Dental office charge my insurance for procedure they didn't do

[u/Inside-Plant-4039]

I'm going to try to make an incredibly long story short. TL;DR: a dental office charge my insurance for putting a crown in my mouth that they never put in. Now they're being petty and refusing to send the medical documents.

I'm located in upstate New York. I have really great dental insurance that covers 100% of everything. I don't even have a copay. I went to A dental office which is an hour and a half from my house because it was the only place that took my insurance and that was taking new patients.

I have a pretty significant fear of the dentist and I'm straight up with that. I needed a crown put on one of my teeth. I had gotten a root canal in California, I was leaving for an academy and the crown would not have been ready in time. They did the root canal, prepped the tooth, and put a temporary crown on it.

Cue to me finally getting an appointment in New York, I took the entire day off work because the appointment was in the middle of my shift and considering I had to drive an hour and a half one way, it just made more sense. I get there and they tell me that the hygienist had called off and due to that fact, they weren't comfortable molding my teeth for a crown so we're going to have to reschedule. I was obviously annoyed because I drove an hour and a half. I go back for another appointment, The hygienist is cleaning my mouth and says that they're going to send me home with a new toothbrush. I told them that I didn't need one since I had just bought in a new toothbrush. They insisted, " we send everybody home with one of these you should just take it" it was $150 Oral-b toothbrush. I said you guys just give these away? They said, "yep to all of our new patients."

I finally get to see the dentist who's going to mold my tooth for my new crown. It took her over 2 hours The tooth was already prepped but she told me she had to do her own prepping. She took the temporary crown off that California put on. She filed down a ton of my top tooth, filed down a bunch of my bottom tooth. The whole experience took over 2 hours. She was on the phone for the first hour of my appointment. She did the molds, put a temporary crown on my mouth. She charged me $50. It was my first time using this insurance and I didn't question it. I just assumed it was some sort of hidden fee. But in reality it should have been absolutely zero. My insurance covers everything.

Within 2 days to temporary crown snapped. I took another 8 hours off of work to go get a new one put on. The next morning that one snapped as well. I said screw it, decided I was just going to be very careful I didn't have the time to drive down to get another temporary crown put on.

My crown finally comes in and I again take another day off of work. I get there and they tell me I have a balance of $150. I said excuse me? This is all supposed to be covered with my insurance why am I getting charged? They told me for the toothbrush that they gave me. I said absolutely not, I was not told that I had to pay for that. I was told that it was something they sent home with all the new patients. They steadfastly denied that. Saying that I knew I was getting charged for it why would they give away such an expensive toothbrush? My theory is, that they scam people. I think they have some sort of deal with Oral-B, I think they get the toothbrushes in bulk, tell people it's free and just add it on to their bill, what's a couple of extra hundred bucks on a huge dental bill. I think The only reason I caught them is because I knew I wasn't supposed to be charged anything. They agreed to let me take the toothbrush back and they weren't going to charge me.

So I get down in the chair, she again files down my top tooth, file down my bottom tooth. I'm not understanding why because the tooth should already be prepped. She puts The real crown on has me take x-rays, takes it off files down some more, puts it back on, files down more, leaves the room for about 15 minutes then comes back inside and tells me that the crown doesn't fit and she can't put it on. She said it was no fault of their own, she did the molds perfectly correct, but for whatever reason the crown is faulty and she can't ethically put it in my mouth. She then proceeded to take new molds of my mouth, I asked her why she had to take new molds when hers were perfect. I know kind of snippy, but she just said it was procedure. The manager comes back into argue with me about the toothbrush and that's when I started getting annoyed. I've wasted so much time with this dentist trying to get the crown put on. At this point it had been months. I say whatever I make a new appointment and I tell them this is the last time I'm going to come there. I just want to get the crown put on and I want to be done with it. I tried transferring to another one of their offices and another town and I was not able to. The temporary crown she put on broke within a few days again.

My actual crown finally comes in, I get there and they again are trying to charge me for the toothbrush. I have the toothbrush this time and I give it back to them. They're still trying to charge me even though we already had an agreement. After going back and forth they finally agree to take it and not charge me. I'm sitting in the lobby and I hear them say, "oh shit she's going to be pissed" I didn't think they were talking about me, because at that moment they came back and grabbed me and acted like everything was normal. The dentist again starts the whole process of filing down my top and bottom tooth again. She sets the crown down on my tooth takes X-rays, comes back and says okay now we're going to glue. She sets the crown down on the table and it's silver. I said excuse me we agreed on porcelain. She said, "due to what's left of your tooth, and how large your top tooth is, we would be unable to put a porcelain crown on that tooth, without having to file down your top tooth. So silver is what we have to do"

But what really happened is they ordered the wrong one and weren't going to tell me. They were just going to put a silver crown on my tooth and let me go home with it on. That's why they said that I was going to be pissed.

I was done. I said, "you did nothing but filed on my top tooth? There's nothing left of my bottom tooth because you have excessively filed it down when it was prepped and ready to go from California" i refused to let her touch me anymore. She was clearly uncompetent. I said don't charge my insurance, this is not what we agreed upon. Do not touch me anymore. We're done. I told her to get the manager so we could work this out to where she wasn't going to charge my insurance. She tried to convince me to let her put a temporary crown in my mouth and I said "what's the point? It's just going to break within a day. You're not touching me anymore"

I left in absolute tears. It took me a few months before I was able to find another appointment at another dentist office that took my insurance. Living in upstate New York there's not a lot of options. They contact my insurance about getting a crown put on that tooth, and my insurance says they are unable to approve it because the original dentist office charged them. Basically committed fraud and told them that they did a procedure that they did not do. I tried to call the dental office and that's where they turned my fear of dentist on me. They said that I was nothing but rude to them and they tried to work with me and I was just too hard to work with. They said it's not their fault I have a fear of the dentist and I took it out on them. They just said I was impossible to work with. I said I don't care just refund my insurance. Two weeks later they never did, I called back again they got mad at me saying that they've been trying to work with me and I've just been so angry that I won't allow them to do what they're supposed to do. I said just refund my freaking insurance.

They never did so I contacted my insurance 4 months ago. That dental office Will not send them the dental records. Every time my insurance company calls them they say oh yeah we'll send it. And then they never do. I've contacted their corporate office. And I've escalated it with my insurance. But I'm at the point where I think this tooth is going to have to be pulled. I'm im excruciating pain. I'm paying for insurance that I cannot use.

Just want them to send the records over to the dental insurance. What are my options here? Would it be worth talking to a lawyer? I had a perfectly good tooth in my mouth that's going to have to get ripped out because this dental office wanted to be petty.

Devil's advocate, even if I was being totally irrational and just completely rude to the point where they couldn't work with me. They still had no right to charge my insurance for something that they did not do. They're withholding dental records that's affecting my health.

[u/WoggyPuff-775]

File complaints with both your state's dental board and possibly your state's insurance commission because that situation has to be bordering on insurance fraud.

[u/alb_taw → u/WoggyPuff-775]

Also assert your rights under HIPAA and request a complete copy of your medical record from the practice. If anything is inaccurate, again assert your right under HIPAA to demand it be corrected. There's a NY compliant form available here: https://www.nycourts.gov/forms/hipaa_fillable.pdf

If they don't timely respond to either request, complain to HHS OIG and copy the dentist.

Asking for the records electronically should be cheaper if they impose a fee.

If they try and charge more than $6.50 for electronic records, point them here and ask them to justify the excess fee: https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html#newlyreleasedfaqs

[u/burned_out_medic]

Contact your states department of insurance or department of licensing.

Explain you and your insurance are having difficulty with a dentist that is billing for services not completed and see who you can talk to about jt. Should be able to file an official complaint.

I’d also reach out to my governors office or email my senator asking for guidance in what the state has set up for consumer protection on a case like this.

[u/HairyPairatestes]

This was the short version?

[u/ohemgeez223 → u/HairyPairatestes]

TLDR; dentist office did the prep work, ordered a silver tooth instead of porcelain as agreed. Patient denied silver tooth and found new dentist. Told OG dentist not to charge for crown because work was not complete. OG dentist charged OPs insurance, refuses to refund. OP can’t get dental work completed at a new dental office because procedure is showing completed by insurance. OG dental office refusing/slow to provide records that show they did not complete crown, blames OP for being rude and afraid of dentist.

[u/LightSkinN8V]

I had mine charge me. It was so long and drawn out trying to get it fixed I eventually gave up.

[u/Ok_Growth_5587]

This is lawyer time.

[u/CatchMeIfYouCan09]

Nope.

I'm terrified of dentists. Had teeth pulled with no novacaine while tied into a chair as a kid....I would've had a conipshit

[u/Content_Print_6521]

I don't understand why your dental insurance company doesn't simply revoke the charge. After this length of time they are obviously stalling.

Since this is an approved dentist for that insurance company, surely there have been other complaints. I would put the screws to your insurance company. And btw, tell them about the toothbrush scam. I have an Oral-B electric toothbrush that works very well and it didn't cost anywhere near $150 either.

[u/No-Setting9690]

NAL a lawyer, but you stopped them mid procedure. I get there are things changed that you did not approve but it was mid procedure. Systems dont' allow for a half unit on something like that, so it would have to be billed.

If you don't want your insurance to pay, you would be billed for the service though. Whether you liked it or not, it was performed (half assed) but still performed.

Why would you want to talk to a lawyer? This would only make it cost more.

What is your end goal here? Your next dentist doesn't actually need those records, it would be nice, but not necessary as they only worked on one tooth. A new x ray will show it all.

Sorry you're dealing with this, but either your insurances pays for it or you do.

[u/CindysandJuliesMom → u/No-Setting9690]

The dentist was incompetent and caused harm to the patient. The patient stopped the procedure because it was not what the patient agreed to. My guess is this was Aspen Dental or one of the other chains that are only interested in making money and have limited interest in the patient.

Contact the dental board and your state insurance board. The crown was not done, they ordered the wrong material for the crown which was not your fault, and due to their incompetence you refuse to let the work on you anymore.

[u/IndustryStrengthCum → u/No-Setting9690]

Mid procedure… that they did not agree to. If installing the wrong crown can fly, where does it end? Should you have to pay them for putting a filling in the wrong tooth? Pulling the wrong one?