Dental Fraud?

[jfairydust]

Hello. I recently moved to Boston and had to switch dentists. I found a dentist through my insurance, and called and asked if the dentist took my insurance and was in network. I was told YES, and so i scheduled a routine cleaning. I also needed to have 2 crowns put in on temporary teeth that I have had since I was 9. After my routine cleaning and the temporary teeth were put on (2 different visits), about 3 days later, the teeth turned BLACK. I then received mail from the insurance saying the dentist was not in network and they were denying my claim. I went back to the dentist on Monday and she had no idea why my teeth were back. She told me to come back on Tuesday. I went on Tuesday and discussed my option about switching dentists to cut my cost on the crowns in half. I had already been billed for 2 CROWNS ONLY, on my credit card. If you paid in fulll, you received a 5% discount. When I went to talk about switching dentist I was told that I would be refunded my money the next day via check, and the only cost they would subtract from the refund ($1425) would be for $64 for my routine cleaning, which I autorized them to do. I was told my refund would be $1425-$64. I was told I had not been bbilled yet for anything for the crowns. Now, 3 weeks later, and several phone calls later, I still do not have a refund. The dentist is trying to charge for temporaries that turned black, and I was not going to have her fix them in the first place...my new dentist informed me it was the previous dentist's FAULT, and can write a written statement to that effect. Since I am arguing over paying for the bad temps, especailly since I was told I would not be charged, I want them to issue a refund for the crowns ($1425). I believe this to be fair since I was billed for CROWNS not for TEMPS. They cannot hold onto something they didn't charge for. The bill itself is for 2 crowns, and says nothing about temps. They cannot "Hold onto" my money, not return my phone calls, and keep saying "they will get back to me." I have been lied to for 3 weeks now, and I am wondering if I have a strong enough case to go after this dentist's office.

 

[dee_dub]

It appears you did not get what you paid for on your credit card. Forget about fraud or suing the dentist. Just phone your credit company and cancel the charges.

 

[amdnivram]

sorry for threat jacking

hey im sorry aout taking your post but i cant make a new thread. I'm sorry but i was wondering if i can get sued for fraud if i sold a world of warcraft account to someone for 150$ but instead they paid 100 and a phone which i found out was stolen after the transaction. he has my info, and i know im breaching a verbal contract, but so did he since its illegal to sell stolen merchandise. Can he sue me? and selling the account is against the terms of service of the account that was sold. I'm just upset that he sold me a stolen phone which the carrier store took since it was stolen.

 

[dee_dub]

I don't see how you're breaching any agreement, unless you didn't give him the account.

Assuming you did give him the account, why would he sue you? You're the one who got less than what you bargained for.

 

[amdnivram]

if i was to take it back would he be able to sue me?

 

[dee_dub]

Well, then you'd have his $100 and he'd have nothing, right?

If you give him his $100 back, and take the account back, you're both back where you started and nobody's lost anything except for the stolen phone, and good luck to him trying to sue you for that. Remember also that suing costs money, even in small claims court, and these kinds of things often aren't worth pursuing.

 

[amdnivram]

ahh ok, how much is it to go to small claims?

 

[dee_dub]

Depends on your jurisdiction and the dollar value of your claim. Consult your local court clerk or check their website.

 

[ppnj4]

1) You can call the credit card company and explain to them that the charges for the "crowns" were unauthorized.....that will start a 3 month process where they will put those charges on hold, contact the dental practice and request written proof you agreed to the charges (such as a signature on the receipt)...If you signed that there might be very little the credit card company can do.

2) In order to win a malpractice case against a dentist you must be able to show the four D's...
DUTY - a dentist/patient relationship must exist (such as patient records/x-rays, etc)
DERELICT - showing a lack of duty or negligence (your new dentist can attest to that but will have to do so in court as witness statements are not accepted in writing, also a copy of your chart showing the repair to the teeth that were not cared for properly can do sometimes)
DIRECT CAUSE - the end result (having to replace temps) was a direct result of the dentists negligence
DAMAGES - pain & suffering, loss of income, and medical bills are all part of damages to you...

If you can prove those four D's existed in your case then you would be awarded what ever reasonable damages you seek including what the old charged you and what the new dentist charged you, BUT if the insurance company paid for any part of the new or old they will take you to court to get reimbursed in full from your judgment...

Understand though that by allowing them to place the temps you gave "implied consent" meaning that you gave consent by your actions (allowing them to do it)...you may not get a refund on the cost of the temps, just the amount above and beyond the cost of a temp for a crown.

I would call the ADA (American Dental Association) or your states Board of Dentistry (they all have one and the ADA can help you find it) and the BBB to lodge a consumer/patient complaint...let your old dentist know that you are doing so. Sometimes just the threat of having those organizations looking over your shoulder is enough for a business (and dentist are simple a business) to try and make it go away. Unless they agree to refund the amount the promised lodge the complaint..at least then you may save someone else from the pain of dealing with them.