Dental billing question - Dentist did not bill correctly and now we are being su!
Question: I may need a attorney to answer this question, but any input would be appreciated...
We are being sued by the dentist for an unpaid balance..My husband had insurance, everytime he went to the dentist, he was told to pay his portion..
Well the dentist did not bill the insurance company correctly, meaning their codes were not correct and the insurance company kicked out the claims or the insurance company needed more information, like xrays, etc.
Well 3 years later, the dentist is suing us for the unpaid balance..I have copies of the dentist claim forms, and the insurance claim forms, that proves the dentist did not bill correctly and did not resubmit. My husband no longer works at that company so we do not have dental insurance. The dentist rebills the insurance company again 3 years later!
So my question is can I be held responsible for the dentist not getting his act together, and can I countersue somehow because this is on our credit history,???
Answers: I may need a attorney to answer this question, but any input would be appreciated...
We are being sued by the dentist for an unpaid balance..My husband had insurance, everytime he went to the dentist, he was told to pay his portion..
Well the dentist did not bill the insurance company correctly, meaning their codes were not correct and the insurance company kicked out the claims or the insurance company needed more information, like xrays, etc.
Well 3 years later, the dentist is suing us for the unpaid balance..I have copies of the dentist claim forms, and the insurance claim forms, that proves the dentist did not bill correctly and did not resubmit. My husband no longer works at that company so we do not have dental insurance. The dentist rebills the insurance company again 3 years later!
So my question is can I be held responsible for the dentist not getting his act together, and can I countersue somehow because this is on our credit history,???
First of all, it was the dentist's STAFF that incorrectly filed your husband's claims, not the dentist himself.
Did you receive monthly statements concerning your outstanding balance owed to the dentist? Did you call when you received the statements, or just filed them away?
Just because your husband does not work for the same company, he was still covered during that time period. My only worry is that since it's been 3 years, the claims may not be honored.
You are responsible for the amount due...you signed a statement saying so when you first filled out the paperwork at your first visit there...
Ideally you'll need copies of the treatment record, with the dates of service and what was done, and copies of the claims allegedly submitted by the dental office. Compare them to see if the right treatment was sent in for payment.. if not, it's a case of insurance fraud and the office is liable.
The office should have kept track of the insurance claims when they were submitted.. if, after a 45 day period, the claim had not been settled, they should have called the insurance company to see what the hold-up was... and if the insurance company requested xrays, they should have been duplicated and sent out immediately, so as not to hold up payment..
You may need a lawyer, or at least someone knowledgable enough to look over your paperwork and see what you have/what you need...too bad you didn't live closer, I'd be happy to help you out of this mess!
You can countersue, but it would be in your best interest to seek legal council on this one... and good for you that you kept copies of everything!
I wish you the best of luck! ...and I apologize for such a long-winded response!
I don't know but I feel for you. That really stinks. My guess is that ultimately...you are responsible. Curious if even a portion of the claim was paid by your then insurance to the Dr. . I would suggest doing what ever you can to protect your credit, even if you had to out of pocket to the Dr.(unfortunately).
Report your story to the dentist's licensing body immediately. Attach copies of your documents, not the originals. They are there to help you sort out your problem. If he is found guilty of billing fraud, he can be disciplined, fined, forced to take courses, have a sabbatical imposed, etc. This measure will cost you NOTHING.
Be patient. Don't be afraid of him. His licensing body will get to the bottom of this. Retain a lawyer immediately, preferably one who has dealt with dentists before. Try to counter sue for harassment and mental anguish.
Make copies of all of your documents and do not lose the originals.
Document the date of any correspondence you have with the dentist, be it by phone or letter.
Send any correspondence to the dentist by registered mail so that there is evidence he received it.
It sounds like you are going to be okay. Your story sounds very solid to me. Just relax and let the licensing body and your lawyer do all of the work. This might take quite a bit of time to work out. Most legal work does.
I am solidly in your court. Good luck!
why after all this time you are asking questions? It might be to late but worth a try to talk to your denist about this problem. Maybe he and you could come to some agreement. Do you still use this dentist?
I think if your dentist didn't fill out forms correctly you should have refilled it when this was happening. Did you receive any bills from the dentist all this time ago?
As for you having to pay... you might just have to do that. You should have done something BEFORE it has come to this.
I think you have hurt yourself by letting this go on for too long. Despite the thumbs down, I believe the first guy is right. Ultimately you owe the money to the dentist, but most healthcare providers are nice enough to basically float you a loan until the insurance pays them (instead of you). Your only recourse may be to pay the bill and work with the insurance company to get reimbursed.