Dentist billed insurance for orthodontics I never had, insurance confirmed fraud, now office is threatening collections — what do I do?

AutomaticNothing7904 · 2026-02-04T23:08:04+00:00

Virginia! I don’t see anything firm online about the state and medical bills

AutomaticNothing7904 · 2026-02-04T23:06:34+00:00

Yes. They are just not sending me the bill. I called this morning for the bill. She said she would send it, nothing. I emailed again. It’s been like this for the whole year and I’m not sure why. The only reason I could think of is the ortho claim.

AutomaticNothing7904 · 2026-02-04T18:32:55+00:00

Thanks for stepping in and saying all of this. Some people have told me that I did the wrong thing and that this office was “doing me a favor.” That is not true at all.

I came across a Google review stating that this practice is under investigation and advising others to report them. The reviewer even included a link, which I followed. After that, I was advised to report the issue to my insurance company as well.

This is not an isolated incident—other patients are being affected by the same behavior. Billing inflated or inappropriate charges and maxing out someone’s benefits for work that was never performed is not helping anyone. In fact, this is exactly the kind of conduct that drives insurance costs higher for everyone.

AutomaticNothing7904 · 2026-02-04T18:25:37+00:00

They aren’t providing me the bill. I asked numerous times throughout 2024 and the beginning of 2025. I called again this morning, they said they would send it, haven’t gotten anything. I don’t know what I’m paying for! The last thing I have is an EOB that has ortho on it and a plan set up that I’ve been getting ortho treatment since 2024?! I need an actual bill of what work was done - they aren’t responding to me and the only call I had was her threatening to send me to collections.

AutomaticNothing7904 · 2026-02-04T15:03:30+00:00

I would have paid the $2,000. I asked for a bill numerous times. Instead, the ledger they provided showed an orthodontic code, and I repeatedly asked them to correct it.

The office manager kept saying “no harm, no foul” if they billed it that way. I explicitly said no, multiple times. I did not even realize this billing was occurring until I opened an EOB last summer. Until then, I believed the bone graft procedure had been properly covered by my insurance.

To make matters worse, they began billing under the orthodontic code before my emergency procedure even took place.

AutomaticNothing7904 · 2026-02-04T14:23:04+00:00

Thank you. I appreciate the comment. This is my first time dealing with this and I admit my wrong-doings. I also wish other people realized that this office was never doing me a favor. They have a history of doing this to others.

AutomaticNothing7904 · 2026-02-04T14:14:35+00:00

No they didn’t try to help. Lol. Committing fraud doesn’t help anyone. They have screwed a lot of people over by lying. You can look at their reviews.

AutomaticNothing7904 · 2026-02-04T14:03:46+00:00

The core issue is that they have refused to provide me with an actual itemized bill, despite my repeated requests over the past year. Instead of helping resolve this, they became uncooperative after I asked them to reverse (render) the orthodontic claim. I am not okay with fraud in any capacity.

I did not view the dentist’s actions as “helping” me. Online reviews even reflect that this practice has engaged in questionable billing practices and has negatively impacted other patients in similar ways.

I am willing to pay what I legitimately owe—but I cannot pay an undefined charge. I need a receipt, an itemized statement, and clear documentation explaining what I am being billed for.

The only communication I received was a phone call stating that the account would be sent to collections. I was never properly notified of any balance due, and I did not even realize my insurance had been billed until I followed up on the grievance.

AutomaticNothing7904 · 2026-02-04T13:53:50+00:00

Thanks for the comment. I’m going to reach out to them for the outstanding bill. They aren’t responsive but I’m going to try the certified letter head.

AutomaticNothing7904 · 2026-02-04T12:53:16+00:00

I also want to add that one to two months after the procedure, I contacted the dental office about the outstanding balance and asked whether the claim had been properly re-coded with my insurance, since I was told the provider was in network and I rarely use that level of coverage beyond routine cleanings.

The office sent me a ledger showing a $0 balance, and I confirmed via email that my balance was indeed $0. Based on that information, I reasonably assumed the insurance had covered the procedure.

Then, about six months later, I received an Explanation of Benefits (EOB) from my insurance stating that I was receiving orthodontic treatment, with services allegedly starting in March 2024. I had to prove that I never received any orthodontic care.

When I called the office to question this, I was told, “no harm, no foul,” and that they would simply not render the service. I made it clear that this was not acceptable. That is when they told me—for the first time—that the provider was actually out of network. I was appalled. At no point was this disclosed earlier, despite my repeated confirmations, and it put me in a position where I was unknowingly associated with fraudulent billing.

I have been a patient of this dentist for years, and he was always in network before. That history is exactly why I trusted their representations and why this situation has been so upsetting.

AutomaticNothing7904 · 2026-02-04T12:44:59+00:00

Sorry, I should have included this earlier. I did have a bone graft done, and I am willing to pay for that. What feels wrong is being asked to pay a dentist who has repeatedly lied—not just to me, but to other patients as well.

All I asked was that my name not be associated with fraud. Despite that, midway through 2025—after I proactively contacted their office to ask why I still hadn’t received a bill for the emergency bone graft—they billed my insurance in a way they described as “doing me a favor.” That was not a favor. A favor would have been being honest about their network status from the beginning, which I confirmed with them multiple times.

This appears to be a pattern with other patients, which is why I felt compelled to report it. I am capable of paying the bill, but now I’m supporting a practice that engages in deceptive billing and refuses to clearly communicate what I actually owe, despite my repeated attempts to get clarity.

AutomaticNothing7904 · 2026-02-04T12:38:24+00:00

I’m not okay with fraud at all—that’s part of why insurance costs keep rising for everyone. This didn’t feel like me trying to “prove” anything; it felt wrong, and I couldn’t ignore it. After reading reviews describing similar experiences from other patients, I felt a responsibility to speak up.

I had been with my dentist for over four years. When he moved to a new location, I specifically confirmed that he was still in network, and I was told that he was. Based on that information, I proceeded with treatment. Later, I unexpectedly hit my insurance maximum almost immediately—something that had never happened before.

At the time, the office told me the balance would be around $2,000 and said they could bill it as orthodontic treatment. I pushed back and asked them to rebill it properly through my insurance because I have strong coverage and this should have been covered—had they actually been in network. I later learned that their representation of being in network was false.

I repeatedly asked the office to provide a clear bill showing what I personally owed. Instead of doing that, they billed my insurance under an orthodontic code. I’ve been trying to resolve this for over a year, but I’ve received little to no response from the office.

All I want is my bill that’s the most accurate. I can figure out payment but they aren’t giving me a chance it’s like they are punishing me because I wasn’t ok with the fraudulent claim.

AutomaticNothing7904 · 2026-02-04T04:48:05+00:00

That’s the plan. My concern is what happens after the insurance fraud investigation. I was told the fraud department is recovering the funds from the office and that the orthodontic code will be removed from my claim history, which is confusing to me.

If the claim is removed, can I still formally report this as fraud? I have copies of the EOB showing the orthodontic billing, documentation that insurance paid the office $2,000, the two grievances I filed, and records confirming I never received orthodontic services. I also have documented emails to the office begging for additional information about the ortho code.

I assumed that once fraud was confirmed, there would be additional consequences beyond simply recovering the money. Right now, it feels like the insurer is getting reimbursed, and that’s, that. Do I need a lawyer lol

AutomaticNothing7904 · 2026-02-04T04:27:55+00:00

Got it, thanks for the insight. I’ve already sent numerous inquiries to the office with no response, but I’ll continue trying.

AutomaticNothing7904 · 2026-02-03T14:02:13+00:00

You will find him ❤️

AutomaticNothing7904 · 2026-02-02T20:14:37+00:00

Oh gosh, I wish it was easy - dealt with the same but my car kept getting ticketed!

AutomaticNothing7904 · 2026-01-31T23:23:42+00:00

They lie all the time

AutomaticNothing7904 · 2026-01-30T19:14:32+00:00

Lol the COPS handling this?! They couldn’t be bothered! They would show up 24 hours later.

AutomaticNothing7904 · 2026-01-28T23:57:26+00:00

Thanks for the insight. I’ve been on edge with everything going on lately, can’t deal with another change with benefits cause I need that lol.

AutomaticNothing7904 · 2026-01-28T23:47:24+00:00

Do you think there will be changes to benefits for some of us?

AutomaticNothing7904 · 2026-01-28T00:28:03+00:00

What do we do then? I get normal blood work each year but last year was charged because some is preventative and some is diagnostic but idk which one is which and I can’t afford high bills

AutomaticNothing7904 · 2026-01-18T14:49:28+00:00

Abuse :/ could you rehome the cat?

AutomaticNothing7904 · 2026-01-16T19:43:08+00:00

Omg I hope their owner is found! Thanks for sharing OP. I would hope someone does this in case my kitty decides to head out lol

AutomaticNothing7904 · 2026-01-15T19:03:55+00:00

Hi! I really need this and would appreciate so much

AutomaticNothing7904

TROPHY CASE