Question: Who do I call for an over charging dentist that lied about my insurance paying?

Answer: There is not enough information to really address your question. However often times when it comes to claims and what is being paid out, it is not the dentist office at fault or the dental insurance plan.  It is in fact the lack of understanding how your dental insurance works and or understanding of your plans terms and conditions.

If you have a PPO or Indemnity Plan:

Since these are plans where you can go outside of network or choose your own dentist the insurance company is out of the lope. Even though a dentist may call on coverages, it is up to you to make sure you are covered. You can do this by submitting a quote only to the claims department before the work is started or you can call. Many PPOs or Indemnity Plans pay based on % up to ACV/UCR so even though you may have coverage if your dentist is above the ACV/UCR you can get hit by a big bill. (that is why I advise to submit claims as quotes before the work is started. This helps you know what is your true cost for any procedure before having them done)

If you have an HMO:

HMOs are different in that you have to go with their dental providers. Cost for procedures are normally fee based. Meaning that the dentist will charge based on the fees laid out to them under the plan. Therefore if you feel your dentist lied to you about your coverages, I would start by calling the insurance company. Telling them what you had done (you will need the ADA codes) and finding out your true cost.

If it was a dental service that is covered under the plan, but the dentist cost is higher then the stated plan benefits, the dental insurance company will straighten that out for you so that you are only playing the cost the plan stated.  They do not want their dentist doing such stuff to their Insured’s and to many complaints will have them removed from the program.

However note, not all dental services are covered under an HMO dental insurance plan. So once again it is up to you that services that are being render are services that your plan covers. If not then you want to know why so you will be able to make your on decision on what you want to have done.

If you still feel the dentist lied to, you could go to the better business, but there is also the America Dentist Association. Most states have there own ADA web site.

You can also find web sites that you can leave a blogs about the dentist you went to this will help others in not going to them. I sell dental insurance and dental plans so I have clients that tell me they google, yahoo, bing ect the dental office before choosing a dentist. I am just not sure how much effort you want to put into this.