Looking for Helen Wait.

November 9, 2011 4:41 PM

I would like to lodge the single most effective complaint against some really misleading and crappy billing practices by a dental office.

I recently went to a new dentist as I just got dental insurance for the first time in... a lot... of years. I asked up front if they accepted my insurance. They indicated that they did.

At the time of the appointment, they were very specific as to what the insurance did and did not cover. I made several other appointments to get the sad disarray of my teeth taken care of. At each appointment, I paid a co-pay based on what my insurance was expected to pay. I scheduled future procedures based on precise estimates of my yearly deductible.

So, all along I was getting very specific information about my insurance policy and had no reason to believe that any of this information was inaccurate.

Until I got a very LARGE bill. I called the office and asked where the discrepancy came from between what the insurance was expected to pay and what they actually paid. They had no idea. I then called the insurance company and they knew exactly what the problem was.

My dentist's office was out of network. The insurance company didn't actually cover them at all.

I called the office, cancelled all future appointments, and made arrangements to pay the bill. What I want to do now is to make the single most effective complaint that I can. I don't have a lot of free time to be calling around, so I want to just make one complaint and have it count.

posted by sonika to grab bag (16 answers total)

I'm sorry this isn't a direct answer, but if what do you hope to accomplish with this complaint? Are you interested in making it a formal complaint resulting in possible sanctions, or is it more of a negative review/feedback for the dental office?

Also, the unfortunate thing is that a dental office can essentially get away with telling you misinformation because ultimately, most have forms you sign that state you are responsible for any amount not covered by insurance, which can be an appealing situation for the less scrupulous dental offices. You want to consider who you want to make the complaint too. I was in a similar situation with insurance wonkiness that ended up with the dentist pocketing $300 of my money.

The whole medical billing and insurance thing is complicated enough and I advise people to check with their insurance companies regarding coverage for treatment and participating providers -- get it in writing too if possible! There is such a potential for errors when it comes to getting the right information and it's not worth the out of pocket costs to learn it happens way too often.
posted by loquat at 5:14 PM on November 9, 2011

Maybe some kind of online review website like yelp? Lodging a complaint directly with the dentist's office or BBB seems like it would have little to no effect, but something that would pop up when someone googles the dentist's name would be pretty effective (relatively speaking).
posted by LyndsayMW at 5:50 PM on November 9, 2011

I asked up front if they accepted my insurance. They indicated that they did.

I don't know what "made arrangements to pay" means. It might preclude disputing the bill now. But based on the above phrasing, you could explore whether you have valid grounds for disputing the bill. Legal action might fit within the broad terms of "the single most effective complaint."
posted by red clover at 6:00 PM on November 9, 2011 [4 favorites]

Are you interested in making it a formal complaint resulting in possible sanctions, or is it more of a negative review/feedback for the dental office?

I'm more interested in something formal that might actually encourage them to change their practices than I am in just whining about them on Yelp. I know that whatever I do won't get my money back - and I'm well aware that it probably won't actually change anything either - but I feel like I should do something. I guess if negative reviews are the only option I have, I'll take it, but this is a smallish town where none of the dentists are even listed on Yelp to begin with - so it's not like that's going to be driving away potential business.
posted by sonika at 6:14 PM on November 9, 2011

The dentist's office is possibly not guilty of anything other than negligence here. Many dental plans (mine included) cover out-of-network dentists, but some don't. And there are a wide variety of options even within the same company. So two patients can walk into an office with Aetna dental insurance, for example, and the dentist can file the insurance and for one they will receive payment, and for the other it will be denied, just based upon the specifics of the different policies.

What the office should have done before seeing you was call to verify that your specific policy covered out of network visits. That they didn't do this doesn't necessarily mean they tried to trick you; they may well have just been incompetent, or they may be making a general assumption that patients are expected to know their own coverage. Not that it makes the result any better for you, but if you're going to write up a formal complaint it might be important to keep that in mind.
posted by something something at 6:22 PM on November 9, 2011 [1 favorite]

Keep in mind too that the dental office might actually be innocent, here.

If a patient walks in and asks, "Do you take Blue Cross?" and they are told "Yes, we do!" that may actually be a true statement, in that the dental office does accept Blue Cross. But it turns out, you're on the Blue Cross Zone A Single Preferred Partner Plan (Category B), which happens to only cover in-network offices.

Most insurance providers offer a variety of plans, and a variety of options within each plan, making it sometimes very difficult to tell at a glance which offices are covered and which are not. And, as others have said, given how bizarre insurance is in the US, it's ultimately up to the patient to make sure they're in the clear before racking up charges.

I'm not denying that it sucks to get stuck with a big bill that you weren't expecting, I'm just not yet convinced, from what you've shared, that the office is necessarily at fault here.
posted by xedrik at 7:01 PM on November 9, 2011

The dental office should have told you they were out of network. That's a blanket disqualification that has nothing to do with the minutiae of their policy (e.g. oh we don't cover zirconium crowns but we cover porcelain, etc.). That the dental office told you were they in network sounds like they were either defrauding you or grossly negligent. Pretty much every dental office knows (or should know) right off the bat if they are "in network" with the major insurers. Although to avoid this in the future, you should double check you insurer's director of providers.

I'm not sure why you are paying the bill in full. No dental office or medical office wants to send a bill to collection because they get pennies on the dollar. Call them or writer a letter offering a percentage up front in cash and point out the mistake they made in telling you they accepted your insurance. Or just write a letter and send a check for a reasonable amount (such as the amount you would have been obligated to pay had your insurance covered it) and write something like "accord and satisfaction payment in full" on it. If they cash it, they're obligated to write off the balance. I mean they might come after you, but that will be your defense - they cashed a check knowing full well it was offered in payment of the full account. But it won't come to that. Almost all healthcare providers will accept a compromise payment amount to avoid sending a bill to collection. Of course, they'll probably ban you from using them again.
posted by KimikoPi at 7:05 PM on November 9, 2011 [2 favorites]

If a patient walks in and asks, "Do you take Blue Cross?" and they are told "Yes, we do!" that may actually be a true statement, in that the dental office does accept Blue Cross. But it turns out, you're on the Blue Cross Zone A Single Preferred Partner Plan (Category B), which happens to only cover in-network offices.

Most insurance providers offer a variety of plans, and a variety of options within each plan, making it sometimes very difficult to tell at a glance which offices are covered and which are not.

Right. To clarify: I asked many times if I was covered under my policy for the work that needed to be done. I was given very specific information regarding my deductible and what my policy covered. As in, to the dollar specific. Only to find out after the fact that they were out of network.

I was trying to avoid exactly this and was pro-active in checking over, and over, and over again if my insurance was covering this. I now realize that taking their word on it was naïve and I should have been checking with the insurance company, not the dental practice, to ensure coverage - which is what I will do next time around. I've dealt with the US insurance system for my entire adult life and this is the first and only time I've been misled in this way. Every other time I've been out of network or otherwise not covered, the office has been up front about it and what the ensuing costs would be.

The reason we're paying the bill is that it's in my husband's name, not mine, since he's the one listed on the insurance policy and he's worried about future ramifications to his credit rating and such. This is ultimately his call to make. If the bill were in my own name, it would be a different story.
posted by sonika at 7:14 PM on November 9, 2011

write something like "accord and satisfaction payment in full" on it. If they cash it, they're obligated to write off the balance.

Anyone who intends to try this should consult an attorney before assuming this is true. Debt collection laws vary from state to state.
posted by soelo at 7:25 PM on November 9, 2011 [2 favorites]

"but this is a smallish town"

Well, I live in a smallish town, and I think my most effective complaint is to talk up my bad experience among people on my street, friends I see in the market or when running errands, friends of my adult offspring, etc. You know, they say "hey forthright, how's things?" and you say "well, I just got drilled by my dentist, financially". I think (or rationalize) that it not only helps me feel better but also reduces the odds that it will happen to others I care about.

Granted, I've almost never had to do that in the 35 years I've lived here, because I think professionals and proprietors know this works well in a smallish town.
posted by forthright at 8:09 PM on November 9, 2011 [1 favorite]

Based on your clarifications, I suppose my advice would be to look into how dentists are licensed in your state. I worked for a client in a similar circumstance who wanted to file a complaint against a professional but wasn't in a position to pursue actual legal action, and this is essentially what we did. In my state (which wasn't that state, by the way), there is a state board that is responsible for licensing dentists, and that board fields complaints along these lines.

I have no idea in what state you're located, and I don't know enough about your situation to give legal advice. As I understand your question, you're also not seeking legal advice. With that understood, I would suggest that one option to consider is a carefully worded (be specific, be factual, avoid characterizations) complaint letter to a board of licensure, possibly cc'd to your local Better Business Bureau and/or a relevant department at your particular insurance company.
posted by red clover at 8:59 PM on November 9, 2011 [1 favorite]

If you've only spoken to office staff/billing about it, the dentist may not even know there was an error. Assume he/she doesn't know and approach them from a (slightly pissed off but) concerned standpoint:

They're a small business--the care you received was great--and yet you're never coming back.
posted by vitabellosi at 3:15 AM on November 10, 2011 [1 favorite]

My dentists' mom was their office manager and went psycho on us, so I took my business (and that of my wife) elsewhere. The dentist called me, and seemed cowed by her own mom when I expained what had happened.

I also told everyone in town. In the years since, I have heard that they're all full up on drama in that office, so word does get around.
posted by wenestvedt at 6:12 AM on November 10, 2011

Have you spoken to the insurance company? Misrepresenting yourself as in-network when you're not is a huge no-no.
posted by snickerdoodle at 9:36 AM on November 10, 2011

What did the dentist say when you called back to tell them they were out of network? Was that a surprise to them? This is powerful ammunition for negotiating a lower bill - they should eat at least part of it.
posted by CathyG at 11:54 AM on November 10, 2011

Have you thought about appealing the insurance company's denial of your claim? I wouldn't necessarily just accept their denial. Maybe there was an error on their part which caused confusion over the extent of coverage. Sometimes insurers deny claims on the slenderest of grounds, relying on the hope that most people will be too busy or too confused to contest it. Many people who do pursue the appeal process end up getting coverage for claims that were initially denied. Simply resubmitting the claim may produce a better result.

Here's another possibility you might want to consider: in a smallish town, for a service provider who relies heavily on word of mouth (ba da BING!), I think that the single most effective form of complaint would be to sue them in small claims court. You'd probably want to name the insurance company as a co-defendant, to cover the possibility that they misled the dental office, or denied your claim in error. The process is easy -- you don't need a lawyer. You do need to be willing to invest a little time and aggravation, but it can be very rewarding to see the immense amount of aggravation you can cause to the defendants, even if you don't win.

Or, maximize the effectiveness of your complaint by writing it once, and distributing it. Write one good complaint letter, and send it to: your state's professional licensing board; dental society; insurance department; Attorney General; consumer protection agency; Better Business Bureau; your local, state and federal political representatives. Who knows -- if your Congressperson gets a couple of similar complaints, their staff person might just make a little fuss for you. Use nice letter paper, be very rational and consise, and send it in the mail. The USPS needs your support.
posted by Corvid at 3:12 PM on November 10, 2011