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Consumer Complaints Consumer disputes include disputes over goods and services.

What are my rights?

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Old Jan 23rd, 2008, 02:23 AM     #1
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Default What are my rights?

I had made an appointment for my family with a dentists office. I told them right up front that my spouse had insurance with a federal employee plan. I asked them if they accepted that type of insurance because it is different from the standard PPO plans. The rep I spoke to told me that yes, they accepted that plan. Afterwards (and before the scheduled appointments) I found out that this particular office was not a participating provider with my spouses insurance. I called and told them that I had spoken to the insurance company and that they had told me that their office was not a participating provider and so I told them that I wanted to cancel our appointments. The rep I spoke to in the office assured me many times that they were in fact participating providers with this insurance company and that there would be no problems with our insurance covering the charges. We went in for the appointments and then later on down the road began getting the claim explanation of benefits many times and all the times, the claims were being denied. Of course, the claims were being denied because this dental office was in fact non-participating with my spouses federal employee insurance plan. We began getting statements in the mail and I spoke to the office manager and told her that we were not going to pay for these charges because their office assured us that they were participating providers and that I had even gone as far as wanting to cancel and was told again that they were providers with this plan. This office manager then told me that she had contacted our insurance company many times and was told by a supervisor that the claims would be reprocessed and paid. Well, needless to say they were not. I contacted the insurance company and they told me that this dentists office had only called one time and that was to verify benefits but that the provider was only a participating provider on the PPO side of the company and not the federal employee plan which is totally different. The rep at the insurance company told me that there was only one other time when this dentists office called and that was when they were going to appeal the insurance companies decision not to pay these claims. This rep told me that the person they spoke to from the dentists office did not seem to understand that there were two different sides (the PPO side and the federal employee side) with this insurance company and they just kept telling the rep at the insurance company that they were participating providers and the rep from the insurance company kept telling the rep at the dentists office that yes, you are a par provider with the PPO side but not the federal employee side. This rep from the insurance company said that they just didn't seem to get it and sounded confused about it all over the phone. We received a letter from the dentists office stating that they were going to appeal this decision and they even went on to say throughout the letter that they knew they were not par providers with this federal employee plan and even told us they would give us a discount if we would pay the debt or could even make payments. Now that the appeal is over, I have contacted the insurance company again and was told by one of the reps that I should take them to small claims court so that they cannot ruin our credit. The total is for $715.00 and now we are receiving statements that have a late/interest fee charge added onto the balance. I know that when I have spoken to the office manager all she keeps saying to me is that they (the dental office) had gotten incorrect information from the insurance company when they called initially for benefits and also the fact that the services were rendered and that we are responsible. I told her that yes, the services were rendered but under false pretenses and that they had misrepresented themselves in telling us that they were par providers when they were not. I told her that in good faith and based on what I was told by their rep in their office, we kept our appointment. I found out this was not the first time this has happened in this office. They had pulled this same scenario with another employee in my spouses office. Are we still responsible for this debt or does this office need to train their staff better and write this off? I would really appreciate some assistance with this as soon as possible as it has been driving me crazy.
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Old Jan 23rd, 2008, 11:24 PM     #2
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Default Re: What are my rights?

Based on what you say here, you could file suit against them (or at least threaten to do so) in small claims court or in regular court; filing in small claims court is easier and requires no attorney...you could try to collect all of the costs and damages that you suffered due to their behavior... You may also report them to your state attorney general's office.
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