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I Had A Root Canal. Dentist Overcharged Me. Insurance Did An Investigation But The Dentist Refuses To Accept Its Finding. Dentist Has Mentioned Legal Actions. Any Insight?

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Location: California

I went to a dentist for root canal. I paid $400 on the day of. I signed standard financial paperwork that if for some reason insurance does not pay or cover for all the costs, I will be responsible for all of it. On that paperwork, a bunch of medical codes in two columns $200 each, total $400 co-payment. One column has 3330/0230/0220 and the other column has 9610.

The 9610 column is the one that has "N.C" noted. They never explained to me what NC was at the time. I assumed it was some medical billing thing. Didn't think much of it.

Explanation of benefits arrived and as it turned out, my co-payment was only $200. I called the office, they said the extra $200 was for some irrigation. I was never informed before, during or after the root canal. They stated the N.C stands for "Not Covered". They insisted that they did nothing wrong and emphasized that the paperwork i signed is a legally binding contract between the dentist and i if we go to the court.

My insurance says all, even uncovered treatments, claims need to be submitted to the insurance for processing. The insurance says their contract with the provider trumps any documents I may have signed and the provider must abide by the terms of their contract with the insurance including accepting the result of an investigation.

Additionally, the insurance also says 9610 should not have been billed separately as it's already included in the main billing code 3330.

Long story short, the dentist refuses to refund me. Insurance did investigation and as expected, it ruled in my favor. The dentist still refuses to refund me and says I will need to take them to court if I want the refund.

Insurance tells me I will get my money either way and the insurance can always refund me the money from their other claims.

My questions

  1. When the insurance, not the dentist, refunds me the $200. Does the dentist have any legal basis to sue me? Wouldn't this technically be a problem between the dentist and the insurance? It's no longer my issue since I paid the full $400. So technically I did not violate the agreement I signed.

  2. Can the dentist send the $200 to collections if the insurance refunds me?

  3. If the dentist sues me, will the dental insurance help me like car insurance would if got into a car accident? I spoke with the insurance, they said they have legal team to go against difficult providers especially those who choose to violate their contractual agreement with them but the representative is not sure if they would provide a legal representation for me.

Thank you.

submitted by /u/leagalillly
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