Fraudulent billing?

[noahpictures]

I received an "explanation of benefits" letter from my dental insurance company that states they paid a dentist for extractions and anesthesia last month. The problem is that I have never had extractions in my life. I visited this dentist about five months ago and he and his staff were pushing me to get extractions even though I was there for a single cavity. Again they were very pushy and took a bunch of x-rays even though I told him not to because I had taken x-rays less than a week ago with my previous dentist. I told them I didn't want the extractions and left the office.

So other than calling my insurance company in the morning, is there anything else I should do?

 

[AABCDS]

Weird! I've never had this happen to me before and am curious as to the outcome. Contacting your insurance company would be my first suggestion.

 

[nole1]

No. The insurance company will go after them for the fraud.

 

[_JP_]

Keep an eye on your credit report. Unpaid debts can wind up there even though they are not valid.

 

[smalltank]

http://www.ehow.com/facts_7497903_do-report-dentist-fraud.html

I hope this helps...I was watching 60 minutes and there was this company in Colorado that was a franchises of dentists...professional looking and everything...their main scam was upselling what wasnt needed...bonuses were given to the staff who sold the most unnecessary services for those who used their credit-card billing services...I cant remember the company but the US Attorney General got a boatload of cases...I wish you luck

 

[MaxP]

It may be an accidental coding error. Medical billing firms code millions of claims each month. And erros do happen. Contact your insurance company and let them do the investigation. They have people and procedures to do exactly that.

 

[DaveNJ74]

If you have a common name such as John Smith etc they might have made a mistake but I highly doubt that. Contacting the dental provider is correct and then maybe physically go back to that office and show them the paperwork for the work which they say they did but actually didn't.

 

[noahpictures]

Keep an eye on your credit report. Unpaid debts can wind up there even though they are not valid.

I didn't think about that. Thanks for the reminder.

 

[jlanger]

Someone other than you might be using your insurance number. I'd call the dentist/insurer ASAP.

 

[Emooring37]

1. Error
2. Staff embezzlement is also a possibility. The Dentist would want to know either way

 

[maskaggs]

I've never had this happen before, but I can imagine 3 people that ought to be made aware of what's going on:

1) Your insurer
2) The dentist - once you tell them you're already in contact with your insurer, they may sober up and realize their mistake
3) As a backup, you may want to reach out to your state's attorney general and the consumer protection department, if your state has one. Just in case - never hurts to get some info.

 

[sychodelix]

Seems very odd that they were pushing for extractions and stuff, and then they show up. Could have been a mistake, but with the pushing, it's a little too fishy. Somebody is gonna get in some serious trouble.


One question, you said you had a previous dentist take xrays a week before the 2nd one.

Why a new dentist?

 

[noahpictures]

Seems very odd that they were pushing for extractions and stuff, and then they show up. Could have been a mistake, but with the pushing, it's a little too fishy. Somebody is gonna get in some serious trouble.


One question, you said you had a previous dentist take xrays a week before the 2nd one.

Why a new dentist?

I had to switch insurance companies.

 

[sychodelix]

Ah, I hear ya. Anytime my insurance gets changed, all sorts of awful things can happen with it. Good luck with it!