Western Dental Ripoff Scam Insurance Fraud Fraudulent Billing Practices Illegal Collection Tactics Antioch California

My husband was a victim of Western Dental Service, also.

Western Dental is the contracted provider of dental services for my husband's dental insurance benefit administrator, United Concordia, through the California Field Ironworkers Union. My husband's dental insurance coverage through United Concordia is an "HMO-Fee for Service" plan with a deductible of $100.00. After the deductible has been met all other authorized dental services are covered at 100%.

Western Dental incorrectly billed United Concordia for the services that were provided to my husband. They billed for the same service using two different CDT-4 codes meaning that they attempted to duplicate bill our insurance carrier.

They performed dental procedures on my husband stating that these services were covered by our insurance when, in truth, these services were not covered by our insurance.

They attempted to bill our dental insurance carrier for dental procedures performed on a tooth, wherein records show that the tooth had been extracted prior to the date of service on the claim.

Western Dental repeatedly billed and attempted to collect from us, the $100.00 deductible, which was previously paid to another dental provider on 1/19/04.

Here is a list of the dental procedures that Western Dental billed to our dental insurance carrier - Please keep in mind that Western Dental is claiming that all of these services were perform during one single solitary visit to their office. The basic description of several of the codes appear to be identical and I have been told by another dental professional that the reason that some have different codes is because there is more than one procedure/service covered under that procedure code.

03/04/04 D2954 Prefabricated Post and Core Denied - Appeal Pending

03/04/04 D3330 Molar Root Canal (Excluding Final Restoration) Paid - Yes

03/04/04 D6750 Crown-Porcelain Fused to High Noble Metal Paid - No

03/04/04 D2750 Crown-Porcelain Fused to High Noble Metal Paid - No

03/04/04 D5214 Mandibular Partial Denture - Cast Metal Framework Paid - Yes

03/04/04 D6240 Pontic-Porcelain Fused to High Noble Metal Paid - No

03/04/04 D6790 Crown-Full Cast High Noble Metal Paid - Yes

Our insurance carrier has been very understanding concerning all of this and they have correctly paid Western Dental for the services that were authorized and covered by our dental plan.

However, for the past several months Western Dental has been trying to collect payment from us for all of the erroneous procedure codes that were billed to and eventually denied by our insurance carrier. They used very abusive collection tactics including harassment and threatening phone calls. Now, they have turned our account over to a third party collection agency who is threatening legal action against us.

We contacted United Concordia and unfortunately they stated that they have no control over the billing and collection practices of Western Dental and they are unable to stop this activity.

My husband's credit record has also been affected.

Recently, I found this information regarding Western Dental and I thought everyone here might be interested in reading this.

Western Dental Fined by the Department of Corporations: Western Dental was fined for 3 million dollars by the Department of Corporation. This fine comes after a long history of patient complaints and Western Dental's repeated refusal to correct violations of the law. Comments in a recent article noted several examples including dental treatment decision making that was improperly influenced by monetary and administrative considerations. Excessive treatment of patients in a single visit, treatment by general dentists when referral to a specialist was indicated, leaving medically compromised patients and or patients undergoing oral surgical procedures unattended. Western Dental is one of California's largest managed care dental providers. -- My opinion, "Western Dental is a prime example of the compromises made while delivering care under the business guidelines of managed care".
Underutilization: The Case of Western Dental Services of California Western Dental, with some 115 dental centers serving 350,000 Californians, was accused early in 1997 by the Department of Corporations of being in violation of the Knox-Keene Act (body of laws governing the licensure and operation of health plans in California). In addition, Western Dental is being investigated by the FBI for alleged insurance fraud11.

Medical audits conducted by the Department of Corporations revealed a repeated pattern of undertilization. Procedures that normally would take two or three visits, such as multiple root canals, were done in one sitting. Poor quality materials were also used. At
the core of the problem seems to be Western Dental's method of compensating managing dentists at the different centers. The Department of Corporation notes that quarterly bonuses ranged from $0 to $36,00012.

Julie
Antioch, California
U.S.A.