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Dental Billing Insurance for 3 times the amount for a crown than quoted to the patient, Legal or not?


Is a high % agent commission contract clause fraud in your jurisdiction?What legal ramifications can be imposed for making a item appears as though it has been stolen in transit, and then allowing the vendor to replace it?Can the Feds not put Bank Executives (or their employees) in Prison for Fraud?Is it legal to deliberately misrepresent the US. legal system for your own benefit?Are there legal labelling requirements regarding the “moisture-wicking” property claimed for certain fabrics?













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The patient is given a quote for a crown total of $900.00.

The patient paid the deductible and her quoted portion of $450.00 up front. When the patient received an EOB from the insurance $1600.00 had been charged to the insurance for the same crown. When questioning the amount, the office manager stated that he can charge any amount he wants to the insurance company. The doctor stated that the billing is out of her hands. The insurance company states that the patient should not have gone out of network and it is out of their hands. IS THIS LEGAL? OR THIS INSURANCE FRAUD?
Not only was the bill to insurance excessive but it also used up $700.00 more of the patients yearly maximum than originally quoted which means she will not be able to complete other dental treatment needed.









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    The patient is given a quote for a crown total of $900.00.

    The patient paid the deductible and her quoted portion of $450.00 up front. When the patient received an EOB from the insurance $1600.00 had been charged to the insurance for the same crown. When questioning the amount, the office manager stated that he can charge any amount he wants to the insurance company. The doctor stated that the billing is out of her hands. The insurance company states that the patient should not have gone out of network and it is out of their hands. IS THIS LEGAL? OR THIS INSURANCE FRAUD?
    Not only was the bill to insurance excessive but it also used up $700.00 more of the patients yearly maximum than originally quoted which means she will not be able to complete other dental treatment needed.









    share







    New contributor




    RDH is a new contributor to this site. Take care in asking for clarification, commenting, and answering.
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      The patient is given a quote for a crown total of $900.00.

      The patient paid the deductible and her quoted portion of $450.00 up front. When the patient received an EOB from the insurance $1600.00 had been charged to the insurance for the same crown. When questioning the amount, the office manager stated that he can charge any amount he wants to the insurance company. The doctor stated that the billing is out of her hands. The insurance company states that the patient should not have gone out of network and it is out of their hands. IS THIS LEGAL? OR THIS INSURANCE FRAUD?
      Not only was the bill to insurance excessive but it also used up $700.00 more of the patients yearly maximum than originally quoted which means she will not be able to complete other dental treatment needed.









      share







      New contributor




      RDH is a new contributor to this site. Take care in asking for clarification, commenting, and answering.
      Check out our Code of Conduct.












      The patient is given a quote for a crown total of $900.00.

      The patient paid the deductible and her quoted portion of $450.00 up front. When the patient received an EOB from the insurance $1600.00 had been charged to the insurance for the same crown. When questioning the amount, the office manager stated that he can charge any amount he wants to the insurance company. The doctor stated that the billing is out of her hands. The insurance company states that the patient should not have gone out of network and it is out of their hands. IS THIS LEGAL? OR THIS INSURANCE FRAUD?
      Not only was the bill to insurance excessive but it also used up $700.00 more of the patients yearly maximum than originally quoted which means she will not be able to complete other dental treatment needed.







      fraud





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