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p { margin-bottom: 0.1in; line-height: 120%; }Hello there,

In middle October last year I went to my dentist for some check up and as I was in the middle of an awry divorce I asked them to check if I was still covered by my wife insurance, they checked and they told me that I was. I had to go back in two weeks and I asked again and again they told me that I was still covered (they also asked for a pre authorization to see what it was covered and what no.

Now after 6 months they are asking me $4,000 as my policy was canceled two weeks before my initial visit. It is clearly a negligence of the insurance as the departments didn't talk each other. If I appeal the insurance I think I won't have any chance to get dismissed so I want the dentist contest their decision as it would even be easier for them as I think they have a direct contact. Alternatively I want to file a small claim motion in court as if I knew I would have waited as the works were not urgent. by the way the dentist doesn't deny that I explicitly ask to check and that they were told I was covered.

Thanks to everyone in advance for the reply
 

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Actually if this is the case and you get a COBRA letter then you can apply for COBRA and it would backdate to when you w... (more)

RedWolfe01 (Apr. 05, 2017 @ 7:04p) |

Thank you guys for all your imputs, it is really a source of inspiration for me. Just a couple of clarifications:

Althoug... (more)

dippieffe (Apr. 07, 2017 @ 1:26a) |

In my experience, after about 2-3 months, United Healthcare will just withhold the money from future payments. The dent... (more)

gatzdon (Apr. 07, 2017 @ 8:57a) |

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rated:
It is not the responsibility of the dentist to ensure your coverage is active. It is SOLELY your responsibility.

Also, having worked in HR for a long time, it is pretty common for employers to have a lag in reporting cancelled benefits (sometimes there is only a monthly file with updates). In other words, when the dentist checked it, they may have been active but in between that time and when they bill dropped, the insurance had been updated with a cancellation date.

Let's say your benefits were supposed to end 4/30/16, you went in for an appointment on 5/20/16, insurance was showing as active. HR (or insurance company) didn't process paperwork until 5/31/16. The cancellation date would still be 4/30/16 and it would have also been active when the dentist checked for your appointment.

Expensive lesson, but be more detail oriented in these types of things moving forward.

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Thank you tennis8363 for your kind and exhaustive reply. I think even if I would be more detail oriented I wouldn't have been able to escape this inconvenient as if I asked the insurance myself, for the explanation you gave, I would have been told that I were covered while in reality, for the lag in reporting the cancellation, I wasn't.

Okay the dentist is without fault, can I do anything with the insurance? At this very moment of my life, attorney bills, forthcoming tax day, alimony and child support I really don't know how to pay such a high bill, you know, $ 4000 is a lot of money.

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dippieffe said:   Thank you tennis8363 for your kind and exhaustive reply. I think even if I would be more detail oriented I wouldn't have been able to escape this inconvenient as if I asked the insurance myself, for the explanation you gave, I would have been told that I were covered while in reality, for the lag in reporting the cancellation, I wasn't.

Okay the dentist is without fault, can I do anything with the insurance? At this very moment of my life, attorney bills, forthcoming tax day, alimony and child support I really don't know how to pay such a high bill, you know, $ 4000 is a lot of money.

The detail oriented comment comes back to knowing what is going on with the divorce. It doesn't help now, but asking your lawyer when the insurance was going to end would have probably been better than asking the dentist (or reading the divorce settlement, assuming it was finalized).

Three options at this point.

1) Ask for a cash pay discount and see how low they will go (should be at least 30% off, if not, don't go with this option). I assume this may not be on the table as it looks like you don't have the funds anyways.
2) Ask for a payment plan. Tell them you can pay $200 per month until it is paid off. Most medical/dental places will offer a no-interest payment plan.
3) The third option is not a good one (however, it is an option), but if your credit already isn't great, just don't pay it and move along. It will ding your credit score, but you can probably escape the costs.

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Ask them for options for a payment plan.

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You reminded me that I am naive (stupid) but you don't know how evil my wife is, however as you said "expensive lesson learned"

Going back with the options, I'm tempted with the 3rd one but I don't want to ding my credit that, believe it or not, is actually excellent so I will consider option 1 and 2. As I don't want to be stuck with $ 200 month for the next 20 months so I am thinking to tell them that, for the above reasons, I cannot afford to pay the bill and I am thinking not to pay it at all but willing to pay half of it cash right away if they like it. We'll see what happen. By the way it's just so simple no to pay it? Won't they do any action to recoup the money, e.g. seize my car, my TV etc.

However thank you very much, isobro as well, you don't even imagine how much relieve you gave me with your kind replies.

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dippieffe said:   You reminded me that I am naive (stupid) but you don't know how evil my wife is, however as you said "expensive lesson learned"

By the way it's just so simple no to pay it? Won't they do any action to recoup the money, e.g. seize my car, my TV etc.

 

  The extent of what they do is 1) send you to collections 2) Report no-payment to the credit agencies. They can't take anything of yours. They will likely ban you from receiving services again at that facility as well.

Also, no one is calling you stupid. You tried to get cute and made a mistake by not paying attention, doesn't matter how evil your ex is, you should have done more due diligence before the visit. You knew it (insurance) was ending soon and rushed out to the dentist.

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I think it would be fair for you to at least get the negotiated insurance rate, which is what the doctor was planning on receiving anyway. I would negotiate for that. And don't forget to include this debt in your divorce filings!

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I know you are not calling me stupid, mine was just an observation about myself even if in my defense I have to say that I am not native of this country, I don't know if you noted it from the way I write, and I still know little about these things here, how they really work, that's why I consider myself naive.

You don't know how many times I asked my wife to remove me from her insurance so I could have enrolled with my employer but, we finalized the divorce in June last year, in spite she never did it. Once I lost the patience and told her don't blame me if I go to the dentist and then you lose your bonus (I am not really sure what I am saying here but once she blamed me because she had some cumulative bonus that were eroded by some works that I had done - does it make sense?) so, here it shows her malice, she behind my back all of a sudden she canceled me from the dental insurance (the regular medical insurance was canceled on December 31st, 2016).

So when I went to the dentist I thought, comparing with my country and as we are in a such high technological country, that it was just a matter of check on their side if I was covered or not and when they said, twice in two weeks time, that I was covered I believe that.

However, I am now confused. Who I have to make my proposal to? The insurance or the dentist? See I am stupid

What do you mean by saying "send you to collections"? Do they force me to pay somehow?

BrianGa - What do you mean by saying "I think it would be fair for you to at least get the negotiated insurance rate, which is what the doctor was planning on receiving anyway. I would negotiate for that"? What shall I exactly do?

Unfortunately or fortunately the divorce was finalized last year so no more margin to include this debt.

Thanks again guys for your patience and replies. Really appreciate.

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dippieffe said:   So when I went to the dentist I thought, comparing with my country and as we are in a such high technological country, that it was just a matter of check on their side if I was covered or not and when they said, twice in two weeks time, that I was covered I believe that.

However, I am now confused. Who I have to make my proposal to? The insurance or the dentist? See I am stupid

What do you mean by saying "send you to collections"? Do they force me to pay somehow?

BrianGa - What do you mean by saying "I think it would be fair for you to at least get the negotiated insurance rate, which is what the doctor was planning on receiving anyway. I would negotiate for that"? What shall I exactly do?

Unfortunately or fortunately the divorce was finalized last year so no more margin to include this debt.

Thanks again guys for your patience and replies. Really appreciate.
 

You were not a customer of the insurance company at the time of service. They owe nothing to you.

Contact the dentist and tell them you can't pay the whole amount. Ask for the payment plan or cash/prompt pay discount - see next sentence.

What BrianGA mentioned is fine if you have the cash now, assume you would need at least 50% of the total owed. You would tell the dentist you would like their normal contracted rate with the insurer, see what they say. They may say no.

As far as collections, if you don't pay what you owe, they will send you to a collection agency. They will harass you daily with calls and letters until they determine you won't pay. At that time they send the owed debt report to the credit reporting agencies and it nukes your credit score.

By the way, I can pretty much guarantee that your wife did not lose a bonus based on dental utilization.
 

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tennis8363 said:   By the way, I can pretty much guarantee that your wife did not lose a bonus based on dental utilization.
  I didn't express myself well, it is something like some credit she had with the dentist, or at least this is what I understood when she told me that she wanted some money back from me because I had some works done that went against that credit. Nothing to do with her employer.

However, thank you guys again, I learned a lot from this conversation. I'll try to go for 50% cash, upfront right away. I'll keep you guys informed.

Good night.

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dippieffe said:   
tennis8363 said:   By the way, I can pretty much guarantee that your wife did not lose a bonus based on dental utilization.
  I didn't express myself well, it is something like some credit she had with the dentist, or at least this is what I understood when she told me that she wanted some money back from me because I had some works done that went against that credit. Nothing to do with her employer.

However, thank you guys again, I learned a lot from this conversation. I'll try to go for 50% cash, upfront right away. I'll keep you guys informed.

Good night.

  
Dental insurance has an annual cap, sometimes individual and sometimes family.  So in theory you would deplete what was available for that benefit year.  

One other thing of note, you don't HAVE to have her drop your insurance to get your own through your employer.  Your employer may have sort of internal requirement, but its not like they can check easily or even that you would know either way since you are a party on someone else's insurance.  Tell your ex to remove you on X-date and then apply via your employer to start that date.  If you end up with double insurance then you are still covered and if she wants to keep paying for you that is her issue.   
 

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RedWolfe01 said:   
dippieffe said:   
tennis8363 said:   By the way, I can pretty much guarantee that your wife did not lose a bonus based on dental utilization.
  I didn't express myself well, it is something like some credit she had with the dentist, or at least this is what I understood when she told me that she wanted some money back from me because I had some works done that went against that credit. Nothing to do with her employer.

However, thank you guys again, I learned a lot from this conversation. I'll try to go for 50% cash, upfront right away. I'll keep you guys informed.

Good night.

  
Dental insurance has an annual cap, sometimes individual and sometimes family.  So in theory you would deplete what was available for that benefit year. 
 

  True, or they could have an HRA type of dental plan setup (possible, but admittedly not likely based on the rest of the story). Only had a certain amount from the employer and that depleted the reimbursement account.

rated:
Three approaches to research here.

1. I believe COBRA applies for the spouse losing coverage due to divorce. If you did not receive required notifications, you may still be entitled to pay the premiums and receive the covered benefits. Don't know how this applies to dental and if you can get dental without health.

2. There are services that negotiate discounts for you. They collect their fee as a portion of the discount and don't get paid if they don't negotiate a big enough discount.

3. Find out what the typical insurance rate is for the services you received, and offer to pay via check for slightly less. You can call the insurance and find out what procedure codes were used and search the internet on those for the typical rates.

If the dentist doesn't accept the typical insurance rate or less, never go back and find another dentist. They legally don't have to accept a discount, but I personally don't care for medical professionals that squeeze patients for more money because they can. Patients that pay by cash or check are a done deal and rarely have the additional administrative overhead that comes with insurance claims.

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dippieffe said:   I know you are not calling me stupid, mine was just an observation about myself even if in my defense I have to say that I am not native of this country, I don't know if you noted it from the way I write, and I still know little about these things here, how they really work, that's why I consider myself naive.

You don't know how many times I asked my wife to remove me from her insurance so I could have enrolled with my employer but, we finalized the divorce in June last year, in spite she never did it. Once I lost the patience and told her don't blame me if I go to the dentist and then you lose your bonus (I am not really sure what I am saying here but once she blamed me because she had some cumulative bonus that were eroded by some works that I had done - does it make sense?) so, here it shows her malice, she behind my back all of a sudden she canceled me from the dental insurance (the regular medical insurance was canceled on December 31st, 2016).

So when I went to the dentist I thought, comparing with my country and as we are in a such high technological country, that it was just a matter of check on their side if I was covered or not and when they said, twice in two weeks time, that I was covered I believe that.

However, I am now confused. Who I have to make my proposal to? The insurance or the dentist? See I am stupid

What do you mean by saying "send you to collections"? Do they force me to pay somehow?

BrianGa - What do you mean by saying "I think it would be fair for you to at least get the negotiated insurance rate, which is what the doctor was planning on receiving anyway. I would negotiate for that"? What shall I exactly do?

Unfortunately or fortunately the divorce was finalized last year so no more margin to include this debt.

Thanks again guys for your patience and replies. Really appreciate.

 You instructed her to remove you from her policy.  That should've been the end of it, and you get your own coverage.  It's her own problem if she was continuing to pay for coverage you were no longer using, and when (or even if) she actually removes you is something you should never even know. 

If you told her to remove you and then proceeded to continue relying on being covered, it's really no one's fault but your own.  You are the one who didn't move on, and thought you could sneak in some extra benefit after being clear you didn't want any further benefit.  This is it backfiring.

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Glitch99 said:   
dippieffe said:   I know you are not calling me stupid, mine was just an observation about myself even if in my defense I have to say that I am not native of this country, I don't know if you noted it from the way I write, and I still know little about these things here, how they really work, that's why I consider myself naive.

You don't know how many times I asked my wife to remove me from her insurance so I could have enrolled with my employer but, we finalized the divorce in June last year, in spite she never did it. Once I lost the patience and told her don't blame me if I go to the dentist and then you lose your bonus (I am not really sure what I am saying here but once she blamed me because she had some cumulative bonus that were eroded by some works that I had done - does it make sense?) so, here it shows her malice, she behind my back all of a sudden she canceled me from the dental insurance (the regular medical insurance was canceled on December 31st, 2016).

So when I went to the dentist I thought, comparing with my country and as we are in a such high technological country, that it was just a matter of check on their side if I was covered or not and when they said, twice in two weeks time, that I was covered I believe that.

However, I am now confused. Who I have to make my proposal to? The insurance or the dentist? See I am stupid

What do you mean by saying "send you to collections"? Do they force me to pay somehow?

BrianGa - What do you mean by saying "I think it would be fair for you to at least get the negotiated insurance rate, which is what the doctor was planning on receiving anyway. I would negotiate for that"? What shall I exactly do?

Unfortunately or fortunately the divorce was finalized last year so no more margin to include this debt.

Thanks again guys for your patience and replies. Really appreciate.

 You instructed her to remove you from her policy.  That should've been the end of it, and you get your own coverage.  It's her own problem if she was continuing to pay for coverage you were no longer using, and when (or even if) she actually removes you is something you should never even know. 

If you told her to remove you and then proceeded to continue relying on being covered, it's really no one's fault but your own.  You are the one who didn't move on, and thought you could sneak in some extra benefit after being clear you didn't want any further benefit.  This is it backfiring.

  The key life event entitling you to enroll with your employer was the divorce.  Not discontinuing the other coverage could be a complication with regards to coordination of benefits, but not that big of a deal in that it would only delay payment to medical providers, not prevent coverage.

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dippieffe said:   p { margin-bottom: 0.1in; line-height: 120%; }Hello there,

In middle October last year I went to my dentist for some check up and as I was in the middle of an awry divorce I asked them to check if I was still covered by my wife insurance, they checked and they told me that I was. I had to go back in two weeks and I asked again and again they told me that I was still covered (they also asked for a pre authorization to see what it was covered and what no.

Now after 6 months they are asking me $4,000 as my policy was canceled two weeks before my initial visit. It is clearly a negligence of the insurance as the departments didn't talk each other. If I appeal the insurance I think I won't have any chance to get dismissed so I want the dentist contest their decision as it would even be easier for them as I think they have a direct contact. Alternatively I want to file a small claim motion in court as if I knew I would have waited as the works were not urgent. by the way the dentist doesn't deny that I explicitly ask to check and that they were told I was covered.

Thanks to everyone in advance for the reply

  
Perhaps I'm crazy, but I feel the insurance company should be held accountable. If you ever tell someone (in this case, the Dentist) that "Yes, this person is covered. Go ahead and do services on him because we will pay for the coverage" then they need to be held accountable for making such a claim. 

The fact that the Dentist can just pass blame on to you and say "You deal with it" is yet another continued problem with our healthcare industry.

rated:
dippieffe said:   BrianGa - What do you mean by saying "I think it would be fair for you to at least get the negotiated insurance rate, which is what the doctor was planning on receiving anyway. I would negotiate for that"? What shall I exactly do?
 

They are asking you for $4,000. But undoubtedly, had insurance covered the procedure, the doctor would have received less than that. The payment would have been at a rate set by the insurer's rate schedule agreement with the doctor. For example, and this is only an estimate, the doctor may have been paid $2,000 for the treatment (between insurance company disbursements and any deductibles / co-payments from you). I would suggest to the doctor that you should be charged for the services at the rate that would have applied had you been covered by the insurance, which both you and the doctor believed at the time of treatment. I wouldn't go so far as saying  that you can demand this, but I think it's both fair and legally justifiable.

rated:
Take them to court alleging malpractice.

Settle for them dropping the bill.

rated:
wateristasty said:   Take them to court alleging malpractice.

Settle for them dropping the bill.

That's unethical and, if the suit is found to be frivolous, could cost the guy in sanctions. Dumb suggestion.  

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tennis8363 said:   ~They can't take anything of yours. ~
 

  off-topic, but my dad worked for a finance company in the 60s and he actually repossessed someone's false teeth one time!

rated:
justignoredem said:   
dippieffe said:   p { margin-bottom: 0.1in; line-height: 120%; }Hello there,

In middle October last year I went to my dentist for some check up and as I was in the middle of an awry divorce I asked them to check if I was still covered by my wife insurance, they checked and they told me that I was. I had to go back in two weeks and I asked again and again they told me that I was still covered (they also asked for a pre authorization to see what it was covered and what no.

Now after 6 months they are asking me $4,000 as my policy was canceled two weeks before my initial visit. It is clearly a negligence of the insurance as the departments didn't talk each other. If I appeal the insurance I think I won't have any chance to get dismissed so I want the dentist contest their decision as it would even be easier for them as I think they have a direct contact. Alternatively I want to file a small claim motion in court as if I knew I would have waited as the works were not urgent. by the way the dentist doesn't deny that I explicitly ask to check and that they were told I was covered.

Thanks to everyone in advance for the reply

  
Perhaps I'm crazy, but I feel the insurance company should be held accountable. If you ever tell someone (in this case, the Dentist) that "Yes, this person is covered. Go ahead and do services on him because we will pay for the coverage" then they need to be held accountable for making such a claim. 

The fact that the Dentist can just pass blame on to you and say "You deal with it" is yet another continued problem with our healthcare industry.

  
I am not defending THIS dentist, but I have gotten Pre-Authorizations approved only to have claims denied due to the condition not being a covered benefit.  It's BS that an insurance company can do that, but it leaves the patient high and dry as services have already been rendered.  It's uncommon, but I have had the State Dept. of Insurance Regulation intervene to compel the insurance to pay for the services that were already rendered prior to the denied claim (which conveniently took 30-40 days to get the provider claim summary).

Many practitioners know their industry and how to avoid the common insurance company gimmicks, but they can't all be blames for the insurance company games.

rated:
Tell them you'll pay 50% or whatever insurance would have paid, and let them know you just had a divorce finalized but would still like to make sure this is paid. Mutter something about having to declare bankruptcy soon anyway. Get it in writing that you're paid in full before paying them, or better yet, have them send you a new updated bill with the amount you've agreed on.

rated:
dippieffe said:   You don't know how many times I asked my wife to remove me from her insurance so I could have enrolled with my employer
  Huh? I haven't heard anyone being held insurance-hostage before, is that a thing? I though that at worst you would have double insurance in such a situation and as long as you don't pay both premiums where's the problem...

rated:
tennis8363 said:   It is not the responsibility of the dentist to ensure your coverage is active. It is SOLELY your responsibility.

Also, having worked in HR for a long time, it is pretty common for employers to have a lag in reporting cancelled benefits (sometimes there is only a monthly file with updates). In other words, when the dentist checked it, they may have been active but in between that time and when they bill dropped, the insurance had been updated with a cancellation date.

Let's say your benefits were supposed to end 4/30/16, you went in for an appointment on 5/20/16, insurance was showing as active. HR (or insurance company) didn't process paperwork until 5/31/16. The cancellation date would still be 4/30/16 and it would have also been active when the dentist checked for your appointment.

Expensive lesson, but be more detail oriented in these types of things moving forward.

  it's also an insurance company's responsibility to tell a patient that "you're covered" doesn't always mean "you're covered."  

there should be a disclaimer:

"When we say 'you're covered,' we actually mean that, 'you're covered, unless there's a lag in your HR dept's reporting a cancellation.' Check with your HR dept. regarding whether your policy is still active, as your HR dept. has better information about your policy's status than we do, even though we're your insurance company."

rated:
gatzdon said:   Three approaches to research here.

1. I believe COBRA applies for the spouse losing coverage due to divorce. If you did not receive required notifications, you may still be entitled to pay the premiums and receive the covered benefits. Don't know how this applies to dental and if you can get dental without health.

2. There are services that negotiate discounts for you. They collect their fee as a portion of the discount and don't get paid if they don't negotiate a big enough discount.

3. Find out what the typical insurance rate is for the services you received, and offer to pay via check for slightly less. You can call the insurance and find out what procedure codes were used and search the internet on those for the typical rates.

If the dentist doesn't accept the typical insurance rate or less, never go back and find another dentist. They legally don't have to accept a discount, but I personally don't care for medical professionals that squeeze patients for more money because they can. Patients that pay by cash or check are a done deal and rarely have the additional administrative overhead that comes with insurance claims.

  
Actually if this is the case and you get a COBRA letter then you can apply for COBRA and it would backdate to when you were cancelled before to make continuous coverage.  They would then have to accept your claim.

Of course the premiums for a few months may be a decent chunk of what the benefit is.  Not sure you can just take dental and not medical.  

rated:
Thank you guys for all your imputs, it is really a source of inspiration for me. Just a couple of clarifications:

Although I asked many times my wife to be removed she didn't do it and my employer needed a formal cancellation letter from my former insurance to enroll me under the benefits they provide. The sentence of the divorce was not enough, they needed that letter that should have shown that I was no longer covered. In lack of that letter I could have only enrolled when they do the medical open enrollment again, which is actually being held in these days.

My divorce has been really not amicable as my wife has a real quarrelsome temper and gave me a lot of troubles. For this reason I avoided to go to her HR directly to avoid any possible accusation of harassment and the likes, she is capable of everything and has tried many times to accuse me of false allegation and also ask the judge for restraining orders.

However, the dentist who I have known for many years, and it seems to be supportive, has not done anything formal yet against me. They have only sent me the insurance communication about the Claim of Overpayment they received. Now it happened that I read it carefully and noticed that it states the following:


"If you have already refunded the above overpayment, or if you have submitted a dispute in accordance with our provider dispute resolution mechanism, please disregard this notice.

Right to Dispute: Section 10123.145 of the Insurance Code requires a provider to reimburse an insures for an overpayment within 30 working days of receipt of the notice of overpayment unless the provider contests the overpayment within 30 working days. To contest this overpayment, send the Claim ID and a explanation to: DISPUTES, PO BOX 30569, Salt lake City, UT 84130. Failure to make reimbursement of an uncontested overpayment within 30 working days after receipt of this notice will result in an accrual of interest at a rate of 10 percent per annum."


English is not my mother tongue but I understand that at this stage is the provider who has to contest this alleged overpayment. The reason for the overpayment is that at the time of the services I was not covered and in effect I was not covered but on my patient ledger, which I get from the dentist, showing what they did for me in October of 2016, we can see they started my treatment on 10/13/2016 and requested a fax the morning of my appointment. At the top of the fax it has the date they requested the eligibility with my insurance and we can see that it shows me as active.

So as it is clearly stated under California Insurance Code Section 10123.145, the right procedure is that they, as a provider, have to dispute what the insurance wrongly state as Overpayment of Claim and as justignoredem says above the insurance company should be held accountable as this just happened for their negligence that after having received the request to cease my coverage after a couple of weeks they faxed the dentist by saying that I was ACTIVE hence covered and authorized to do the works. They should have in place a better system than this to update the record in real time to avoid situations like this.

I am stubborn, I do not give in so easily.

rated:
In my experience, after about 2-3 months, United Healthcare will just withhold the money from future payments. The dentist will not ignore it and will refund the money (otherwise it really screws up managing their records).

The only basis that the provider would have for appealing is if the repayment was for something the provider failed to do (medical review, incorrect diagnostic/procedure codes, incorrect reimbursement rate, ...)

This is on OP to appeal.

I would determine if the legally mandated notifications were sent for COBRA and pursue that if they weren't. At this point, it may be 6 months worth of premiums needed to get it covered, so it still may not be worth it. Others with experience may know if you can argue lack of notification to get retroactive COBRA until some other date (like 12/31/2016 instead of present date).

The termination date is what it is and there probably isn't much you can do to move that to a later date.

I have no experience with dental, but some procedures require multiple visits. I do believe the insurance payments stop when coverage is terminated even though the course of treatment is incomplete. You can research the nuances of this, but it's probably a dead end.

Disclaimer: I'm not a laywer and I don't know your specific plan details.

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