Why did she refuse?
If they're a participating office, they would bill the rate they've negotiated with the insurance company. If they're not, odds are the insurance company will cap the reimbursement to the rate it deems reasonable and pass the balance on to you - at which point you can assert the contractual rate you negotiated.Quoting Rita Hoeffner
If you are claiming that the insurance company is choosing not to treat the claim as fraudulent, then that's what they've chosen to do. Beyond that, what do you mean by "nothing they could do" - they're going to pay whatever it is they're contractually obligated to pay, right? Is there something more you think they're supposed to do?Quoting Rita Hoeffner
As this is a new issue since your last complaint about the office's bills, get back in touch with your insurance company and explain that your husband has not yet received the billed services. I am not aware of any dental insurance company that will pay in advance.Quoting Rita Hoeffner
What do you mean by "charges that were never authorized to be done" - are you talking about dental treatments your husband received, but believes he should not have to pay for? Explain.
The insurance will only pay out what it is obligated to pay out, so if they've paid out the maximum benefit for the year they're not going to pay more. If you successfully dispute a past bill such that they recall a payment made by one provider, then they would free up that money to be paid to another provider.Quoting Rita Hoeffner
You insisted that this office bill your insurance company, they did so, and the insurance company paid the bills. That's what the insurance company is supposed to do. What do you believe they have done wrong?Quoting Rita Hoeffner
The Texas State Board of Dental Examiners accepts complaints here. The TDI accepts complaints here. You can explore for additional agencies or groups that might entertain complaints.
If in fact the dentist is in their PPN, they will pay pursuant to the aforementioned pre-negotiated schedule. The dentist can bill $1 billion for a filling, and they'll still only get the pre-negotiated amount.Quoting Rita Hoeffner

