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  1. #1
    Join Date
    May 2014
    Posts
    2

    Default Dental Bill Not Properly Submitted to Insurance, in Collections

    My question involves collection proceedings in the State of: Colorado

    Background:

    Minor child had a dental procedure approx 3/2012. The provider is in-network for Cigna.

    #1 - Provider states we never provided the insurance information to them to bill; though insurance shows claims both before and after provider in question rendered services.

    #2 - Provider sent us to collections that showed on the credit during a mortgage application - which stopped the process.

    #3 - The provider will not respond to questions from the guarantor via email and assigns incompetent staff to answer questions which they cannot do. This has happened three times already.

    #4 - The collections agency now seeks bill + $300~ stating they have already demanded payment to the rental we have now, albeit the date they provide as having sent this to us is before the move-in date to the current location. No demand was received at the previous address otherwise it would have been paid.

    Issue: obvious we're trying to get a mortgage, but are hamstrung due to the non-responsive provider and the collections will not negotiate in any capacity and the only information they've sent was the ledger provided them from the provider themselves. This had no dates or service, procedures, payments etc..

    So, my question is: #1 how is the collection agency allowed to bill substantially in excess of an amount of a bill for which we've never received? This seems to have an element of extortion tied to it...

    The insurance has already said that timely filing has expired, so they will deny the claim, but we gave the provider that info. Can we force this into court and/or would this be helpful at all? I feel like we're being extorted due to their lack of administrative competency due to filing and are basically stuck.

    We have sent letter after letter to the provider asking to pay this, but they won't respond to us, but are also not referring us to the collections agency, nor is the agency cooperating to any extent.

    Thanks in advance!

  2. #2
    Join Date
    Sep 2005
    Location
    Behind a Desk
    Posts
    98,846

    Default Re: Dental Bill Not Properly Submitted to Insurance, in Collections

    Did you discuss with your insurance company the fact that the dentist had previously and subsequently billed them for services performed under the same policy and number? The requirement in their contract with the in-network provider for timely submission of a bill may also include a provision that if they miss the filing deadline they cannot pursue you for the money the insurance company would have reimbursed.

    Your contract with the dentist may include provisions for late fees, interest, and collections fees. That would explain a higher amount. You can ask the collection agency to verify the amount claimed, but verification requirements are slight and it sounds like you're past the 30 day window from their first contact with you such that verification would be mandatory under federal law (the FDCPA).

  3. #3
    Join Date
    May 2014
    Posts
    2

    Default Re: Dental Bill Not Properly Submitted to Insurance, in Collections

    Should clarify-

    The before and after services were not from the same provider. I wanted to contrast that we did not withhold the insurance from other providers as that was a comment made to us from the collections.

    The collections also suggested that they have already sent a demand letter to us from February and implied they are compliant and continued their demand...yada yada yada.

    We've hired an attorney to pursue it as we are getting nowhere with everyone quickly.

    Thanks for the input though -

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