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  1. #1
    Join Date
    May 2011
    Posts
    3

    Unhappy Sued Over Dental Bills

    My question involves insurance law for the state of: Pennsylvania

    I apologize for the lengthy post, but I am desperate for help:

    On march 17th, my wife to get her teeth cleaned at a local dentist. She has been too busy with the babies so 3 years elapsed since the last cleaning. Newvertheless, she walked to the office, x-ray, no cavities, then had 35 minutes cleaning with the Higenist. They told her that they removed all the big plaque and she will need to come for a second short appointment just to brush on tiny residues that were left. They took x-rays all over again for all teeth this time.

    In April, they called and cancelled the appointment and said please wait till they receive an approval from our insurance (U Concordia) for the second cleaning. A week later they called and said the visit was preapproved and scheduled her for the second cleaning. We received in the meanwhile a bill for $50 (the deductable) from the office for all the work she had in March.

    On May 12th I went had my cleaning done the same office, same routine, the hygenist spent 25 minutes on my teeth, the dentist spent 10 minutes chatting as he was curious about my cancer research. I walked out and my wife came in later for her second appointment at "fine cleaning". After 30 minues, she walks out they stop her at the door ask her to pay over $250!! She asked why? She just had cleaning, the lady replied that this is what my wife owed and has to be paid. My wife asked for the bill to be sent with explanation and we will call the insurance co to find out why since she was approved.

    My wife calls the insurance 3 days later with general questions (she did not have our dental card with her) and called the office same day afterwards. She said the insurance do not understand what the charges are if it was a matter of fine cleaning. When they learned that we are talking to the insurance co. exactly 4 more days later, we got a refistered letter of a LAW SUIT by the office charging us a $1035.

    We were shocked, I went in to my dental records on line and saw that the only claim that was filed was her first visit and that there is a $50 deductable, which is the maximum deductable per person/year. The Insurance also stated that the provider is a part of network and agreed never to bell the difference between the allowed and the billed. I found however a predetermination they had an approval for as they classified the second cleaning session by code D4341 (Scaling and planning) 4 times in the predetermination, each side is $175, had we received the service our uncovered portion should not exceed $190, but my wife did NOT. There was no scaling and no planing and no 4 sides, all what it was a 30 minutes of finalizing what they missed in the first session (she is jumpy with pain).

    What is interesting, they never billed the insurance for this, they only wanted to collect the money from my wife at the door without any explanation for it, without any scaling/planning service provided, and DEFINATELY with no explanation for what the service is or was.

    When they learned we are talking to the insurance company to understand, in a bullying move, they are filing a law suit of $1035 3 days after they said it was $200+ when we protested and demanded explanation. We are immigrants, I wonder if that has anything to do with it believing that we are push overs?

    This in details what happend.. If any of you can please give us any tips, on how rooting and planning is or what to research for our court appearance day. I sent a letter to the attorney general. We can't afford a private attorney to stand by us against these bullies and scammers. Please help. What should we do, and how can we show they are liars. I thought of asking for the x-rays before and after the first visit but I am afraid that will tip them. I thought to summon the Hygenist to the hearing but I don't know if she will be honest either.. Please help!!

  2. #2
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Sued Over Dental Bills

    And of course before going to the dentist, both of you contacted your insurance company to determine what was covered and what authorizations were required, right?

  3. #3
    Join Date
    May 2011
    Posts
    3

    Default Re: Sued Over Dental Bills

    We had the same insurance for over 10 years. It is not the first time to have dental services.

    What is puzzling is:
    1. We were told it is a cleaning session, not scaling or rooting
    2. The first cleaning session for my wife took almost everything out, and we are billed for the co-pay of $50, yet in the second (make sure all is out visit) they are trying to push it (without our concent or knowledge) under a process that takes weeks of work, 4 teeth at the time, and claimin that this final fine touch cleaning was the extensive scaling and root planning.
    3. They mentioned initially that the co-pay for the second visit was over $200, when we asked explanation, they threw a law suit 3 days later for a $1035 to install fear and deter us from seeking information from the insurance co.
    4. From all the records on the insurance benefits page, this office never even submit a claim to the insurance for the second visit. We think because Insurance C. will demand details on how the process was done, when it was not really done, neither we were concented to it. Some how they figured that we need to pay $200+ of co-pay without filing a claim?
    5. The insurance co. determined that the dentist was network dentist and can not charge us for the difference between what is allowable and what they are charging.

    We had the same insurance for over 10 years. It is not the first time to have dental services.

    What is puzzling is:
    1. We were told it is a cleaning session, not scaling or rooting
    2. The first cleaning session for my wife took almost everything out, and we are billed for the co-pay of $50, yet in the second (make sure all is out visit) they are trying to push it (without our concent or knowledge) under a process that takes weeks of work, 4 teeth at the time, and claimin that this final fine touch cleaning was the extensive scaling and root planning.
    3. They mentioned initially that the co-pay for the second visit was over $200, when we asked explanation, they threw a law suit 3 days later for a $1035 to install fear and deter us from seeking information from the insurance co.
    4. From all the records on the insurance benefits page, this office never even submit a claim to the insurance for the second visit. We think because Insurance C. will demand details on how the process was done, when it was not really done, neither we were concented to it. Some how they figured that we need to pay $200+ of co-pay without filing a claim?
    5. The insurance co. determined that the dentist was network dentist and can not charge us for the difference between what is allowable and what they are charging.

  4. #4
    Join Date
    May 2011
    Posts
    1

    Default Re: Sued Over Dental Bills

    Scaling and root planning should be performed only if periodontal disease has been diagnosed. Each quadrant is charged for separately using D4341. The dentist should have probed the periodontal pockets prior to the procedure to determine the scope of the disease. Generally, each quadrant's treatment should take 45-60 minutes to be performed well. A follow-up visit 6-12 weeks after the completion of the scaling and root planning is recommended to determine the therapeutic value of the treatment and whether or not a referral to a periodontist is appropriate. You may also want to alert the Dental Board in your state.

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