Monday, June 27, 2011

Is this considered dental fraud?

I recieved a check in the mail from Delta Dental (ppo) for the amount of 1500.00 and I deposited this check into my bank account and spent the funds. I deposited this check with the assumption that it was an overpayment from the insurance company because this has happened a couple of times before. Any way, I called in today to get my receiept for my FSA payment (monthly payments) and they asked me for the check, I was shocked when they told me this and then I realized that the check was supposed to go to them. They are now saying that I committed insurance fraud. Is this true? I am in no way denying that I owe the amount, I just dont have the funds to make this happen right away. Not to mention most of the work that they are billing me for hasnt even been done yet. (started root canal and was supposed to restructure and crown it but havent restructured or crowned it yet)
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You did not commit insurance fraud as far as I can tell. A light should have gone off in your head that you got a $1500 payment to you from an insurance company. Now you are responsible for the full amount to the dental office. I'm guessing payable at the time of service. You may not owe for the buildup and crown yet, but if the root canal was started, you owe. The office's mistake was letting the check be sent to you instead of them. Regardless, the insurance contract is between you and your insurance company, not the dentist. Pay your dentist immediately.
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