I went to Western dental for sudden wisdom teeth extractions. My dental insurance covers 80% of this procedure and the Dr. is in my network. Because they are in my insurance list of providers they are under contractual agreement to honor prices set by the insurance for the procedure. At the time of service I paid $90.00 as a first payment and they had estimated the price of the procedure and the insurance payment to the procedure. When I received my Explanation of Benefits from my insurance, they stated that my financial responsibility was only $98.50. After a huge run around with the Western Dental office and many claims they would speak to my insurance about the costs - they haven't and I sent a letter of complaint with the $8.50 I owed. They are still hounding me to pay the rest, but I have determined they are trying to make me pay the full cost even though my insurance entitles me to the contractual price. I have sent a complaint to the state attorney (CA), but is there anything else I can do to protect myself? Western Dental is threatening to send the account to collections (this has been ongoing for little over a month now), and I am worried about my credit. Is there any type of legal action I can take? Thanks!
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Your insurance company should be handling this for you. Speak to them and ask them to have a representative come on the call with you to the dental office. If they have a dispute regarding the reimbursement rates, there are generally specific policies that are followed in each state. One note, you didn't say how much they were asking for, but it's possible the $98.50 was AFTER your $90, depending on how it was reported.
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