to his CR's. He's aware of that.

Thanks for the replies so far,
Tegleg

 

I have just sent a letter off to the CEO of Monarch Dental via Planet Feedback. I also requested a copy of every record they have on hubby. If I have no response to that I will send a letter to them via CMRR with the same info & request. Start a papertrail, no more phone calls unless it's from the CEO to apologize and write off the amount.

I am hoping to get this resolved with these measures but while I am awaiting results I need to figure out what the next course of action needs to be.

I am thinking disputes with the Attorny General? BBB? Any other places I need to dispute with? Contact Carecredit and request thier records of the transaction and thier procedure in handling payments?

Jlynn thank you for mentioning the texas deceptive trades. I am brain dead from working all night but found Section 17.46 very informative esp these parts which state:

(a) False, misleading, or deceptive acts or practices in the
conduct of any trade or commerce are hereby declared unlawful and
are subject to action by the consumer protection division under
Sections 17.47, 17.58, 17.60, and 17.61 of this code.


2) causing confusion or misunderstanding as to the
source, sponsorship, approval, or certification of goods or
services;

11) making false or misleading statements of fact
concerning the reasons for, existence of, or amount of price
reductions;


(24) failing to disclose information concerning goods
or services which was known at the time of the transaction if such
failure to disclose such information was intended to induce the
consumer into a transaction into which the consumer would not have
entered had the information been disclosed;

I'm sure there might be more but my brain is too fried atm...

My last course will be to contact a lawyer.

Do they really get away with treating people this way?

Thanks Jlynn, I really appreciate the advice. And Hannah thank you too!

Tegleg

 

Absolutley jlynn, in my job unfortunatley I often see people with the "end result" of inability to receive proper care, they become so ill they end up in a critical care unit fighting for thier lives.

I have been studying Chapter 76 of the Texas Health & Safety Code, thank you so very much for that info!

I found some interesting parts:

(3)AA"Discount health care program" means a business
arrangement or contract in which an entity, in exchange for fees,
dues, charges, or other consideration, offers its members access to
discounts on health care services provided by health care
providers.AAThe term does not include an insurance policy,
certificate of coverage, or other product regulated by the Texas
Department of Insurance or a self-funded or self-insured employee
benefit plan.

(6)AA"Member" means a person who pays fees, dues,
charges, or other consideration for the right to participate in a
discount health care program.

(8)AA"Provider" means a person who is licensed or
otherwise authorized to provide health care services in this state.
Added by Acts 2007, 80th Leg., R.S., Ch. 914, Sec. 2, eff. September
1, 2007.

(2)AAa provision prohibiting the provider from charging
a member more than the discounted rate agreed to in the written
agreement with the provider;

Interesting stuff. So far I think I have gathered some very useful information.

If I get no response from the CEO Planet Feedback letter I sent do you think I should include the parts from the Texas Deceptive Trade Act & Health & Safety Code in the letter I will send CMRRR to them?

Have I got an adequate defense to request the amout be waived?

Thanks,
Tegleg

 

Thank you Enigma. I called GE Money Bank this am who does the financials for Carecredit. I confirmed that the amount of 3,099 was paid to Monarch Dental on September 07, 2007. They are going to send me a copy of the statement stating that.

I asked them what is involved on thier part per payments made to a provider. They stated just an amount is given to Carecredit and charged to the members account. There is no breakdown of specific charges and what the charges were for.

In essense ours was 3,099 for dental services.

Thanks!
Tegleg

 

Just to clarify though,

We never had "insurance" all we had was a "discount plan". Insurance involves deductibles, copays claims etc. Whereas a plan has a list of discounted procedures that the member can obtain at those costs when using a provider who accepts that plan. A provider who accepts that plan agrees to offer those services at the discounted price. There are no deductibles or claims involved. We checked ahead of time and Monarch Dental was listed as a Safeguard dental discount plan provider.

When hubby went for the consult it was deemed it was not an emergent procedure and that financial arrangments were to be made first. A copy of our discount card that lists the plan number was made. We told them at that time that according to our plan only 25% of the services would be discounted.

We received the call from the person at Monarch Dental that sets up procedures and makes financial arrangments. They stated they had called Safeguard & determined that it was a discount plan and as providers of that plan they would only discount 25% of the speciality providers services. In hubby's case he had to see an oral surgeon who is a speciality provider.


We said yes we were aware of that and needed a estimate of what the cost would be. She phoned back a day or two later and gave us the amount of 3,200 and we arranged that amount to be paid by Carecredit two days before he had the procedure.
We stated we knew the plan only offered a 25% discount and needed the estimate based upon that.

According to the discount plan payments need to be made at the time of services. We made the payment amount they gave us.

I am sure when I receive hubby's copies of thier records I will find a form that states:

"In the event your insurance does not pay, you are 100% responsible for the cost of services. "

However my argument is that we never had insurance. Only a discount plan.
They should have informed us ahead of time if our cost was potentially to be double of what they originally told us. They did not. And we weren't told at the time services were rendered or shortly after that any further work had been done that was not plannned or that we were given a wrong estimate.

It makes sense to me that they would have wanted the full amount covered before the procedure. Thats what I thought was being done. If we had been told it potentially would be 6K we wouldn't have had it done. However we weren't even offered that scenario.

They waited until 4 monthes later to say hey, you owe us 3,000 more that we didn't disclose to you that you would need to pay. We never informed you of this or told you it was a possibilty but you need to pay it anyways.

This is such a nightmare, lol.

So in essence I don't think suing the dental plan is what we need to do because they aren't, in my opinion, responsible.

Monarch dental is responsible, it was thier screwup and they need to abide by thier word. They filed a claim when there was no insurance to file to.

I have a feeling we are in for a long haul... but I will not just let them have thier way just because they say so. I will raise as much hell as I posiibly can. I bet they have done this to others & I feel it is deceptive practices on thier part. It is deceptive to offer services at one price and then after the services are done say, you owe us double because we say so.

Thanks for the advice crystal, I do appreciate it it just doesn't appear to be the scenario I am facing. I appreciate you taking the time to look at this, please take no offense at my reply as none was intended.

Tegleg

 

Biz thank you for the reply. I have requested copies of all documents and billing records they have. So that I have a better handle on what is going on.

Crystalveg thank you for your information, I am glad to know about these questions ahead of time as I am sure these questions will come up depending on how far I have to go to fight this. So your advice is welcomed & no offense is being taken. I need to be prepared for anything that comes up.

However, a few things are not clear to me. Let me please address a few points in your post for clarification.

"I know from my work that if your husband signed a waver that soul purpose was to protect this Dentist, from this exact situation, there is no defense that will allow you to maneuver away from this obligation. It is a valid contract that has been challenged under the exact same circumstances has yours since the 1960s. "

I fully beleive this has been challenged before, no doubt, what I am challenging is the fact I was not informed of a cost of 6K or was I ever informed that the potential for a 6K cost was possible. Since when is it ok to charge people for things without disclosing those costs actual or possible to them first? I was not even informed of that potential or we would not have had the procedure done. The work was not emergent, it was planned ahead of time and the dental provider requested entire payment upfront which is what we did. Are they allowed to maneuver more money out of me just because they say so?

"The dental plan came with full disclosure regarding what it does and does not cover, the court is going to put the duty on you to have more knowledge of the facts, and that when you were given the wrong information of coverage that it was up to you to call at that time to insure the facts given were true. "

Ok, when we received the call and given the amount of 3200 we were told it was based on a 25% discount off the total price. We were told that they had contacted the dental plan company via phone and were told that a 25% discount for the total services is what we were to receive as members of that plan. Which is what we knew from the start before we ever went in for the consult. We told them specifically at that consult visit that 25% off the total cost was what the plan would allow us.

So at that time I had no cause to beleive I was being given inaccurate information. How could I have questioned something that appeared right at that time? It wasn't until 4 monthes later they hit me up saying "Oh we told you wrong, it's double and we didn't tell you that ahead of time but that doesn't matter just pay up" If the cost should have been 6K why wasn't I told that? I was told 3200 & that is what I paid.

From the Texas Deceptive Trade Act:

(a) False, misleading, or deceptive acts or practices in the
conduct of any trade or commerce are hereby declared unlawful and
are subject to action by the consumer protection division under
Sections 17.47, 17.58, 17.60, and 17.61 of this code.


2) causing confusion or misunderstanding as to the
source, sponsorship, approval, or certification of goods or
services;

11) making false or misleading statements of fact
concerning the reasons for, existence of, or amount of price
reductions;


(24) failing to disclose information concerning goods
or services which was known at the time of the transaction if such
failure to disclose such information was intended to induce the
consumer into a transaction into which the consumer would not have
entered had the information been disclosed;

And from the Texas Health & Safety Code:

(3)AA"Discount health care program" means a business
arrangement or contract in which an entity, in exchange for fees,
dues, charges, or other consideration, offers its members access to
discounts on health care services provided by health care
providers.AAThe term does not include an insurance policy,
certificate of coverage, or other product regulated by the Texas
Department of Insurance or a self-funded or self-insured employee
benefit plan.

(6)AA"Member" means a person who pays fees, dues,
charges, or other consideration for the right to participate in a
discount health care program.

(8)AA"Provider" means a person who is licensed or
otherwise authorized to provide health care services in this state.
Added by Acts 2007, 80th Leg., R.S., Ch. 914, Sec. 2, eff. September
1, 2007.

(2)AAa provision prohibiting the provider from charging
a member more than the discounted rate agreed to in the written
agreement with the provider;


"Perhaps this document was not signed (not likely) but even that was the case this would not matter since the services (sounds like it was an emergency major pain and infection) were provided."

I am awaiting copies of all his records to clarify exactly what has occurred. He doesn't recall signing any such document at his first visit & I know we signed nothing but a consent for the procedure and a post procedure instruction sheet after the procedure. The estimate & billing were all done via phone. There was no emergency measures. He needed the extractions in preparation for a bridge he was having our regular dentist make. The regular dentisit was unable to do the extractions himself which was why he was referred to a oral surgeon. So it was not an emergent needed procedure. It was planned. There was ample time for the dental provider to have gotton all of thier facts straight before asking us for payment. We had no cause to beleive that things weren't being done properly. They are a cooperation of dental providers, we are just consumers, we would expect them to know how to do thier job properly.

Why should they be allowed to get away with thier mistake? Are we consumers just supposed to sit back and let the big dogs have thier way?

I won't & even if I fail I'll go down fighting. I fail to see how we are in the wrong.

Tegleg