I have an HOM detest (CAPITATED PROGRAM). I have many serious dental problems that I have not had treated because my detest says my insurance does not cover them. I called my insurance and the nine procedures I needed were ALL covered in full.

The detest even documented these false statements about my coverage in my medical records. So I have proof. I have been through hell because I have not been able to get any HOM detest to treat me under the terms of my insurance agreement.

The bottom line or the loop hole is this: ANY time I question a detest about how I was covered for for a procedure that going to have to make him provide me with that high cost and or time service for free (under the terms of my insurance agreement) he just finds a reason to dump me as a patient. My insurance company says they can not force a doctor to treat me.

Yes there lots of regulatory agencies, but none of them are interested in or have any legal power over consumer fraud. What can I do?

David

You can not force a doctor to treat you, unless it is a life threatening emergancy need.

So merely change dentist

You should be able to get your hands on a benefit coverage book that tells you what is or is not a covered benefit. Take tha book to the dentist so he/she can see for themselves what you have coverage for.

And please understand, the dentist normally calls in and gives them specific code numbers for approval, not merely names of a procedure. They are paid by actual code number filings.

And of course if you merely agree to pay the dentist if the insurance does not pay, I don't see where they will refuse.