I will submit your claim Tuesday for an expensive dental procedure today
August 5, 2011 10:27 AM Subscribe
My wife's dentist is proposing submitting an insurance claim in January for work that is mostly going to be done much sooner. He says it's ethical, but I'm not so sure. Open up and say ahh...
Originally the plan was to replace an old bridge the same dentist had put on about 10 years ago, but after removing it he discovered a lot of decay and didn't feel qualified to completely assess the damage or do a root canal, so he sent her to an expensive, out-of-network Manhattan endodontist. The endo took a look at the damage but decided not to do any work. She returned to the dentist, who ended up pulling the tooth and putting in an implant.
In the meantime, the dentist submitted a pre-approval claim for the bridge work. She had no bridge in her mouth while we waited for the approval to go through. I'm a little confused about the particulars of why he decided to seek preapproval for replacing the bridge after beginning the procedure, but I think there was some question about whether they would cover it after he discovered the decay.
As an aside: money is tight, and my wife is stressed by the whole experience, thinking that her teeth are causing us financial hardship. The dentist is in Brooklyn, we moved to upstate NY several years ago, so it's not easy to see him. She also has a hard time communicating with the dentist, and we thought that for cultural reasons maybe he would have an easier time talking to "the husband." So we got a credit card, and I also started talking to the dentist.
Anyway, the preapproval went through, so now we can do the bridge, right? Well, it turns out that the Manhattan endo had burned through half of our $1500 limit just for the examination, so the insurance company can only pay $200 or so towards the bridge. The dentist says that's not what he intended, and that he's going to try to get at least some of our money back.
Not that it really matters, because the bridge work that he wants to do costs $2600, and we've only put a $100 down payment on it. We're going to have to pay some cash no matter what. The new bridge has been constructed and is ready to go.
So this is what the dentist is proposing:
1) Put the bridge on now, because it's bad to go too long without it
2) We pay him all the money for the procedure
3) My wife goes back to him in January for a final adjustment to the bridge
4) The dentist submits the claim then, after all the work is done and we have a fresh $1500 insurance limit
5) We somehow get reimbursed for whatever the insurance company covers.
I plan on calling the insurance company (especially after re-reading my question), but I want to know what you think:
Does this sound reasonable, or does this sound fraudulent?
Originally the plan was to replace an old bridge the same dentist had put on about 10 years ago, but after removing it he discovered a lot of decay and didn't feel qualified to completely assess the damage or do a root canal, so he sent her to an expensive, out-of-network Manhattan endodontist. The endo took a look at the damage but decided not to do any work. She returned to the dentist, who ended up pulling the tooth and putting in an implant.
In the meantime, the dentist submitted a pre-approval claim for the bridge work. She had no bridge in her mouth while we waited for the approval to go through. I'm a little confused about the particulars of why he decided to seek preapproval for replacing the bridge after beginning the procedure, but I think there was some question about whether they would cover it after he discovered the decay.
As an aside: money is tight, and my wife is stressed by the whole experience, thinking that her teeth are causing us financial hardship. The dentist is in Brooklyn, we moved to upstate NY several years ago, so it's not easy to see him. She also has a hard time communicating with the dentist, and we thought that for cultural reasons maybe he would have an easier time talking to "the husband." So we got a credit card, and I also started talking to the dentist.
Anyway, the preapproval went through, so now we can do the bridge, right? Well, it turns out that the Manhattan endo had burned through half of our $1500 limit just for the examination, so the insurance company can only pay $200 or so towards the bridge. The dentist says that's not what he intended, and that he's going to try to get at least some of our money back.
Not that it really matters, because the bridge work that he wants to do costs $2600, and we've only put a $100 down payment on it. We're going to have to pay some cash no matter what. The new bridge has been constructed and is ready to go.
So this is what the dentist is proposing:
1) Put the bridge on now, because it's bad to go too long without it
2) We pay him all the money for the procedure
3) My wife goes back to him in January for a final adjustment to the bridge
4) The dentist submits the claim then, after all the work is done and we have a fresh $1500 insurance limit
5) We somehow get reimbursed for whatever the insurance company covers.
I plan on calling the insurance company (especially after re-reading my question), but I want to know what you think:
Does this sound reasonable, or does this sound fraudulent?
Well, call your insurance if you want them to deny the whole thing.
posted by amanda at 10:38 AM on August 5, 2011 [9 favorites]
posted by amanda at 10:38 AM on August 5, 2011 [9 favorites]
Best answer: It sounds both reasonable and fraudulent. Your dentist is basically doing you a favour by moving your insurance claim to the next insurance cycle. it isn't uncommon with sympathetic billers. Do not tell your insurance company this.
posted by DarlingBri at 10:43 AM on August 5, 2011 [12 favorites]
posted by DarlingBri at 10:43 AM on August 5, 2011 [12 favorites]
First, I'd ask the mods to make your username anonymous.
Then I'd forget everything he's said and just let him handle how he handles his billing. You're in no position to tell him how to run his billing unless it somehow costs you more money.
And it's generally bad form to tattle on someone trying to do you a solid.
posted by inturnaround at 10:47 AM on August 5, 2011 [2 favorites]
Then I'd forget everything he's said and just let him handle how he handles his billing. You're in no position to tell him how to run his billing unless it somehow costs you more money.
And it's generally bad form to tattle on someone trying to do you a solid.
posted by inturnaround at 10:47 AM on August 5, 2011 [2 favorites]
My keen sense of personal ethics is confounded by the fact that insurance companies bone you every chance they get. I think your only risk here, provided you trust the dentist, is that they somehow deny it in the end. But I think I'd do it, and sleep soundly.
posted by randomkeystrike at 10:48 AM on August 5, 2011 [1 favorite]
posted by randomkeystrike at 10:48 AM on August 5, 2011 [1 favorite]
This actually happens a lot. Ethical? Probably not. You'll see this happen a lot at the end of the year when people need to use their FSA dollars but the doctor/dentist/eye doc are all booked up, so you can't get into the office until January/February but they bill for the service in December.
posted by magnetsphere at 10:52 AM on August 5, 2011
posted by magnetsphere at 10:52 AM on August 5, 2011
Best answer: Yes, do NOT call your insurance company about this.
It's perfectly fine (and very nice) for him to alter the billing cycle.
It bothers me you are paying in full, up front. Don't do that. Negotiate!
Pay him $900 ($2600 - $1500) then in January, pay him the balance on whatever the insurance doesn't cover.
Do not not not let this guy talk you into reimbursing you. That's hunky.
posted by jbenben at 11:01 AM on August 5, 2011
It's perfectly fine (and very nice) for him to alter the billing cycle.
It bothers me you are paying in full, up front. Don't do that. Negotiate!
Pay him $900 ($2600 - $1500) then in January, pay him the balance on whatever the insurance doesn't cover.
Do not not not let this guy talk you into reimbursing you. That's hunky.
posted by jbenben at 11:01 AM on August 5, 2011
Yeah I think the dentist is trying to do you a favor. If you call the insurance company you're pretty much tossing him (and your claim) under the bus.
Doubtless he's also looking out for himself, and asking for payment upfront is part of that ... for him that ensures that he's not on the hook if you run your mouth to your insurance company and the claim gets denied later.
These sort of white lies are how the healthcare system operates these days. Without them, everything would be even more screwed up than it currently is.
posted by Kadin2048 at 11:04 AM on August 5, 2011
Doubtless he's also looking out for himself, and asking for payment upfront is part of that ... for him that ensures that he's not on the hook if you run your mouth to your insurance company and the claim gets denied later.
These sort of white lies are how the healthcare system operates these days. Without them, everything would be even more screwed up than it currently is.
posted by Kadin2048 at 11:04 AM on August 5, 2011
Insurance company is not your friend. Neither is the dentist usually, but his interests are closer to yours and more complicated! The only priority of the insurance company is to pay as little as possible. Just about every dentist, glasses store, and independent doctor I've had has made little tweaks like this so they get paid and I don't get totally screwed because of the rules of a giant profit making company. Possibly what he proposes breaks the rules of the insurance company, and possibly not, medical billing is so complicated that it's a career. The question is whether you think rules = ethics, and whether you want to play cop for them at your own expense.
I agree with Jbenben that you should negotiate and also try to work out a payment plan, but in my experience it is normal to get a check or (more commonly) a bill, months after dental work when the company and the dentist reach a final agreement on what was done and what was covered - that's what would happen for you here. It's happened to me many times in situations that weren't even remotely sketchy.
posted by crabintheocean at 11:04 AM on August 5, 2011 [1 favorite]
I agree with Jbenben that you should negotiate and also try to work out a payment plan, but in my experience it is normal to get a check or (more commonly) a bill, months after dental work when the company and the dentist reach a final agreement on what was done and what was covered - that's what would happen for you here. It's happened to me many times in situations that weren't even remotely sketchy.
posted by crabintheocean at 11:04 AM on August 5, 2011 [1 favorite]
Response by poster: And it's generally bad form to tattle on someone trying to do you a solid.
I don't want to tattle, I want to ask the insurance company if this is okay. If it's not okay to ask them, doesn't that make it fraud?
My worry is whether him doing the majority of the work in one billing cycle, then billing in another, would be construed as misrepresenting the time of treatment.
posted by swift at 11:05 AM on August 5, 2011
I don't want to tattle, I want to ask the insurance company if this is okay. If it's not okay to ask them, doesn't that make it fraud?
My worry is whether him doing the majority of the work in one billing cycle, then billing in another, would be construed as misrepresenting the time of treatment.
posted by swift at 11:05 AM on August 5, 2011
I don't want to tattle, I want to ask the insurance company if this is okay. If it's not okay to ask them, doesn't that make it fraud?
The insurance company is out to screw you every single chance they get, and to worry about whether this is fraud or not is the height of ridiculousness.
The dentist is trying to do you a solid, say thank you and keep your mouth shut after that.
posted by crankylex at 11:10 AM on August 5, 2011 [6 favorites]
The insurance company is out to screw you every single chance they get, and to worry about whether this is fraud or not is the height of ridiculousness.
The dentist is trying to do you a solid, say thank you and keep your mouth shut after that.
posted by crankylex at 11:10 AM on August 5, 2011 [6 favorites]
Best answer: If it's not okay to ask them, doesn't that make it fraud?
I'm not a dentist or... insurance company guy, but yeah, it probably does.
If you're truly uncomfortable with that you could
a) pay cash/payment plan
or
b) find out how bad it would be to actually wait and have the procedure done just after New Year's. I have done that before for crowns and stuff.
posted by drjimmy11 at 11:10 AM on August 5, 2011
I'm not a dentist or... insurance company guy, but yeah, it probably does.
If you're truly uncomfortable with that you could
a) pay cash/payment plan
or
b) find out how bad it would be to actually wait and have the procedure done just after New Year's. I have done that before for crowns and stuff.
posted by drjimmy11 at 11:10 AM on August 5, 2011
Response by poster: Also, if there are any dentists out there, it turns out I've messed up a few of the details of my wife's treatment -- for example, she now has her old bridge back on with some temporary cement.
But the question about billing the treatment stands.
posted by swift at 11:10 AM on August 5, 2011
But the question about billing the treatment stands.
posted by swift at 11:10 AM on August 5, 2011
Are you concerned that it's fraud by you, or fraud by him? Because (IANAL) there's no way it's the former unless possibly if you go digging and then do it anyway. Why would you care if it's the latter when it's a standard workaround and it means you have $1500 extra in your pocket?
posted by crabintheocean at 11:10 AM on August 5, 2011
posted by crabintheocean at 11:10 AM on August 5, 2011
Oh swift, of course its a minor fraud and a misrepresentation, but its a kinda white lie that is going to save you money with no true (in my mind) ethical ramifications. Your dentist is trying to save you the out of pocket by working within the system. He presumably knows how to do it, the system is set up screwy and he deals with it every day. Just let him do what he does.
posted by stormygrey at 11:11 AM on August 5, 2011 [1 favorite]
posted by stormygrey at 11:11 AM on August 5, 2011 [1 favorite]
If you are worried about the moral culpability of any dealings with an insurance company, take solace in the fact that they are by default 'lawful evil' in all of their actions, and anything you do to gain advantage over them is 'neutral good'.
posted by FatherDagon at 11:11 AM on August 5, 2011 [3 favorites]
posted by FatherDagon at 11:11 AM on August 5, 2011 [3 favorites]
Response by poster: The insurance company is out to screw you every single chance they get, and to worry about whether this is fraud or not is the height of ridiculousness.
I'm not worried about the interests of the insurance company, or the moral implications of doing this. I'm worried about the risk.
posted by swift at 11:12 AM on August 5, 2011
I'm not worried about the interests of the insurance company, or the moral implications of doing this. I'm worried about the risk.
posted by swift at 11:12 AM on August 5, 2011
It may not even be fraud/against the rules. I'd bet the dentist has significant professional leeway for when he considers treatment to be completed, and billing at completion may be totally the standard.
posted by crabintheocean at 11:14 AM on August 5, 2011
posted by crabintheocean at 11:14 AM on August 5, 2011
Best answer: The risk to you is that they deny the claim. The chance your insurance company will bother to investigate a $1500 claim is near nil.
posted by DarlingBri at 11:14 AM on August 5, 2011 [1 favorite]
posted by DarlingBri at 11:14 AM on August 5, 2011 [1 favorite]
Response by poster: Are you concerned that it's fraud by you, or fraud by him?
Well ... both. If he's asking me to agree to this, then I feel like I'm a party to it.
posted by swift at 11:17 AM on August 5, 2011
Well ... both. If he's asking me to agree to this, then I feel like I'm a party to it.
posted by swift at 11:17 AM on August 5, 2011
If you must call your insurance company because you think this might come back to bite you in the ass, at least try to do it anonymously, or as a theoretical policy question. Be coy about details, just ask something like "would there be issues with relieving dental treatment now and then having a claim made several months from now."
posted by Patbon at 11:19 AM on August 5, 2011
posted by Patbon at 11:19 AM on August 5, 2011
Yes, this is fraud. Yes, crossing the street when the light is red is jaywalking. If it bothers you, you have two options: pay cash, or go without the procedure. You seem bothered, so pay for the procedure out of pocket and be happy that the shareholders of your insurance company made a little extra money this year.
posted by jrockway at 11:20 AM on August 5, 2011 [3 favorites]
posted by jrockway at 11:20 AM on August 5, 2011 [3 favorites]
I mean that instead of "HEY is it cool if DentistX does this bridge work now and he bills you later? Here's his address call the police!" Exaggerated, obviously, but don't screw the guy.
posted by Patbon at 11:21 AM on August 5, 2011 [1 favorite]
posted by Patbon at 11:21 AM on August 5, 2011 [1 favorite]
Insurance companies are out to fuck you.
Sounds like you have a very nice, compassionate dentist.
Don't look a gift horse in the mouth!
Don't call the insurance company, save yourself some money,
posted by handbanana at 11:22 AM on August 5, 2011 [1 favorite]
Sounds like you have a very nice, compassionate dentist.
Don't look a gift horse in the mouth!
Don't call the insurance company, save yourself some money,
posted by handbanana at 11:22 AM on August 5, 2011 [1 favorite]
If he's asking me to agree to this, then I feel like I'm a party to it.
No. While IASNAL, I'm pretty sure it is not your responsibility to know the ins and outs of the contract between the dentist and insurer.
posted by crabintheocean at 11:23 AM on August 5, 2011
No. While IASNAL, I'm pretty sure it is not your responsibility to know the ins and outs of the contract between the dentist and insurer.
posted by crabintheocean at 11:23 AM on August 5, 2011
Best answer: The rules for when a multi-step dental procedure is complete and should be billed are very complex and tend to vary from insurer to insurer - without reading your dentist's contract and provider reimbursement manual with your dentist it's impossible to know whether this is kosher or not.
Paying up front while the dentist has it on bill hold and then waiting for him to pay you back does sound pretty risky though.
posted by strangely stunted trees at 11:24 AM on August 5, 2011 [1 favorite]
Paying up front while the dentist has it on bill hold and then waiting for him to pay you back does sound pretty risky though.
posted by strangely stunted trees at 11:24 AM on August 5, 2011 [1 favorite]
Best answer: If you want to call someone official to ask this question, you might see if there is a legal aid hotline that you can call in your area to pose the question to. This might be a good place to start?
Even if you *do* call the insurance company, the low-level phone worker you talk to probably is not the person qualified to make such an assessment. All you can possibly do is get your claim flagged, and get advice about as reliable as you'd get on Metafilter.
posted by Made of Star Stuff at 11:26 AM on August 5, 2011
Even if you *do* call the insurance company, the low-level phone worker you talk to probably is not the person qualified to make such an assessment. All you can possibly do is get your claim flagged, and get advice about as reliable as you'd get on Metafilter.
posted by Made of Star Stuff at 11:26 AM on August 5, 2011
Of course it's insurance fraud.
It might still be ethical for all the reasons stated above. That depends on your ethical code.
posted by J. Wilson at 11:31 AM on August 5, 2011
It might still be ethical for all the reasons stated above. That depends on your ethical code.
posted by J. Wilson at 11:31 AM on August 5, 2011
I don't want to tattle, I want to ask the insurance company if this is okay. If it's not okay to ask them, doesn't that make it fraud?
My worry is whether him doing the majority of the work in one billing cycle, then billing in another, would be construed as misrepresenting the time of treatment.
At this point, you kinda just have to pay out of pocket now. You've stated, in public, that you know about it. So if you do it now, there's a clear way to trace this to you.
I mean, the insurance company is almost certainly going to say this isn't kosher. They're in the business of denying claims because the more claims they deny, the more money they make.
Had you just been ignorant to most of it or feigned ignorance, I'd wager you'd have been okay. Can't really do that now.
posted by inturnaround at 11:48 AM on August 5, 2011
My worry is whether him doing the majority of the work in one billing cycle, then billing in another, would be construed as misrepresenting the time of treatment.
At this point, you kinda just have to pay out of pocket now. You've stated, in public, that you know about it. So if you do it now, there's a clear way to trace this to you.
I mean, the insurance company is almost certainly going to say this isn't kosher. They're in the business of denying claims because the more claims they deny, the more money they make.
Had you just been ignorant to most of it or feigned ignorance, I'd wager you'd have been okay. Can't really do that now.
posted by inturnaround at 11:48 AM on August 5, 2011
The risk is that they will deny the claim and you'll end up 100% out of pocket. Which is not that much worse than if you ask the dentist not to delay billing, since you have blown your cap for the year. It's also exactly the same as you'll be facing if you ask a lot of funny questions and get someone in their cost-control or audit departments onto you.
Looks like a win/win situation for you, at least to me. Or at least that the situations are all about equally bad, and there's a reasonable chance if you go along with the dentist's plan that you might end up slightly ahead.
The dentist is the one taking the risk here really.
posted by Kadin2048 at 11:49 AM on August 5, 2011
Looks like a win/win situation for you, at least to me. Or at least that the situations are all about equally bad, and there's a reasonable chance if you go along with the dentist's plan that you might end up slightly ahead.
The dentist is the one taking the risk here really.
posted by Kadin2048 at 11:49 AM on August 5, 2011
It can't be fraud if the dentist doesn't bill until all the work is done. You did mention that your wife would be seeing him in January for a final adjustment. If the dentist is comfortable waiting until then to do the billing why would you want to pay in advance?
posted by Gungho at 11:57 AM on August 5, 2011 [3 favorites]
posted by Gungho at 11:57 AM on August 5, 2011 [3 favorites]
Is it dishonest? Probably
Is it common practice? Probably
Does it violate the terms of your insurance? Probably
posted by blue_beetle at 12:16 PM on August 5, 2011
Is it common practice? Probably
Does it violate the terms of your insurance? Probably
posted by blue_beetle at 12:16 PM on August 5, 2011
Best answer: This is fraud.
I used to manage a dental office.
Patients would ask us to do this kind of thing all the time, and let me tell you, it can be very bad news for the dentist if he is caught, and! For you too. The insurance company makes money by not paying claims. This is true. BUT, this is so clearly outside the realm of the contract you have with them, they will come after you for the money if they find out.
Additionally, what if something major needs doing next year? You'll have already used your money.
Third. What if you no longer have dental insurance next year? (Job loss, employer switches carriers, fees increase wildly)
Regarding this:
No. While IASNAL, I'm pretty sure it is not your responsibility to know the ins and outs of the contract between the dentist and insurer.
posted by crabintheocean at 2:23 PM on August 5 [+] [!]
Actually, it is the patient's responsibility, and not the dentist's. The patient has a copy of the contract, or should have. The dentist does not have room to store that much paperwork, and probably wouldn't be given it by the insurance company even if they wanted to store it. We had very clear language in all of our consent forms saying, basically, "you have insurance, we'll submit your claim as a courtesy. If the company denies the claim, or tells us you no longer have insurance, YOU ARE PAYING US FOR THIS TREATMENT" I cannot tell you how many patients have no idea what their coverage is actually for.
Please don't help your dentist commit fraud, but do look into why that endo charged $750 for an exam. That seems...high. Request a copy of all the bills and claims forms from that doc. It might be totally legit, but check the codes and make sure you got what you paid for.
posted by bilabial at 12:24 PM on August 5, 2011 [1 favorite]
I used to manage a dental office.
Patients would ask us to do this kind of thing all the time, and let me tell you, it can be very bad news for the dentist if he is caught, and! For you too. The insurance company makes money by not paying claims. This is true. BUT, this is so clearly outside the realm of the contract you have with them, they will come after you for the money if they find out.
Additionally, what if something major needs doing next year? You'll have already used your money.
Third. What if you no longer have dental insurance next year? (Job loss, employer switches carriers, fees increase wildly)
Regarding this:
No. While IASNAL, I'm pretty sure it is not your responsibility to know the ins and outs of the contract between the dentist and insurer.
posted by crabintheocean at 2:23 PM on August 5 [+] [!]
Actually, it is the patient's responsibility, and not the dentist's. The patient has a copy of the contract, or should have. The dentist does not have room to store that much paperwork, and probably wouldn't be given it by the insurance company even if they wanted to store it. We had very clear language in all of our consent forms saying, basically, "you have insurance, we'll submit your claim as a courtesy. If the company denies the claim, or tells us you no longer have insurance, YOU ARE PAYING US FOR THIS TREATMENT" I cannot tell you how many patients have no idea what their coverage is actually for.
Please don't help your dentist commit fraud, but do look into why that endo charged $750 for an exam. That seems...high. Request a copy of all the bills and claims forms from that doc. It might be totally legit, but check the codes and make sure you got what you paid for.
posted by bilabial at 12:24 PM on August 5, 2011 [1 favorite]
Look, Swift, you clearly don't want to do this. The rest of us are jaded peons who are clearly not your best source for angel-on-your-shoulder advice. However, if cost is an issue, then it sounds like you'll need to delay treatment until after Jan. 1. Then everything is on the up and up, no? If cost is not an issue then go forward and pay out of pocket. Maybe you will need that money for next year. Maybe not.
And I agree with bilabial, there's no reason for someone to charge you that much just for a consultation. Dig into that and find out what's going on.
posted by amanda at 3:35 PM on August 5, 2011 [1 favorite]
And I agree with bilabial, there's no reason for someone to charge you that much just for a consultation. Dig into that and find out what's going on.
posted by amanda at 3:35 PM on August 5, 2011 [1 favorite]
Response by poster: Look, Swift, you clearly don't want to do this. The rest of us are jaded peons who are clearly not your best source for angel-on-your-shoulder advice.
I jaywalk and download torrents with the best of 'em, and I have no more love for insurance companies than anyone (I do have a soul, after all), but something about potential under-the-table fraud seems, I don't know, a little more serious than jaywalking. And a little more mysterious, since insurance rules are not something I think about that often, so maybe it isn't even fraud. The only way to really find out is to ask the insurance company, which I'm not about to do -- thanks for steering me from that road.
We are going to consult with a friend-of-the-family dentist couple before making a decision. Thanks for all the great input.
posted by swift at 5:50 PM on August 5, 2011
I jaywalk and download torrents with the best of 'em, and I have no more love for insurance companies than anyone (I do have a soul, after all), but something about potential under-the-table fraud seems, I don't know, a little more serious than jaywalking. And a little more mysterious, since insurance rules are not something I think about that often, so maybe it isn't even fraud. The only way to really find out is to ask the insurance company, which I'm not about to do -- thanks for steering me from that road.
We are going to consult with a friend-of-the-family dentist couple before making a decision. Thanks for all the great input.
posted by swift at 5:50 PM on August 5, 2011
Well, I think the penalty for this with your insurance is them denying your claim. For the dentist, who knows. Probably not much. No one is going to jail for it, I don't think.
posted by amanda at 7:46 PM on August 5, 2011
posted by amanda at 7:46 PM on August 5, 2011
The penalty is them denying your claim and the dent in your reputation. I'd bet that insurers keep some sort of records of this kind of thing, and it could follow you for a long time, making it more difficult to get reimbursed later.
posted by amtho at 7:57 PM on August 5, 2011
posted by amtho at 7:57 PM on August 5, 2011
For the dentist, it's probably being dropped as a provider by that insurance company. Which is a pretty big deal. It's also increased scrutiny of previously approved claims, as the insurance company looks to find fraud everywhere once it catches a whiff.
For the patient, if you knowingly engage in this, it's losing your coverage.
Thankfully I never worked in an office that engaged in this stuff, and we were just this side of polite with patients who tried to talk us into this. We went out of our way not to see first hand.
But I could look at your insurance contract and within two minutes find the part that says you can't bill next year for work performed this year. Or vice versa.
posted by bilabial at 8:00 PM on August 5, 2011
For the patient, if you knowingly engage in this, it's losing your coverage.
Thankfully I never worked in an office that engaged in this stuff, and we were just this side of polite with patients who tried to talk us into this. We went out of our way not to see first hand.
But I could look at your insurance contract and within two minutes find the part that says you can't bill next year for work performed this year. Or vice versa.
posted by bilabial at 8:00 PM on August 5, 2011
This thread is closed to new comments.
posted by crankylex at 10:35 AM on August 5, 2011 [4 favorites]