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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Legal
Satisfied Customers: 116828
Experience:  JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
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I work for a dental office in MI. Can the company charge the

Customer Question

I work for a dental office in MI. Can the company charge the patients that has dental insurance (My healthy Mi plan for example) that is not a covered benefit (crown) higher fee than the insurance customary fee? Also can they apply a discount for the treatment without informing the insurance company and write off the remaining (discount) after collecting the insurance check from the patients insurance company? The dentist that I work with is also telling patients that they have decay (cavities) when it is not needed. Many of the patients have My health Mi plan with the state do not have co pay for filling, extraction, regular cleaning, dentures and partials. I am not a dentist but I been working in the dental field for over 20 years and I believe the dentist and the owners are abusing the insurance company and the patients they treat. What can I do to stop the abuse? I'm starting to get harassed by the office manager because of my concerns and the working environment is hostile. The office manager had me sign a paper stating that I voluntary give up my hours because I have to leave 2 hours early two days a week and after the semester is done that they are unable to guarantee that I can get my hours back. I signed the document because I felt threatened that I would be completely out of a job. Before I was hired I explained to them that I needed to leave early for school and they agreed that it was okay and hired me. I have work 10 to 12 hour shift with out being able to take a lunch or break. I was told once if I left for lunch that I would be out of a job. I have ask for medical insurance many times and the manager told me that I do not work enough hour for the company to pay for these benefits. I work between 35 and 40 hours a week. then I was hired they told me that I would get medical benefits I believe that other employees at the company do have medical benefits. I have many concerns regarding this company and would appreciate any information that will help.
Submitted: 10 months ago.
Category: Legal
Expert:  Law Educator, Esq. replied 10 months ago.
Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.

There is no law in MI preventing a dental provider from billing the patient for the difference between what the insurer pays and the cost of the treatment. The charges for services are based on what the dentist tells the patient their prices are and what the patient agrees to pay. However, if the dental office is charging some patients more than other patients for the same procedure, the State Attorney General is where you would file your complaint for unfair and deceptive business practices.

An employer cannot harass or retaliate against any employee for raising concerns of violation of laws and if they do so then the employee could have a suit against the employer for that retaliation and actually would be able to file a complaint with the EEOC for such retaliatory conduct.

As far as you leaving early and needing to leave work, the employer is entitled to have their employees at work and if you needed to leave early then the employer has a legitimate excuse for reducing your hours at work I am sorry to inform you, as an at will employer has a right to demand their employee show up and stay at work when the employer wants them to be there.
Customer: replied 10 months ago.
Even If the dental provider participates and agrees to the insurance company's usual and customary fee's. The provider agreed that they would use the insurance companies fees schedule? I was informed that if the provider participates with the insurance company that they have to except the insurance fee's schedule.
Expert:  Law Educator, Esq. replied 10 months ago.
Thank you for your reply.

If the dentist is actually a network provider, then that is a breach of contract issue between insurer and the dental office and that would be prevented by the network provider agreement. So if they are charging more than the amount determined in the network agreement, that is a matter to be reported to the insurer AND for the insurer and state insurance commission to investigate.