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Advice Needed

NMEDGE

NMEDGE

Professional
In January I went to the dentist and they told me I needed a crown. Of course since they are the professionals I let them proceed. I did ask if my dental insurance would cover it and they said yes. So they did the prep work and put in a temporary and said they will call when crown comes in. Two weeks later the crown came in, was installed, I paid my portion and thought I was done. Yesterday I was informed that the procedure was not approved by United Concordia and they expect me to pick up the bill to the tune of $1400. Actually my wife was the one who told me because she had gone there for her 6 month cleaning and they mentioned it to her. I went over there and of course things did not go well. I mentioned to them that they had told me that the procedure was approved. Then I said they have never sent me a bill or given me any notice that there was an issue. They now insist that I must pay them and feeling that I was duped I told them where to go in not a nice way. Told them to take me to court cause I wasn't paying for their mistake. I did call insurance company and they told me that they never put in for a pre-approval and they should not assume that a procedure will be approved by them, every situation is different. What do you all think I should do about it and has any of you had an issue like this. What would you do in my situation.
 
NMEDGE said:
In January I went to the dentist and they told me I needed a crown. Of course since they are the professionals I let them proceed. I did ask if my dental insurance would cover it and they said yes. So they did the prep work and put in a temporary and said they will call when crown comes in. Two weeks later the crown came in, was installed, I paid my portion and thought I was done. Yesterday I was informed that the procedure was not approved by United Concordia and they expect me to pick up the bill to the tune of $1400. Actually my wife was the one who told me because she had gone there for her 6 month cleaning and they mentioned it to her. I went over there and of course things did not go well. I mentioned to them that they had told me that the procedure was approved. Then I said they have never sent me a bill or given me any notice that there was an issue. They now insist that I must pay them and feeling that I was duped I told them where to go in not a nice way. Told them to take me to court cause I wasn't paying for their mistake. I did call insurance company and they told me that they never put in for a pre-approval and they should not assume that a procedure will be approved by them, every situation is different. What do you all think I should do about it and has any of you had an issue like this. What would you do in my situation.
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I had almost the same thing happen once. I was told my portion would be about $300. About a month later I got a bill from the dentist for $1000. I paid him $10/month for awhile and then I just quit paying him. Dude was trying to barter with me to put a pair of French doors in his house. F that guy.


To make matters worse I have since had to have both crowns replaced. The cement he used showed very visibly between the tooth and the gum, which irked me but I dealt with it. About 15 years later one got real loose and my new dentist was appalled by the previous dude’s work. He replaced them and they look great.
 
I am sorry you have to deal with this. What a mess. First off, i’d find another dentist. Second, tell them that you spoke with the insurance company and they claim your dentist never put in for pre-approval (get that in writing). Suggest to your dentist that you’d be willing to pay some amount, but not all, of the bill. I’ll say 25% of the bill, $350. This is a sign of good will that you’re willing to work with them. If they won’t budge you can always take them to small claims court. Finally, be nice about everything. Don’t run your mouth at their office. It’ll only make matters worse.
 
Well I have already paid $325 which was my portion to them. I also got an attitude with them so I gave them mine. Needless to say I told them I would not pay and they could take me to court. Tired of being taken advantage of. I will call insurance company again today and see if they will give me a letter stating there was no pre-approval. As far as keeping from running my mouth---I have issues with that. Thank you for giving me your opinion, I appreciate it.
 
I wouldn't pay if they told you it was covered, get something from the insurance to prove they didn't pre approve it like mentioned. I doubt they will take you to court, probably turn it over to a collection agency and they will hound you. you might have to take them to court to keep from ruining your credit.

No pre approval and them telling you it was covered. you will probably win that and they probably know it. You will definitely have to find a new Dentist now.
 
NMEDGE said:
In January I went to the dentist and they told me I needed a crown. Of course since they are the professionals I let them proceed. I did ask if my dental insurance would cover it and they said yes. So they did the prep work and put in a temporary and said they will call when crown comes in. Two weeks later the crown came in, was installed, I paid my portion and thought I was done. Yesterday I was informed that the procedure was not approved by United Concordia and they expect me to pick up the bill to the tune of $1400. Actually my wife was the one who told me because she had gone there for her 6 month cleaning and they mentioned it to her. I went over there and of course things did not go well. I mentioned to them that they had told me that the procedure was approved. Then I said they have never sent me a bill or given me any notice that there was an issue. They now insist that I must pay them and feeling that I was duped I told them where to go in not a nice way. Told them to take me to court cause I wasn't paying for their mistake. I did call insurance company and they told me that they never put in for a pre-approval and they should not assume that a procedure will be approved by them, every situation is different. What do you all think I should do about it and has any of you had an issue like this. What would you do in my situation.
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the doctors office "could have assumed" the procedure would be covered, from maybe a previous checking of your benefits.

however each year, many insurance companies change things...i have had my meds get changed from 1 tier to another, with out notice and i found out when i got hit with a $500 bill....!! which since i did not accept the meds, they were cancelled and put back into stock.

you could ask the insurance company for a letter stating "no previous request for dental work was submitted", and see what happens.

then frankly, i'd report this to the state licensing commission for doctors.

then i'd go to a lawyer for him (or her) to keep on hand for your protection, in case of a small claims suit, or even if the doctor side steps and puts a lien on you.

you already paid your co-pay, and to me that was payment in full, but i am not a lawyer, which really, you need to consult.

also, i'd ask your insurance company to send you an updated policy with what is allowed and the limits of co-pay, and charge backs.

i'd not be squeamish in not going forward with what to do, i can assure you the office most likely sent this to "collections", and that can mess with your credit, even mess with your homeowners/auto insurance, as they too check credit scores and remarks.
 
After my divorce in 2008 I was dating
(Not living with) a lady who referred me to her dentist for some minor tooth repair, at the time I had full dental insurance, at intake I was asked how I found their office and told them I was referred to them by; “her name” I was told everything was covered by insurance…..
Two months later my lady friend went to the same dentist and the next time we got together she told me that during her checkout she was approached by someone from the billing office who told her my insurance had declined payment and then proceeded to share with her my personal information and that I had not returned their multiple phone calls to me about payment.
Well besides never receiving any phone calls from the office I was furious about the office sharing personal information with someone.
I contacted the office and found out they had submitted the bill to my insurance company using an incorrect birth date, I also contacted my attorney about them sharing my personal information without my consent. He sent them a letter explaining to them my intention to sue them for unlawful and unethical sharing of personal and medical records.
I now record all (in person) conversations with doctors office personnel making sure I get the names of people I’m talking to and have an app on my cell phone that records phone conversations.
 
NMEDGE said:
In January I went to the dentist and they told me I needed a crown. Of course since they are the professionals I let them proceed. I did ask if my dental insurance would cover it and they said yes. So they did the prep work and put in a temporary and said they will call when crown comes in. Two weeks later the crown came in, was installed, I paid my portion and thought I was done. Yesterday I was informed that the procedure was not approved by United Concordia and they expect me to pick up the bill to the tune of $1400. Actually my wife was the one who told me because she had gone there for her 6 month cleaning and they mentioned it to her. I went over there and of course things did not go well. I mentioned to them that they had told me that the procedure was approved. Then I said they have never sent me a bill or given me any notice that there was an issue. They now insist that I must pay them and feeling that I was duped I told them where to go in not a nice way. Told them to take me to court cause I wasn't paying for their mistake. I did call insurance company and they told me that they never put in for a pre-approval and they should not assume that a procedure will be approved by them, every situation is different. What do you all think I should do about it and has any of you had an issue like this. What would you do in my situation.
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Sorry brother that is a sucky situation. What I really hate about this is, you could be totally right, but if they make a claim via collections it will hit your credit, and even though being right, you will have to fight to get it all fixed... Assuming you want or care about your credit, these dummies have us normal folks at a disadvantage. Its like guilty until proven innocent, and you have to pay to be proven innocent.
 
Sad to say, I think you might be on the hook for the charges legally. Those little signs saying customer is responsible for all charges are put there for a reason.

As far as what someone told you it beong covered, it might end up thier word versus yours if it ever went to small claims. As it is, they will just get a collection agency on you to damage your credit.

Hope it doesn't go that route but you will likely take a hit one way or other if it does.

Worth the hit to fight it? Only you know...
 
I have been turned into collections before with medical issue bills mostly my Wife's crohn's disease treatments. They had no issue covering almost half a million when she spent 60 some days in ICU but would not cover her strellara treatments which cost between 4 and 6 thousand Had to get my Attorney involved and her specialist and it took a few months but eventually got it taken care of. One thing I learned is to keep all documentation and also as mentioned here previously keep records of who you speak to and what dept. they are in.
 
i had a situation at my bank.

i pay my mortgage EVERY month, on time, or early....NEVER past the grace period...EVER....

sometimes i put a little extra on the principal, other times, i do not.

well about 3 months ago, the dumbass teller screwed up my payment, by applying nearly all the payment to the interest, and NOT the principal...

i had to go to the bank, SHOW them my payment reference slip......then it "got fixed"

but...... IT DID NOT

they still hit me with a "late charge"

like WTF...??

call the bank this time, gal said that she has removed the late charge (although when i went to the bank that first time..??? it was "supposed" to have been removed..>!!

i shall see in November if that late charge has been removed or not


so you see...someone else screws up, and i/we, gotta go thru hell to fix it.......
 
Been through a similar experience. You must do what you think is right of course. For me I would pay the bill and then take them to court, perhaps small claims court. That way your credit doesn't suffer and your insurers don't black mark your coverage. JMO
 
Hi,

NMEDGE said:
In January I went to the dentist and they told me I needed a crown. Of course since they are the professionals I let them proceed. I did ask if my dental insurance would cover it and they said yes. So they did the prep work and put in a temporary and said they will call when crown comes in. Two weeks later the crown came in, was installed, I paid my portion and thought I was done. Yesterday I was informed that the procedure was not approved by United Concordia and they expect me to pick up the bill to the tune of $1400. Actually my wife was the one who told me because she had gone there for her 6 month cleaning and they mentioned it to her. I went over there and of course things did not go well. I mentioned to them that they had told me that the procedure was approved. Then I said they have never sent me a bill or given me any notice that there was an issue. They now insist that I must pay them and feeling that I was duped I told them where to go in not a nice way. Told them to take me to court cause I wasn't paying for their mistake. I did call insurance company and they told me that they never put in for a pre-approval and they should not assume that a procedure will be approved by them, every situation is different. What do you all think I should do about it and has any of you had an issue like this. What would you do in my situation.
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Lots of common sense in this thread. What would I do? I'd pay a lawyer for an hour of his time to see if I could make a case in small claims for ineptitude, fraud, whatever. I'd probably pay the bill so as not to ruin my credit and try to recoup all my losses in court. I'm sorry this happened to you.


Thank you for your indulgence,

BassCliff
 
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