My dentist's office requires payment upfront, and then they wait to get paid by the insurance. On Yelp, people say that it takes a lot of sweat and tears to get a refund from them. (In my case the insurance paid them almost 2 months ago, and they owe me over $1000 - still no sign of refund).

How long do they have to issue a refund, and can I demand penalties if they take too long?

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    Why is the insurance company sending your money to the dentist? – DJohnM Dec 7 '14 at 22:21
  • @User58220: It's not uncommon in the US to pay a doctor up front when it isn't clear how much your insurance will cover, and for them to reimburse you when their payment comes in. It's more common for them to simply wait to bill you until after the insurance has responded, and I would suggest that MaxB drop them a polite letter asking what's going on and saying that he really doesn't want to get consumer protection agencies involved... AND change dental offices immediately. (No, penalties are unlikely unless you go to court. Interest... maybe.) – keshlam Dec 7 '14 at 23:32
  • Is the dentist in-network or out-of-network? – mhoran_psprep Dec 8 '14 at 4:12
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    Botton line - they owe you money. Consider what they would do if you didn't pay them on time, and do the same. I.e.: threatening letters, lawsuits, collections - the whole thing, including charging late fees and interest after you issued first deadline. Get a good lawyer and nail them. – littleadv Dec 8 '14 at 4:50
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    @keshlam Admittedly this is in Canada, but when I pay my dentist up front my insurance sends the payment to me, not my dentist. Why should they send it to the dentist? They have their money. – DJClayworth Dec 8 '14 at 22:21

This is a civil matter, so while they should refund your money immediately, you may have to pull some teeth to get them to act. (sorry, couldn't help it)

Send a strong letter requesting payment by a certain date. Something like, "According to ABC insurance, you received payment from them two months ago. I contacted you three times already regarding reimbursement to no avail. I hereby demand reimbursement in the amount of $1000 by Friday, December 19th or I will be forced to take further action."

Might even want to send it certified mail, return receipt requested. That should do it -- a threat of legal action without explicitly saying so should get the point across. I'd expect a check pretty quickly. If it were me and they still don't pay by the deadline, I'd take them to small claims court (no lawyer needed). You won't get interest or penalties, but the costs of small claims court will be included in the judgment. I doubt it goes that far.

Oh, and use Yelp to find another dentist!

  • 1
    Upvoted, though I'd like to propose deleting "use Yelp to" -- how it's done is less important than doing it, and there are lots of other resources. – keshlam Dec 8 '14 at 22:37
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    Naming Yelp was supposed to be a bit humorous since OP mentioned that the dentist already has a lousy rep on Yelp. Hindsight, right? – Rocky Dec 9 '14 at 19:47
  • Ah. Missed that. Sigh... – keshlam Dec 9 '14 at 22:16

Some insurance companies in the US insist that if the dentist has been paid in full by the patient, then any insurance benefits will be paid directly to the patient and not to the dentist. Others do not insist, but will send the insurance benefits to the patient if the dentist's billing office marks the box saying "Benefits to be paid to the patient" or something similar. When I am paying the dentist bill (on the way out from the dentist office), I always remind the person I hand my check to to make sure that I get the reimbursement checks directly from the insurance company. These checks always arrive some time later, and if the check arrives more than three months late, included is another check for $x.yz as interest earned on money due to me. So, maybe all that is needed to remind the office about this when making the payment.

This is not to say that a careless data-entry clerk might still not check the right box, or that the dentist office might be doing what you are experiencing as a matter of policy: "keep the patient's money for as long as possible". Also, note that in some insurance company systems, the date that a claim is marked as processed and/or paid is not the day that the check is in the mail (or an ACH transfer is made).

If the problem persists, you should consider whether switching to another dentist with a better and more accommodating billing system will be better for you.

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