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Learning, Sharing, and Teaching => Ask a Mustachian => Topic started by: secondcor521 on December 01, 2014, 09:04:13 PM

Title: Help with orthodontist situation please!!
Post by: secondcor521 on December 01, 2014, 09:04:13 PM
Hi all,

To make the following narrative a little easier to understand, there are two orthodontists involved in this story.  Ortho #1 is located in the town where my son was going to college.  Ortho #2 is located in my city.

My oldest son was in college away from home and started braces with Ortho #1.

I signed a financial agreement with Ortho #1 which had me putting $0 down and paying the rest via a combination of dental insurance benefits and money from my FSA.  (I agreed to pay for my adult son's orthodontics because the problem that he is getting corrected is something that should have been detected when he was about 13.)

Ortho #1 did the initial consult, installed the braces on my son's teeth, and then saw him for a second visit.

My son then dropped out of college and has moved back home.

My son will be finishing his orthodontic treatment with Ortho #2.

I contacted Ortho #1 to pay them what I owed them for my son's partial treatment.

Ortho #1 is now asking for an amount which I find unreasonable.

I asked Ortho #2 what they thought about the fees and they also were amazed at what Ortho #1 was asking because it is about 250% what Ortho #2 would charge in the same situation.

I also shared with Ortho #2 one of the statements that Ortho #1 shared to justify their fee when they claimed a certain charge was their professional organization standard.  Ortho #2 said that they had never heard of that industry standard before.  Ortho #2 has been in business for probably 20 or 25 years.

Ortho #1 is also trying to say that the treatment plan was of shorter duration than their own documents state.  This has the effect of increasing their pro-rated share that they are asking for.

Finally, Ortho #1 is asking for a large amount of money to transfer my son's records to Ortho #2.

I want to pay Ortho #1 a "fair" amount but I am not sure how to best figure out what that is.

As noted above, Ortho #1 and I have a signed contract but it says nothing about a situation where a patient transfers.

Does anyone here know if there is some way to mediate or arbitrate in this situation?  What would you do?

Thanks for any help or advice.
Title: Re: Help with orthodontist situation please!!
Post by: ltt on December 01, 2014, 09:17:24 PM
Could you call your insurance company and find out what their contracted rate is with Ortho #1 and explain.  They will be able to tell you the amount you are responsible for.  And explain the situation to them. 
Title: Re: Help with orthodontist situation please!!
Post by: Goldielocks on December 01, 2014, 09:43:15 PM
I transferred my daughter's ortho to a new country, and that was quite easy.

There was a high initial  cost for the appliance , about 1/3, maybe more, then all agreed that 18 mos of appts was std treatment, which was the last 2/3rds.

I agree with the other comment, ask insurance company, dental college/ state assn, or even get a third opinion.
Title: Re: Help with orthodontist situation please!!
Post by: secondcor521 on December 01, 2014, 11:12:18 PM
Thanks for the replies.

The insurance is a little complicated, but basically they will pay 50% of whatever the orthodontist bills, up to a $1500 lifetime max on my ex-wife's dental insurance, and 50% of whatever the orthodontist bills up to a $2000 lifetime max on my dental insurance.  I believe neither insurance has a contracted rate with Ortho #1.  But I will check with them to see if they can help.
Title: Re: Help with orthodontist situation please!!
Post by: Allie on December 01, 2014, 11:54:10 PM
Oh my!  I would call the insurance company, for sure.  Get everything in writing.  Information you communicate to them and the information you get from them.  If they persist in trying to collect money they are not owed, which is exactly what they are doing if they make up fees and lie about documented treatment, consider reporting them to their professional organization, the State board, and consider an attorney. 

After our son's birth, the hospital tried to rebill us for services already paid by insurance companies.  At first, they gave me a hard time and threatened collections and such, claiming it was a different bill (for the mystery 2nd baby?) or that it hadn't been covered.  So, I had our family attorney call back.  Done in about 30 seconds.  I don't want to sound litigious, but without the threat of legal action, they probably would have kept hounding me. 
Title: Re: Help with orthodontist situation please!!
Post by: secondcor521 on December 24, 2014, 10:34:11 PM

After a few back and forth emails with the ortho's finance person, I basically said that I thought $1500 was fair, and if they didn't think that was fair, then I would be happy to bind myself to arbitration through a review with the state dental board.  I wasn't meaning to sound mean or litigious, I just thought they would be an unbiased, knowledgeable arbiter, and it seemed to me that if we both bound ourselves to their decision in advance, that was about as fair as we could get in an ambiguous situation.

I sent them a check for $1500 earlier this month and haven't heard a peep from them.  They also haven't cashed the check.  That's OK with me; my conscience is clear.

Thanks to all for the advice.
Title: Re: Help with orthodontist situation please!!
Post by: ThatGuy on December 25, 2014, 11:46:37 AM
I'm late to responding to this but what I'm adding is useful in many situations like this.  Contact the State Attorney General office.