Is this insurance fraud?

[u/ChickenGooooood]

I got Invisalign. My dentist submitted the claim to insurance for $6000. The insurance negotiated the price to $3800. The dentist still wants me to pay $6000 with my insurance covering $2000. The statement from my insurance says I only owe $2000 but the dentist wants $4000 from me.

UPDATE: I just called Delta dental. They confirmed my dentist is an in-network provider. The office billed 6k and the contracted rate for Invisalign is $3879, of which I am responsible for half. I already made a 1.5k down payment prior to starting treatment. The office is trying to bill me $3500 instead of $1939. This is considered balance billing and is a violation of the contract my dentist has with delta dental. I can open a grievance with them if they do not comply.

Question.. if I signed an agreement prior to receiving a letter from my insurance, am I required to pay?

I don’t want to make things super awkward considering I just started my treatment. I’m going to send the following email (so I have documentation). I’m welcome to suggestions to make this less awkward.

Good morning,

I hope you’re doing well. I’m writing to clarify a billing issue I noticed regarding my Invisalign treatment which I attempted to clarify with you at my first appointment. I contacted Delta Dental for further clarification and they confirmed that the contracted rate for Invisalign with in-network providers is $3,879. Delta will cover 50% of that amount, and my responsibility as the patient is $1,938.

Delta also confirmed that Dr. G is an in-network provider. As such, billing me beyond the contracted rate would be considered balance billing and would not align with Delta Dental’s in-network billing guidelines.

I truly appreciate the care I’ve been receiving from your office and want to make sure we’re all on the same page. I’m bringing this to your attention in the spirit of transparency and to ensure that everything is handled in accordance with the insurance agreement.

After double checking my file, could you please confirm the balance I owe considering I already made a downpayment of $1500.

[u/the_legend_hs]

Happened to my wife for some dental work.

I personally know the dentist (staff doesn’t know) but took a few emails to get it sorted out. They took pre negotiated balance - insurance payment.

I think the hardest part for the office was to actually admit they might of made a mistake.

[u/ChickenGooooood → u/the_legend_hs]

This is what I’m experiencing. The woman at the front desk doesn’t even want to talk to my insurance company. She said “it wouldn’t be helpful”. I think she either doesn’t want to admit her mistake or they want to collect the extra payments despite it being in violation of their contract with Delta. She even suggested I end care and told me that the 1.5k deposit is nonrefundable. I said I want to continue treatment bc I like the dentist. I feel like the receptionist is taking it personally.

[u/the_legend_hs → u/ChickenGooooood]

Maybe just in with your statement from insurance and have her go over it with you for “your understanding”.

[u/ChickenGooooood → u/the_legend_hs]

Yeah, I tried doing that. I told her I’m so confused. I need her to explain it hoping she would realize the mistake. She told me just to ignore the statement from insurance and pay what they bill me. 🤦‍♀️