I had a little problem with my dentist and insurance. After making a few phone calls and getting no where I chose to send a written correspondence. It is below:
Hi, I’m sure you remember me, I hadn’t seen a dentist in 7 years and needed $5000 in dental work done, $2500 of which could be covered by my insurance, but my insurance wasn’t going to kick in and pay for major for another month, despite your warnings I chose to wait to get my work done. So I came in on the 6th of June and had a route canal done. I paid for full price for the procedure, and then the plan was to wait for my insurance check to come in and then come in and get the second route canal done.
Guess what? The insurance didn’t pay my claim. Why? Because you are not one of their providers. Let’s go back a bit. I got the number to your office off of my service provider list for a Doctor S… who apparently you took the business over for. When I called in originally I spoke to a woman (whose name I do not know). She asked me who my insurance carrier was when I called, I told her, and she said that you guys used them all the time. So I made an appointment. Within an hour after making my appointment I was reviewing some information and noticed that you, Doctor D, were not the Doctor named on my insurance. It was, as previously mentioned, Doctor S. I called back that same day and mentioned this to the same woman I spoke to initially. I told her that I didn’t want to end up getting work done and then not have my insurance cover it. She assured me that your office dealt with this all the time, and that the Dental Select Gold plan paid out for all of your clients that had it. I spent a few minutes talking to her and she did a terrific job assuring me all would be well. So I kept my appointment.
I came in and we found out that the insurance wouldn’t pay on “major work” until June 1st. So I came back in on June 6th and you preformed my route canal. After the work was done the matter of payment came up. Upon conferring with Sensi (spelling?) I chose to pay for the procedure upfront to receive a small discount and then wait for my insurance check. I paid with my debit card, and, at the time, due to your office move your card reader was malfunctioning for some reason. So Sensi took down my payment information. I assumed that the payment would be taken out shortly… I assumed wrong. On June 12th, my debit card was stolen, as a result, when you finally did run my card for the payment it did not go through. No phone call was placed to inform me of this fact, time just simply continued to pass.
Then a while later I received word from Dental Select that they would not pay my claim because “I was not using a covered provider.” I was baffled especially because of the long conversation I had with the woman I spoke to the first time I called. So of course I called in to speak with your office about what I thought could only be an error. I spoke to Mary, I explained to her my situation, and she had no answers for me. She gave me some sort of, “Well they pay on other clients that are Gold Members with Dental Select, but I guess they didn’t pay on yours.” I informed her of my exchange with the first girl I spoke to months ago, and how she assured me that this wouldn’t happen. Mary simply had nothing to tell me but that my procedure wasn’t covered, and there was nothing she could do. Trying to be helpful she offered that I could use “care credit” to pay since it wasn’t covered… though she didn’t seem to understand that this would still mean I was paying $400 more then I was planning. In lieu of yelling and cursing at Mary, because it seemed clear that she didn’t know what she was talking about, I sat down and wrote the first two paragraphs of this email. I was interrupted when Sensi from your office called me back not a half hour after I had gotten off the phone with Mary.
Sensi, explained to me that there was some signature or some part of the claim process that she didn’t do because “She usually doesn’t have to” but that they must require it now. She told me that she had resubmitted the claim and was certain that upon receipt of the corrected request that I would be covered. I felt validated and thought “oh good.” This is when Sensi informed me (a full month after authorizing the payment) that my card had never been run. I guess some blame could be placed on me for not knowing whether or not the charge had gone through, but I seldom watch my bank account if I think I know what has been paid or not already. In any case, I mentioned to Sensi how interesting it was that here 30 minutes ago I thought that you had stolen from me, and at the same time you must have been thinking what a deadbeat I was. I pointed out to her that maybe I should wait to reauthorize the payment until she delivers on her whole “getting me covered by the insurance” promise. She seemed uncomfortable at the idea, and frankly I didn’t feel right about doing that, so after she again reassured me that my work would be covered and that I should expect a check in the next few days, I agreed to have my card run, which this time went through without a hitch.
Well, today I got word from the insurance company. They still are not going to pay my claim! The paperwork says that it is a “duplicate claim”. Now I feel like a tool and wish badly that I had not allowed you to charge my card for the work. Because it seems rather malicious that I would be promised so much only to find out that none of it were true. You have stolen approximately $400 dollars from me as far as I am concerned. Whether maliciously or accidentally, I have been wronged here. Had someone simply told me that my work would not have been covered because you are not a provider with my insurance I would have gone somewhere else… but instead I have been told over and over again by people in your employ that it was no problem, and would be all taken care of. I really find it difficult to believe that you would train people to lie about my insurance coverage to get me (a customer) in the door to make a little bit more money then you would have made had you turned me away like you should have in the beginning, but maybe I am wrong to think that… right now it looks to me like that is exactly what is happening.
Clearly I am upset and possibly being a little over dramatic, which is why I have chosen to write you this email detailing my plight rather then coming in or calling right away. I have a bit of a temper and do not want to lose it and jeopardize actually communicating. It has now been nearly two months since my first route canal and I still need another. I want my money back, either you made a mistake or you lied, either way I have been victimized.
I look forward to your response, and hope that this is all a misunderstanding that can easily be remedied. If so, I would be happy to continue the remaining $4000 in dental work that I require through your office. If you refuse to sort this situation out… well like a jackass all I can do is eat the $400 and dish out scathing reviews to all of my friends, family, and colleagues in hopes that they never step foot through your door. Maybe you don’t care about that, laughing all the way to the bank at the sucker who’s Four Hundy you just stole.
The next day I received this response:
Thank you for your email. I can understand how upset you must be. I would be also. I am personally looking into what the heck is going on. I was unaware of it. As I find out the details, I will let you know what's what. Thanks for your patience. Please don't think we are out to "sucker" you. We want to do what's right.
One week later I received a check from my insurance company and all was well. It's a good thing I watched "Summer School" as a kid and those crazy teens got a bunch of sunglasses in response to their letter so I could know how to do this.