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  1. #1
    Join Date
    Jun 2009
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    California
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    666

    Default Re: Scammed by My Dentist

    Quote Quoting cbg
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    and that in the absence of a clause in your insurance policy that very specifically says, "You are not responsible for filing the claims - your dentist is responsible for doing so", the ONLY person who is responsible for filing a claim or seeing that it is filed is YOU.
    There actually is a whole class of health insurance policies now in which this is true. The concept of "in-network" charges in which the insured is either required or strongly encouraged to use providers within the insurance carrier's network for the policy involved. When receiving services from an in-network provider, the provider must do the billing; the insured cannot. There is an actual contract between the insurance company and the provider in which the provider agrees to accept the insurance company's payment and determination of how much the patient owes.

    I don't know if this applies to all states, since insurance is regulated by the states.

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

    Default Re: Scammed by My Dentist

    I'm aware of that; I used to work for the insurance company that premiered the concept. That's why I was so specific about what the policy had to say. The poster now knows what to look for in the policy. If s/he finds it, great, s/he can bring it to the attention of the dentist, or, for that matter, the provider relations department of the carrier. If s/he doesn't find it, though, s/he is stuck with the bill however much s/he feels s/he shouldn't be.

    This kind of clause is, however, still the exception rather than the rule, and generally exists only with managed care plans.

    mfurlan, perhaps you can show me something a little more substantial than a wikipedia article that excuses a patient from paying a doctor, or taking responsibility for seeing that it it submitted, simply because in the past other doctors or dentists have submitted claims for them. At any time during the year in question, the patient could have called the insurance carrier and found that the claim had not been submitted. At any time during that year, the poster could have submitted the invoice he received at the time of the billing (and the patient, in my experience, is ALWAYS given an invoice showing the treatment codes and any copays already made) to the insurance company directly.

  3. #3
    Join Date
    Sep 2009
    Posts
    5

    Default Re: Scammed by My Dentist

    Quote Quoting cbg
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    I'm aware of that; I used to work for the insurance company that premiered the concept. That's why I was so specific about what the policy had to say. The poster now knows what to look for in the policy. If s/he finds it, great, s/he can bring it to the attention of the dentist, or, for that matter, the provider relations department of the carrier. If s/he doesn't find it, though, s/he is stuck with the bill however much s/he feels s/he shouldn't be.

    This kind of clause is, however, still the exception rather than the rule, and generally exists only with managed care plans.

    mfurlan, perhaps you can show me something a little more substantial than a wikipedia article that excuses a patient from paying a doctor, or taking responsibility for seeing that it it submitted, simply because in the past other doctors or dentists have submitted claims for them. At any time during the year in question, the patient could have called the insurance carrier and found that the claim had not been submitted. At any time during that year, the poster could have submitted the invoice he received at the time of the billing (and the patient, in my experience, is ALWAYS given an invoice showing the treatment codes and any copays already made) to the insurance company directly.
    You are not responding to what I wrote.

    My question remains:

    If a medical provider tells a patient that they have submitted a claim, knowing that they have not, and that misrespresentation caused the patient to lose coverage for those services, does the patient still have responsibility to pay?

    Or what about a medical provider who doesn't even bill for a year and a day? Or 10 years?
    Are there no limits?

    I'm sure all these matters have been litigated.

    If nobody knows the case law, I'll check elsewhere.

  4. #4
    Join Date
    Jan 2008
    Posts
    1,948

    Question Re: Scammed by My Dentist

    Quote Quoting mfurlan
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    If a medical provider tells a patient that they have submitted a claim, knowing that they have not, and that misrespresentation caused the patient to lose coverage for those services, does the patient still have responsibility to pay?
    Did the patient sign the very common release form at the providers office that states they accept full responsibility for payment regardless of third party billing?

  5. #5
    Join Date
    Sep 2009
    Posts
    5

    Default Re: Scammed by My Dentist

    OK, just so I have this correct.

    Everybody here thinks it is OK if:

    On day 365 the medical provider says, "you don't owe me anything, please don't worry about it, I submitted all the claims and will accept what ever I am paid."

    On day 366, a day late for the patient to file and be re-embursed, the medical provider says, "Sorry I lied, pay the full amount immediately or this goes to a collection agency."

    And furthermore there is case law supporting that this is the way things are supposed to work?

  6. #6
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Scammed by My Dentist

    Actually, no. No one said it was okay, or that they approved, or that they thought the dentist was doing the right thing.

    What the responders here may approve of or think is "okay" and what the law permits to happen, are not necessarily the same thing.

    The poster needs to determine whether or not, under his or her policy, the dentist was required BY THE TERMS OF THE POLICY to make the submissions. If he was, then the poster is in the clear. If he was not, then any issues about payment are between the poster and the dentist.

    You didn't come up with any case law clearing the poster from responsibilty, I notice.

    I'm not going to say it's impossible that the poster might prevail in court, if they wanted to go that far. But in the absence of a contracted responsibility on the part of the dentist to make the insurance submissions, the poster is responsible for the bill until a court says otherwise.

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