Is this an insurance scam?
Hey everyone, I could really use some advice on a frustrating situation. I went to an orthodontist for wisdom teeth extraction (they are in my network). Right off the bat, I paid a $200 consultation fee, which I know isn’t covered by my insurance. They informed me that my insurance wouldn’t cover the procedure upfront, but I could pay out-of-pocket and they would submit a claim for reimbursement if I was eligible. So, I went ahead and paid in full, had the surgery, and healed up.
Twelve days later, I followed up with my insurance and discovered that no claim had been filed at all. To my surprise, my insurance actually does cover the extraction and bone graft. I should only be responsible for 20%, with the insurance covering the rest.
We contacted the orthodontist’s office, requesting that they file a claim since they’re in network. The receptionist assured me she would pass the message along to the billing team. Days went by with no updates, so I called every day until something changed.
After two weeks of this back-and-forth, I finally saw that they had submitted a claim. Keep in mind, I paid $5,356 out-of-pocket—$5,000 for two bone grafts, $268 for the extractions, and $88 for anesthesia (though I’m not sure if that amount belongs there, as it just shows “Ir”). However, they filed a claim for $5,000 but for a completely different treatment than what I had. And guess what? That treatment isn’t even covered by my insurance.
I feel like this office is trying to take advantage of me. I spoke with the oral surgery department at my insurance, and they called the orthodontist today, confirmed my actual treatment, and instructed them to submit a new claim. The insurance representative advised me to wait a week for any updates, and if nothing changes, I should call back to file a formal complaint.
Will that help? I’m feeling really anxious and just want my money back. I’ve definitely learned my lesson and I will NEVER pay upfront for a procedure that should be covered by my insurance again.
I’m really sorry to hear about what you’ve been going through. It sounds incredibly frustrating, and it’s understandable to feel anxious in this situation. Based on what you’ve described, it does seem like there could be some serious issues with how the office is handling billing. You did the right thing by following up persistently and getting your insurance involved.
Filing a formal complaint could potentially help, especially if other patients have experienced similar issues. Insurance companies usually take complaints seriously, especially when it comes to billing practices. Additionally, consider reaching out to your state’s dental board or consumer protection office. They may be able to provide guidance or look into the office’s practices.
It’s also worth keeping a detailed record of all your communications with both the orthodontist office and your insurance company, including dates, names of individuals you spoke with, and what was discussed. This documentation can be crucial if you need to escalate the issue further.
It’s unfortunate that this has been your experience, but hopefully, with continued pressure, the office will correct the claim and you’ll receive the reimbursement you deserve. Good luck, and I hope everything gets resolved soon!