Sunday, November 28, 2010

Can a dental office not submit claims to insurance by choice?

I saw a dentist in 2004. I had dental insurance and provided this information to the dental office. I never heard anything after that but changed dentists due to location. I get a copy of my credit report last month and see there is a collection for this dentists office. I contact them direct and was told my insurance denied the claim. My coverage was active at the time of service conducted. I called the insurance carrier and was told the dental office NEVER even submitted the claim to them. So, the dental office is going to submit the claim to the insurance now but says they still can charge me the fee that it cost them to turn it over to the collection agency. i dont feel this is right because the $38 fee would never had to happen if the dental office had submitted the claim like they were supposed to. I was referred to this dental office by the insurance company's website so I know they accepted the insurance. Is this a violation of the Fair Credit Reporting Act somehow?
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Many health care professionals file an insurance form as a courtesy to the patient. However, they are not required to do so. If you were referred by the insurance company website, the dentist had an agreement with that carrier to accept their usual and customary fee. It may or may not have had a requirement to submit the forms for the patient. However, that agreement would be between the provider and the insurance carrier. Your best bet is to contact the insurance company, since their website did the referral. They are more likely to refund the fee than the dentist's office. If you took them to small claims court it would cost you more than you would recover and you would probably spend a fortune trying to get the dental office to pay you. The BBB is really a farce. They take reports, but when you call them to find out about a compnay all they will say is they have or have not received reports about them. The BBB will not disclose what was reported- good or bad. You might try your state insurance commissioner.
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