Patient Advocacy Notes: Dental HMO Scams and How To Resolve Most Health Insurance Disputes

This brief episode can help if you want to know how to complain about your doctor, how to complain about your dentist, or how to dispute an overcharged medical or dental bill. Steps for most plans below.

Other notes from my experience: Avoid Dental HMOs. They lead to overcharging. Though lasers can sometimes help, dental laser scams are common and according to my insurance, the Current Dental Terminology by the American Dental Association says lasers are to be billed as part of the same service, not a separate line item on the bill.

1. For billing disputes: Compare your charges to the plan contract or rates. Ask customer service for the contracted rates. Also dispute anything you did not receive. Important: You can also file for quality of care issues (doctor/dentist/staff not treating you right).
2. Ask to file a written grievance. Check your member handbook or website for the specific terminology or an online form.
3. Detail all violations in writing. Reference any denial letter to bill. Note if your health issue is an emergency with proof of such (eg. Doctor’s note).
4. Mail or submit online and note the response timeframe set by law.
5. If your plan does not respond favorably or there is no grievance mechanism (PPOs and self funded plans may use different terms), consult your member handbook or plan website for correct complaint mechanisms, consult your state Department of Managed Care or Insurance, or call 211 and ask for a referral for assistance from your local Legal Aid Society.

This content is for entertainment and general informational purposes only. The listener should not rely solely upon such and consult a competent professional before deciding to follow any course of action.

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