Donna

I just can't get a break.

First I see Dr. Horrible, a.k.a Dr. Hart at Exceptional Smiles (on S. Craig St.)---DO NOT EVER SEE THIS DENTIST. He will do unnecessary dental work, and claim that you really needed it. Now I have a terrible pain in my jaw every time I eat something cold probably because he drilled into a healthy tooth.

So I go see Dr. Schmeler (a.k.a Shadyside Smiles) on Copeland St., and she tells me I need only 2 additional fillings, as opposed to 5. Which is great news. But then they make me pay in full, even though I have dental insurance. They say they will issue a refund once the insurance company pays, because they think the insurance company might not pay.

But then I notice that they never filed a claim. I call, and they say the problem is that they need x-rays from the other dentist. I have the other office send the x-rays AGAIN, and I forget to call them back to follow up. Now, 2 months later, I remember that still nothing has been filed, and call up Dr. Schmeler's office.

This is what they tell me: since my insurance company does not pay based on the price of white fillings (they pay 80% of the cheapest possible way to fill the tooth, an amalgam filling), it would be *insurance fraud* for them to file a claim with the company. First they say that the company changes the procedure code, then when I explained that they do not, they made some other excuse.

I've since called my insurance company who says there is nothing fraudulent about such a claim, and they are going to follow up with me.

I am PISSED. One dentist sucks, but files claims correctly; the other dentist seems good, but won't file my claim! I wonder if I can file myself, since I did pay in full.

UPDATE: The insurance company called the dentist's office, and get this: they say they filed the claim in July and it got lost by the insurance company, and now since 30 days have passed and they received payment in full, they have no obligation to send the claim again. They are going to send me the claim form and I'm supposed to call the insurance company once I get it. Apparently the insurance rep asked the woman at the office about the insurance fraud issue, and she just ignored the question. I think I want to write a letter of complaint to the dentist, and hope that the claims person isn't the one that reads that letter...

UPDATE #2: I need a new dentist; anyone have any recommendations?