Legal Question in Consumer Law in California
I took my daughters, 7 years and 10 years old, to their Dentist to have their teeth cleaned. As part of the cleaning the Dentist took Xrays and proceeded to clean both ofmy daughtes teeth. At the end of the visit I was told that both my 10 year old and my 7 year old daughters needed to have a couple of their teeth sealed and I was advised by the Dentist to make an appointment for the routine proceedures to be done at their next visit. As advised I set the appointment and took my daughters back to the their Dentist where their teeth were sealed as planned. At the end of the visit I was told to see the front desk person who notified me that I had to pay an out of pocket fee of $140.00 to which I asked why and was told that our dental insurance did not cover all of the costs of the proceedures. I obliged and paid the money I was said to have owed. I later called my insurance company to inquire about to the out of pocket fee. My insurance company told me that I was not responsible for the out of pocket fees and that my insurance had covered and paid all fees to the dentist office leaving me with a $0.00 balance. They advised me to connect with the dental office to recover the $140.00 out of pocket fees. The insurance company also sent me an invoice of the bill and payment in full. I contacted the dental office and was connected to their billing office. I explained my claim and was asked to send the dental offices billing department the invoice from my insurance company to which I immediately complied. I was told that the accountant for the dental office would look over the invoice and contact me. I called the following day to do a follow up with the billing department of the dental office who informed me that the account for the dental office only stopped by their office on Mondays. This was a friday when I spoke to the billing department on my follow up call. I told them no problem and informed them that I would be calling their office back on Monday to follow up on my claim. I called back on Monday and was told that the Accountant did not show up on Monday and I was told to call back on Tuesday. I called back on Monday to speak with the billing person who I had been in contact with throughout this ordeal and was told that she was out to lunch. I called back again and got another excuse about the where abouts of my contact person. On Monday I was not able to connect with this particular person and was informed that she was the manager and the only person that I could talk to regarding my claim. I called on Tuesday the following day and was told that my contact was not in the office. I then got a hold of this contact person who then told me that the Accountant only comes into the office 1 a month. What is this, first the Accountant only comes in once a week then I am told he only comes in once a month? Then She proceeded to tell me, mind you, after insulting me a few times that the Accountant would contact me if he saw the need to reimburse me for the out of pocket fees of $140.00... I told my billing contact person that I wanted to speak with this Accountant and if I could have his phone number. I was giving an excuse as to why I could not have the number of the dental offices accountant to discuss fees that I was charged and paid out of pocket. I have a receipt of payment from the dental office and a record of my check being cashed from my bank. I also have an invoice of payment from my insurance company Humana Dental proving that the Dental office received full payment for services render to my daughters. What recourse of action do I have in this situation.
3 Answers from Attorneys
Small claims court.
Send a certified, return receipt letter addressed to the dentist, demanding repayment of your $140 by a reasonable date. If you don't receive payment by that date, you can file suit in small claims court. Bring all of your extensive documentation with you, and perhaps a letter from the insurance carrier that states that you are not liable for any of the amount.
If the dentist is any kind of plan participant with your insurance company, like a dental PPO or HMO, file a complaint with the insurance company. Also file a complaint with the Dept. of Consumer Affairs. It is a siginificant problem in medical and dental billing these days that unscrupulous providers are illegally charging patients on top of their insurance recipts. Both the insurance carriers and the government are taking these cases pretty seriously.
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