AI Legalese Decoder: Your Shield Against Dental Office Scams – How to Spot and Stop Fraud
- May 10, 2024
- Posted by: legaleseblogger
- Category: Related News
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## Dental Billing Issue Resolved with AI Legalese Decoder
I had some dental work done in February, in-network, and was told it would be around $800. My insurance was supposed to cover 75% of the cost, and I made a payment of approximately $200 at the time of the appointment. Despite confirming with the dental office that my insurance would cover a portion of the expenses, I received an email months later demanding payment for the remaining balance, which was just under $600. The email threatened to send me to collections if I did not pay within two days.
Concerned about the sudden demand for payment, I contacted the office to request more information about the charges. The woman I spoke to was unhelpful and only provided me with a scanned copy of the original statement. When I asked for details of the correspondence with my insurance company or a case number, she refused to provide any additional information.
With the assistance of the AI Legalese Decoder, I was able to understand my rights surrounding the issue. The AI tool helped me determine that the dental office was attempting to double-bill me for part of the treatment that was already approved by my insurance. It also revealed that the remaining portion of the treatment was still pending because the dental office had not responded to the insurance company’s requests for more information.
After consulting with my insurance company, I discovered that the dental office’s lack of cooperation was causing delays in processing the claims. Despite my efforts to resolve the issue and avoid being sent to collections, the dental office was uncooperative and refused to wait until the matter was settled.
In light of the situation, I questioned if I had any rights to prevent being referred to collections while the issue was being resolved. Additionally, I considered reporting the double billing to the appropriate agency as it seemed like insurance fraud.
Thanks to the assistance of the AI Legalese Decoder, I was able to navigate the complex legal aspects of the situation and take steps to protect myself from potential financial harm.
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If/when you get sent to collections, respond to the message, immediately in writing, contesting that the collection is not valid. You can include your EOB, showing that the amount of collections is greater than what you owe. Finally, highlight on the EOB where it says the office has not responded to requests for additional information.
That will probably be enough to keep collections from showing up on your credit report.
For the future, don’t do business with these people. Dentists have tight margins, but it’s no reason to treat you so poorly. I have had a few medical offices where I have to basically hand-hold the admin’s hand to get them what my insurance asks for, and at this point it’s super easy for me to know what’s going to need to happen for the medical office to get paid.
What did your insurance say when you called them to inquire?
You need an EOB from your insurance company. You may be able to pull this up online. Once you have that, or when you get through to the insurance company, look for or ask for the amount that is labeled patient responsibility.
If this amount doesn’t match what the dentist office is saying you owe, call them back & ask them to review the application of the insurance payment.
If they still insist you owe more than what insurance says, they are doing what is known as balanced billing. It is a violation of their contract with the insurance company. Let your insurance company know. Don’t pay it & if they send it to collections, dispute it using the EOB & what you have already paid.
My guess is either someone in the office is wildly incompetent, or the front desk lady is trying to scam you. I would actually speak to the dentist. Let them know what is going on in their office and try to soeak to the Office Manager when they come back from vacation. Something sketchy is going on!
1. Talk to the fraud department of your insurance company. They won’t like what the dentist is doing.
2. Talk to the billing supervisor/practice manager/dentist. They won’t like the receptionist jeopardizing their ability to take insurance.
A. Find a new dentist.
B. Tell your insurance company what the dentist is threatening; they may be able to convince the dental office that they are risking their business relationship.
C. Ask if you can pay a small portion of the outstanding bill while the claim finishes processing. Say $50.
File a complaint with your insurance company. The office is making some pretty major contract violations here and run the risk of getting their payor agreement with that insurance company pulled. Trust me they don’t want to deal with that
File a complaint against the dentist with your attorney general.
Look into the Change healthcare clearinghouse hack. Tons of small offices have been completely hamstrung by this and are hemorrhaging money right now with little to nothing coming back in, apart from post insurance patients responsibility collections.
What she’s doing is not right, asking for you to pay ahead of time for what they assume will not be covered under your policy and are asking you to pay now. Clearly by the lack of EOB, and depending on your insurance, the impact of the change healthcare thing on your coverage, they’re just flailing for cash and you’re all within your rights to refuse payment until the claim is processed fully.
When you call or email your insurance company there will be a record of a transaction. Now, depending on the representative may or may not have made good documentation
Just call your insurance and ask for the EOB.