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MamaLlama

Orthodontist collected for services not rendered from ins. AND sent $200 to collections!

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I need help drafting a letter. We took my son to an orthodontist in our town on a recommendation of a friend. He began treatment but then we started having issues with the front office staff. He received less than 6 months of treatment before we switched to another orthodontist. New ortho couldn't file insurance claim because old one had hers in here. We called old to cancel the plan and in the meantime started paying out of pocket for his treatment. Long story short, life got in the way and we paid it all out of pocket.

Recently I pulled my reports for this year and noticed an entry from old ortho for $209! I then called our insurance provider and they stated they paid old ortho the full lifetime benefit ($2,000)! Of course, since he finished treatment quite some time ago, if Delta requests the money back from old ortho then they'll keep the money and he'll have ortho benefits reapplied... But if I can get it back it goes to us as it should and would had he finished treatment within the last 180 days or something.

 

So, obviously I need to ask them for moneys collected for services not provided, but what, if any, laws apply to the situation to add a heavier hand to my letter? And, I want to slip in there something about how can they put a collection out on me for $209 when they were overpaid approximately $1,500!

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What are you trying to accomplish??

 

What we can do is to help you get this off your reports, your problem with the original orthodontist and/or your insurance Co is outside our realm.

 

Follow the guides:

https://whychat.me/GUIDEBOOK.html

( if you haven't moved since the date of service you do not need to delete old addresses. If you HAVE moved and this entry is the ONLY medical account that is blemishing your reports, you do not need to bother to delete old addresses)

https://whychat.me/GUIDE%20HIPAA%20PROGRAM.html

 

Send each CRA where the account is reporting this;

https://whychat.me/hipaadisp.html

 

This will likely get it deleted.

If it does not, come back to this post and we will give you further assistance.

 

As to the over-payment to the orthodontist-- as it affected your cost to finish the treatment your only recourse is to file a complaint with your insurance Co and request that they "claw-back" the over-payment and refund to you the appropriate benefits for the completed services. You can add a "heavier hand" by stating that you will be reporting the issue to the proper State Insurance regulators failing resolution. Unless this took place over a year ago, in which case your insurance contract likely has a time limit for such appeals.

Edited by Why Chat

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I've followed your protocol on other medical claims and it works beautifully when there are errors.

 

I was seeking guidance on how to word the letter to the old orthodontist to give it more bite.

 

Thank you.

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I've followed your protocol on other medical claims and it works beautifully when there are errors.

 

I was seeking guidance on how to word the letter to the old orthodontist to give it more bite.

 

Thank you.

As I said, your best bet is to send a letter to your insurance Co not to the "old orthodontist" it is the responsibility of your insurance Co to properly pay claims and to deny claims. If the "old orthodontist" misrepresented himself in his claim to your insurance Co it is THEIR responsibility to fix it.

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