Alleged Dental Insurance Fraud Exposes Frustrations with Claims Process (MSN)

Alleged Dental Insurance Fraud Exposes Frustrations with Claims Process

Monday, May 20th, 2024 Fraud Insurance Industry Liability Litigation

Alberta, a policyholder, shared a troubling experience involving alleged dental insurance fraud, shedding light on the challenges consumers face when filing complaints. In a video, she explained that her insurance company billed her for a dental procedure supposedly conducted via Zoom, a claim she found absurd since she had never used or heard of such a service for dental care.

When Alberta reported the fraudulent claim to her dental insurance company, she encountered a frustrating back-and-forth. The insurer ultimately sent her a letter stating that they were unable to contact the dentist to verify the procedure. Consequently, they decided to drop her fraud claim. Alberta expressed her disbelief, arguing that the inability to contact the dentist should itself be evidence of fraud, as it indicated the potential nonexistence of the dental practice.

The situation became even more exasperating when the insurance company advised her to get an estimate for future dental work from the same dentist. Alberta, baffled, pointed out that she had no prior knowledge of this dentist and had been unable to establish any communication with them.

Alberta’s ordeal highlights a significant issue within the insurance industry: the difficulty consumers face in proving fraudulent claims and the lack of effective communication channels. Her story underscores the need for insurance companies to improve their processes for investigating and addressing fraud claims, ensuring that policyholders are not left to navigate such complex situations on their own.

Claims Pages Staff Writers are dedicated professionals covering a broad spectrum of insurance topics, including auto, catastrophe, education & training, fraud, legislation, liability, life & health, litigation, property, risk management, technology, underwriting, and workers' compensation. With over 25 years of distribution, our publication brings you accurate and timely information to keep you informed and ahead in the claims industry.

External References & Further Reading

Mid-America Catastrophe ServicesChurchill Claims ServicesU.S. Forensic

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