Re: Parents victims of dental fraud? What can be done?
- From: Steven Bornfeld <dentaltwinnonsense@xxxxxxxxxxxxx>
- Date: Sat, 04 Jun 2005 12:27:33 GMT
spamnadazilch@xxxxxxxxx wrote:
I'm becoming increasingly concerned that my parents are victims of dental fraud and I would appreciate professional opinions on possible recourse or what they should do at this point.
Among the many, many fishy things to go on (with their DMO dentist) are the following:
Price is quoted for say $800. Once the procedure is underway, it's $1600 ("oh, didn't we tell you that was per tooth!?"). To make matters worse, this procedure (among many others they have done) could have been substituted with a covered/free procedure but they weren't properly presented with these options. I fear, however, that they've probably signed paperwork that will hide the office's deception. "I have been presented with alternatives, etc. sign here."
My father has appeared 7 times for scheduled teeth cleanings and keeps getting inane excuses as to why they can't take him that day and that he'll have to come back. Unbelievable!
They extracted my dad's tooth and left part of the root in. When going in to fix it they broke a crown. When my father's there to get it fixed they hand him the bill to fix the crown. Shouldn't they be paying for their own mistakes?
They did one-half a deep cleaning on my dad and when he went to finish the other half he clarified with the dentist that it was already paid for. Once assured of this he agreed and surprise, surprise he got a bill for the second half after he's in the chair ready to go so, of course, he signs and pays.
The problem I see is that throughout all of this they have paid before even leaving the dentist's office. How can they possibly have any recourse if they continue to pay?! I plead with them to switch dentists but since my dad is in the middle of a procedure they're sticking with this one. With this last visit my dad finally asked for his medical records and was refused. I'm finally left thinking I'd better try to do something on their behalf since this can't go on. (They've actually had to take out a loan for what has amounted to over $5000 in dental bills). They feel confident that by complaining they'll get their money back but so much of this isn't documented but just "they said/I said", so do they really have a shot? Also, does it water down their case when they keep going to this dentist? Their "plan" has a fraud department but will that help get their money refunded once it's already been paid? I have begged them to not get anything done without getting it in writing but my dad assures me he knows what he's doing and he'll take them to small claims court. I just have that sinking feeling they won't have a leg to stand on after the fact (and retirement is looking farther and farther away with each procedure - my parents' not the dentist's!).
Please help!!! What can I/they do? They don't want to make the dentist angry since they have to keep seeing her right now but I say they need to start talking lawsuit or complaints to professional associations. By the way this is in California.
Thanks for any help. I'm feeling pretty desperate right now for help from someone who knows what's what.
What you have described is the stereotype of the DMO (capitation) model--that the dentist is paid by the subscriber and not the treatment, so there is a disincentive to get patients into the office to do work. Once they are there, there is a tendency to steer patients to the few procedures that are not covered under the plan.
Most of the insurance companies that run these plans are not dumb, and must know that this goes on. My conclusion is that they are not trying very hard to eliminate these practices. If they didn't tolerate these practices, many dentists would drop off their panels, and the insurance companies wouldn't be able to show purchasers of the insurance that nice, long list of participating providers.
I don't know what the law is in California, but in NY a patient MUST be furnished with a copy of their records if requested (a "reasonable" fee is permitted for duplication).
My feeling is this would be difficult to prove this rises to the level of fraud, as your father by continuing to be treated could be seen as giving tacit approval to the office's policies. If however there was a signed agreed upon treatment plan that you can demonstrate was deviated from you may be able to do something.
The thing which may be the most troublesome thing in your description is the repeated refusal to treat for scheduled appointments. This could be seen as abandonment, or perhaps insurance fraud. I wouldn't go to the insurance company though. I would inquire at the state board for dentistry or even the state insurance department.
Good luck, Steve
-- Cut the nonsense to reply
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