OMP777X
Topic Author
Posts: 453
Joined: Fri Jan 23, 2015 8:10 am

What To Do About Hack Dentist Who Owes Me A Device

Fri Sep 11, 2015 6:13 am

Hi all,

I'm going to put this out here on A.Net because none of the attorneys I know personally have any experience with this issue, nor do I know of anyone else who's gone through it before.

Last year I saw a sleep specialist for sleep apnea, and after a sleep study, she determined my apnea was mild and referred me to a dentist who makes oral appliances to wear on your teeth which prevent apnea from occuring. I went to the dentist, got fit for the device, and was told it would be made by the dental lab within 5 weeks.

A couple of months went by and I hadn't heard anything from the dentist, so I called and he told me to come in. I went in several days later assuming I was going to pick up the device and be done with it, and the dentist informed me it was not ready due to a delay in manufacturing. At that time he fitted me for a temporary device that lasts 90 days, and sent me on my way expecting the one he billed my insurance $3000 for would be ready fairly soon.

Several more weeks went by and no word from the dentist's office. I called in again and was eventually told to come in on a day later that week. I arrived again thinking that the device would be completed and available for me to take home, and again it was not. This time the dentist informed me that there was a problem when he moved offices, and he implied someone misplaced the paperwork that should've been sent to the company who manufactures the device months earlier, and he said he'd need to refit me for it and resubmit the molds to have the device made up for me. That was months ago.

Since then, the dentist has told me he's been on medical leave for heart trouble, yet I've called his office and the receptionist informed me he was there and seeing patients. Since then, after asking him in an email when he's planning on being done with medical leave, he eventually responded earlier this week and said he could see me tomorrow (9/11) and would get back to me as to what time my appt would be. Tonight I emailed him back asking for the appt time, and reminded him I'd be near his office tomorrow morning anyway since I see my neurologist for Botox in the AM. He responded half an hour ago to say that he is now out of state helping a friend who's dealing with health issues, but he may be back in time to see me at some point before the end of the business day tomorrow. He's said I'll be getting an email tomorrow morning from him stating if he can see me, and when, if he ends up being back in time.

At this point I'm basically certain that this dentist is a fraud, and he pocketed the $3,000 check from BCBS and never sent my molds to any lab to manufacture the device. I notified him previously I felt it was unprofessional to tell me it would take 5 weeks and it is now over 9 months later and I still have nothing but a 90 day free trial device. I told him I'd call my insurance and inform them I received nothing, and that I planned on seeking the treatment from a different dentist ASAP.

Does anyone have advice on what my next step should be? I'd appreciate any suggestions you might think could be helpful here. I've never had issues with a healthcare provider before, so I'm lost in terms of a solution at the moment. Thanks in advance!

Best,

OMP777X
"Happy Flighting!"
 
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fr8mech
Posts: 7734
Joined: Mon Sep 26, 2005 9:00 am

RE: What To Do About Hack Dentist Who Owes Me A Device

Fri Sep 11, 2015 6:21 am

Quoting OMP777X (Thread starter):
At this point I'm basically certain that this dentist is a fraud, and he pocketed the $3,000 check from BCBS and never sent my molds to any lab to manufacture the device.

Contact your insurer and inform them of your suspicions. Provide a timeline and any documentation you have (you kept a record, right?) and let their people go after him.

Contact the local dental accreditation folks, including the state licensure board and provide as much detail as possible.

Oh, I don't forget to respectfully trash the dentist on Yelp! and any other social media outlet you want. Though, if your case isn't rock-solid, this may cause you some legal issues. Hell, it may cause issues if your case is solid, anyway.

Inform them (the insurer) that you plan on seeking treatment elsewhere and that you expect them to cover the cost as per your policy. Keep all documentation, including records of conversations on the hone. Try to do all you business with the dentist and insurer on paper or through email.
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rwessel
Posts: 2448
Joined: Tue Jan 16, 2007 3:47 pm

RE: What To Do About Hack Dentist Who Owes Me A Device

Fri Sep 11, 2015 6:56 am

Quoting Fr8mech (Reply 1):
Contact your insurer and inform them of your suspicions. Provide a timeline and any documentation you have (you kept a record, right?) and let their people go after him.

To the OP: AFAIK, all of the Blues have a fraud hotline and reporting procedure, and I would assume essential all of the other health insurers. For example, the one for BCBSIL can be found here:

http://www.bcbsil.com/company-info/who-we-are/fraud-prevention

They'll be happy to chat with you.

An additional reason to deal with this is if they’ve already paid for one appliance, they’ll probably not want to pay for a duplicate without good reason. So if you went to another dentist to get this made, you’re likely going to have trouble getting BCBS to pay for it.

[Edited 2015-09-11 00:06:03]
 
OMP777X
Topic Author
Posts: 453
Joined: Fri Jan 23, 2015 8:10 am

RE: What To Do About Hack Dentist Who Owes Me A Device

Fri Sep 11, 2015 7:42 am

Quoting Fr8mech (Reply 1):
(you kept a record, right?) and let their people go after him.

I have kept a record. The idea of someone else going after him is appealing considering I'm tired of his B.S. and he is wearing me thin. I almost wonder if he thought I'd just forget about it and move on.

Quoting Fr8mech (Reply 1):
Inform them (the insurer) that you plan on seeking treatment elsewhere and that you expect them to cover the cost as per your policy. Keep all documentation, including records of conversations on the hone. Try to do all you business with the dentist and insurer on paper or through email.

Okay, so that actually brings up an issue of forgot to mention before now. I was on a Blue Cross Blue Shield PPO plan through my union at the time he treated me initially. Now my union's long term disability benefits expired (including insurance), and COBRA would've been $1,400/mo, so I'm only insured through Medicare. Therefore, I have no dental coverage to speak of, but wondered if they would cover me retroactively given that I was covered when I sought to have this device made and was apparently the victim of insurance fraud. I have emailed and even texted during all previous communication with this quack, and will continue to do so. I even forgot to mention that during the email exchange he and I had about him being on medical leave, I told him I would be seeking to have my insurance revoke the payment to him (or whatever they could maybe do), and planned to seek that device elsewhere if he couldn't provide it by the end of the month. At that time he claimed he hade two dentist's "covering for him", and I said I'd gladly see one of them to have them provide the device to me, and asked for contact information for them. He then never responded to the last email of that thread, and then I only heard back when he invited me to his office this Friday.

Quoting rwessel (Reply 2):
To the OP: AFAIK, all of the Blues have a fraud hotline and reporting procedure, and I would assume essential all of the other health insurers. For example, the one for BCBSIL can be found here:

http://www.bcbsil.com/company-info/who-we-are/fraud-prevention

They'll be happy to chat with you.

An additional reason to deal with this is if they’ve already paid for one appliance, they’ll probably not want to pay for a duplicate without good reason. So if you went to another dentist to get this made, you’re likely going to have trouble getting BCBS to pay for it.

Wow, thanks, rwessel! I'm so glad to hear that, and am surprised that neither I nor my attorney friends knew of it. The weirdest thing about all of this is that the guy lives in my family's old house, the house I grew up in. I didn't know that when my sleep specialist referred me to him, but after chatting with him in my first visit we narrowed down that we know the same block in the same town, he mentioned he lived on it, and I said I used to as well, and it turned out he is the second to last person to have owned that house since my mother sold it when my grandma needed to downsize. So, to me it's weird that even knowing what I know about him (his home address, etc) he still seems to think he can flake off and disappear and nothing will come of it. I thought for a little I wouldn't hear from him and would have to send him a leeter from an attorney, but I'd much rather let BCBS handle that kind of thing. Thanks for the huge tip! I greatly appreciate it!
"Happy Flighting!"
 
Ken777
Posts: 9901
Joined: Thu Mar 11, 2004 5:39 am

RE: What To Do About Hack Dentist Who Owes Me A Device

Sat Sep 12, 2015 1:13 am

If there is any problem getting dental care (even though you are being treated for a non-dental condition) consider moving to an autopap. Unless you have now started exercising and loosing a lot of weight (if you are overweight) the autopap may well be a better option - financially and medically.

With the autopap the system evaluates your pressure needs on a continual basis, increasing and decreasing pressure during the night. (A normal pressure graph looks like a mountain range.) The older you get the more you will need more pressure as your airway "relaxes" and an autopap addresses that. It also addresses your airway relaxing after having a few drinks as well as medications that might have a muscle relaxant effect. If you have surgery a high upper limit can address the need to recover from a general anesthetic - that generally takes me 3 days minimum.

And, in reality, your OSA will probably progress over time and you'll eventually move to a "pap" device sooner or later. I've used a cpap or autopap since 1998 and won't even take a nap without it on. For general information my "rig" is:

- ResMed AirSense 10 AutoSet with built in humidifier. Range 8 - 16, no ramp, auto start
- ClimateLine Oxy hose
- Activa nasal mask
- chin strap when needed for mouth leaks

The ResMed 10 is their newest version and is very quiet. The lower setting of 8 allows me to dump the ramp (hate them) and the upper level of 16 takes care of me when I have a general anesthetic - I need a 16 the day and night of the surgery. The ClimateLine hose is a heating hose and greatly improves comfort. The Oxy part is simply a nipple for an oxygen hose and ready handy if you need it. The mask has an active cell (looks like a bellows on an accordion) which allows the frame to move in all directions without breaking the seal on the skin - great if you roll over a lot in bed.

Best part? Medicare covers pap therapy. The sleep Doc should be able to write a Rx for the full rig and, if you have supplemental insurance (strongly recommended) you aren't out a cent.
 
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DocLightning
Posts: 21549
Joined: Wed Nov 16, 2005 8:51 am

RE: What To Do About Hack Dentist Who Owes Me A Device

Sat Sep 12, 2015 1:38 am

Quoting OMP777X (Thread starter):
At this point I'm basically certain that this dentist is a fraud, and he pocketed the $3,000 check from BCBS and never sent my molds to any lab to manufacture the device. I notified him previously I felt it was unprofessional to tell me it would take 5 weeks and it is now over 9 months later and I still have nothing but a 90 day free trial device. I told him I'd call my insurance and inform them I received nothing, and that I planned on seeking the treatment from a different dentist ASAP.

First of all, inform the dentist's office (in writing if possible) of what you are planning to do if you don't have the promised equipment in 30 days.

Then you call the insurance company and the State Dental Board.
-Doc Lightning-

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