[jjggy]

The dentist did a couple of operation for me, prior to the operation, he assured me the totall fee would be covered by my insurance company, he knows the insurance policy and the amount that's covered.

The dental operation has two precedures, each precedure has its own invoice. The first precedure was finished in year 2009, however, they did not make the claim until the second precedure is finished, which is in 2010. The result is that the insurance company only covered 2/3 of the total fees. So the dentist is asking me to pay for the remaining amount, which is about $2000 (prior to the operation, the dentist did not acknowledge me that I have to pay the fees that isn't covered by insurance company), and they have hired a collection agency to phone me every week for the payment, and theathend to put the case on credit report).

I have did some research online, I know that if I do make the full payment, my credit score may still get damaged. If I ignore them, they may sue me and do soemthinjg to my personal propertiy and/or paycheck. (I have full time job, owns apartment and currently have good credit score),

So my questioin is, should I hire a lawyer and counter sue the dentist, or should I wait till they sue me ? What's the best actions I should take (I don't want to just pay them because I believe the dentist are also at fault, for not making clear about the payment)?

[tickle]

Your insurance company only pay two thirds sounds just about right. My dental insurance only covers two thirds. I am happy with that and pay the rest. It is better then having to pay the whole amount out of pocket.

I don't know why, or how he could assure you the whole fee would be paid by your insurance carrier. Perhaps you misunderstood, and if you realize how insurance pays, you should have clarified, asked again if this was correct, or perhaps checked with your insurance carrier directly. Sounds like you had some very expensive extensive work done. Dental work is graded by insurance companies, some procedures are not covered at all during these hard times.

In any event, you still owe the balance and if you don't pay the dentist, then you will have to suffer the consequences of colllection agencies hounding you and taking you to court for a judgment.

Unless of course, you have it in writing from the dentist whereby he states that your insurance coverage would pay all procedures.

This may not be what you want to hear, but it is the facts.

Tick

[ScottGem]

First you need to find out whether what the carrier paid was standard or not. A carrier may refuse a claim because it wasn't file on time, but they don't reduce it because of that.

Second, do you have anything to prove the Dentist stated the carrier would cover the procedures. Some medical practitioners will accept whatever the carrier pays even though they bill higher.

But, if the carrier paid what the policy called for and you have no proof that the dentist agreed to accept this, then I would suggest trying to negotiate a settlement.

[jjggy]

The insurance cover for a few thousand dollars, it's not by percentage.

The problem is that the first precedure was performed in 2009, which he could have claimed before the end of 2009, but he didn't, and the 2nd precedure is done in 2010, at the same time, the dentist sent me to some specialist which also used up some of the insurance coverage (and the rest is paid by me, this is clearly stated in written words, I have no problem with that). So the problem is the dentist tried to claim for both precedures in 2010, which of course will not be enough, and I have talked to him before the 1st precedure that he should make the claim as soon as possible before 2010, and he has understood that.

My insurance policy WILL cover all the precedure performed by the dentist. I do not want to pay him the extra because he didn't let me know before hand that I will have to cover up the over charge, if he did then I will pay for it. Now it seem like he's scammming.

If taking to court is the onlything those collection agency will do, then I am in.

[J_9]

Have you called the insurance company and asked them directly why they did not pay the entire claim?

[jjggy]

The dentist filed the first claim too late, so the cost of both precedures are over the limit of my insurance.

[jjggy]

Yes he didn't file the claim ontime, that's exactly what happened here

The proof is the insurance policy ? It does covers for those precedures

[J_9]

If you got that in writing from the Insurance Company, take that to Court with you.

[ScottGem]

Are you saying that you had a max benefit that his charges exceeded? And had it spread the charges out over 2009 and 2010, they would not have exceeded this max?

That shouldn't be an issue if the work was done in 2009. It shouldn't matter when the claim was put in.

Sounds to me you need to get the carrier and the dentist's billing person in a conference call and see what REALLY happened. Only then will you know how to proceed.

[jjggy]

Sorry, the above comment was replying to tickle.

[jjggy]

Yes, if the dentist's receptionlist made the claim for the 1st precedure in 2009, it would be OK.

But I will take your advice and try to contact both the carrier and the dentist's receptionlist, again. And see how it goes from there.

[ScottGem]

Please don't use the Comments feature for follow-up. Use the Answer options instead.

Again, WHEN he filed doesn't matter, it's the date the work was performed that matters.

[jjggy]

Thank your for your advice Scott, I will contact the insurance company (Carrier) again to find out what happened there.

[jjggy]

I have talked to the insurance company and the billing person of the dentist. Apperently, the insurance company have preauthorized them the total amount.

1. The dentist is claiming more than the insurance coverage, because there is some type of lab fees they didn't know about before the operations, (they used some other labs), nor did they let me know before hand
.
2. Before the operation, the dentist told me the full operation was able to be spread out in 2009/2010; but the billing person is now saying it has to be claimed after both operation are finished, and the invoice for both operations are 2010.

3. The dentist did not let me know the extra amount has to be covered by myself, nor did they let me know the full amount or the estimated amount before the operations.

[ScottGem]

Ok, so the work was preauthorized for a specific amount. After the fact, the dentist added some charges that the carrier isn't covering because they were for unauthorized lab work.

Did you get an EXACT accounting of what charges were filed and what was paid?

Let me also point out that the story you originally told was different from the information you have just posted. Which is why I advised you to go back to the each party and get the exact story.

So we next need to find out what the carrier paid against what was claimed.

[jjggy]

I need to clairify something first:

I used two carriers, my spouse's and myself.

For the first operation, my carrier preauthorized them for the operation only, my spouse's preauthorized them both operation and the lab fees.

For the second operation, both my spouse's and my carrier preauthorized for the operation only, but not for the lab fees.

[jjggy]

I will have to wait till weekdays to find out what exactly was claimed and what was paid from both carriers.

[Fr_Chuck]

Part of the real issue, you will get into

Normally most doctors in the fine print say that they file the insurance only as a courtesy and you are responsible for making sure it is filed.

Next that fine print always ( never seen it not) say that you are responsible if the insurance does not pay.

Do you have anything in writing from the doctor that says you will not owe anything ?

While they get a good idea of coverage and benefits, it is not for sure till it is filed.

[jjggy]

Where should I find those fine prints ? The dentist did not get me to sign anything, nor inform me any of such documents.

And no I don't have anything in written to prove that.

[Fr_Chuck]

When you first started using the dentist, enrollment forms, often when treated you sign for the treatment.