How to get the cops to punish insurance for denying clean claims

[music] >> Welcome to the Navigating Dental Insurance podcast, where we don't take from insurance [music] companies. Here your hosts, Mr. Jordan Comstock and Mr. Ben Tuinei. >> Welcome to another exciting episode of the Navigating Dental Insurance podcast. My name is Ben Tuinei and I'm one of the co-hosts of this podcast and here I have today a Tessina Bullock with us today. Tessina, great to be with you again. >> Yes, thank you for having me. >> Thank you for joining us. So, as we promised to our

listeners, um Navigating Dental Insurance podcast is merging with Insurance Untangled podcast. So, if you're interested in the Insurance Untangled podcast, we'll still push out episodes on this platform for the next year to 2 years. Um but everything's migrating over to the Insurance Untangled podcast. Check that podcast out, insuranceuntangled.com. So, uh this is a weekly tip, 5 to 10 minutes of a quick tip about how to resolve a insurance problem within your practice. And um I got Tessina to commit to doing multiple episodes for us over

the next few months. Uh she's probably probably one of the best or probably the only, you know, guest that we'll have in terms of an insurance expert, but today we want to talk about the topic that brought you to this episode, [laughter] how to get the cops to punish insurance companies for denying clean claims. And let me just clarify the cops in this situation are the insurance commissioners, [laughter] not the actual police that you see out there patrolling on the streets and so forth. But, in

a roundabout way, when you talk about law enforcement, attorneys are in that realm, right? Judges, prosecutors, um criminal defense attorneys, you know, those are the ones, you know, you have so many different aspects of law enforcement. And in this case, when you talk about who enforces insurance companies, well, it's the insurance commissioner, right? So So, tell us about tell us about your story. So, last episode, we talked about where you briefly mentioned um that you fought a particular major insurance company and sort of brought them

to their knees. Uh can you kind of uh start from the beginning on on how that all started and and walk us through the whole story from start to finish? >> Yeah, you bet. Um it was very exciting uh times. Uh at the beginning was not exciting. It was so stressful. Um but I and I won't name names here. I'll be careful, but um there was an insurance company that was uh wrongfully denying um claims for our patients or downgrading like crowns uh to a filling

uh procedure and told us that we couldn't charge the patient any differently. And I was fighting every which way, trying to figure out how um how to put a stop to this, right? And I called all of the higher-ups of this insurance company I was battling. They uh she literally, this higher-up gal in this named no-name company, uh flat-out said to me that they were a nationwide company and that they would do what they please and there was nothing that I could do about it. She

didn't deny what they were doing was wrong. She didn't uh deny that there was evidence that the tooth needed to be restored with a crown. None of that. Just that they were bigger than me and I couldn't stop them. And that really infuriated me. >> [laughter] >> And I it's like, um no, right? Like, that's not right. And I'll I'll prove to you that we can. So, um I did. I reached out to attorneys. I reached out to um all these departments, one of which being

the insurance commissioner. And even the insurance commissioner at first was like there's not a whole lot we can do. And I called them several times and I had to point out to them several different claims. One claim wasn't enough. I had to take every single claim to them and then I had to find records of other offices having the same issue. So then I brought to their attention that I would have all of these offices together all come to their office filing complaints against the same

company if that's what it would take cuz she kept saying we we have to see a pattern. We have to see um that this is something that they're doing and it wasn't just a one case scenario. So um I did uh once I talked to her about having all of these uh providers reach out and complain, she kind of said, "Okay, like hang on. Calm down. Don't be rash." >> [laughter] >> Um she said, "Let me let me talk to the insurance commissioner cuz obviously I'm

just talking to a representative for the insurance commissioner." And they did launch an investigation and they did find fault in this insurance company. They did fine the company and tell them that um like it was a warning that they were not allowed to do that anymore. Um they were to pay claims correctly with you know without those issues that we were seeing. And I started not only did I get all of my claims reprocessed that they had messed up, but moving forward United Healthcare really didn't

get oh >> [laughter] >> You're fine. >> Now I said the name. >> You're fine. You're good. Don't worry about it. It's United Healthcare but I'll repeat it. >> [laughter] >> Now I'm name dropping. Um but yeah, they didn't give me any issues and I'll actually tell you to this day if they give me too many issues, I reach out to the insurance commissioner and I say I know there's already a spotlight on these guys. They're already being watched. So, they respond to me pretty quickly

like, "Uh, we don't want any trouble with her." And and they don't want any more of my patients. >> So, they flagged you with like in on the flag it says, "Don't mess mess with Tessina." >> Yes. [laughter] Yeah, so I never did hear back from that gal that had told me that I couldn't touch them. They were a nationwide company. She wouldn't return any of my phone calls after that. Um, and I don't know. I think I heard actually she's not there, you know, long

after that she wasn't there cuz they did bring that to the insurance commissioner's attention as well. That they openly threatened me. There was another time that a company um, was had [clears throat] misprocessed our address and then used that address against us to change our network status and then refused to fix it. So, again several attempts with the insurance commissioner and they're trying but they are bound by certain laws, certain things that they can do, what they have within rights. But, I don't really just take

that, you know. >> Yeah. [laughter] >> I keep fighting and I keep looking and I say, "Okay, what are my laws? What are my rights then?" And then we work those angles until I find a solution. Um, and in that instance as well, that same company that had done the address mix-up, they threatened me also. They called me and said that if I were to continue to do this, they were actually going to reprocess my claims out of network at a lower rate and tell me

that the patients were going to have to pay the difference. They threatened me several times. And I gave that information to the insurance commissioner as well. And again, we were able to get them um, to correct that behavior, reprocess my claims for correct payment, and back off, basically. But, it takes some work but it can be done and we have to know you have rights, we have rights, our patients have rights. And the insurance companies keep saying, we're so big you can't touch us. That's what

the insurance commissioner is for, but you have to know to go to the insurance commissioner and sometimes you have to even fight once you get there as well. But if you fight hard and use the insurance commissioner's policies and rules together with them, they will make those guys fall in line and they would they have to adhere. So if they don't do what the insurance commissioner says, this is what the insurance commissioner has explained to me, they actually have the right and the ability to tell

them that they can't practice in the entire state. So that's a pretty big threat for even these nationwide companies. They would be banned from the state. So they do fall in line pretty quickly. They're pretty eager to follow the rules when the insurance commissioner tells them they need to. >> Oh jeez. Imagine every practice in in the United States >> Right. >> using this technique. And going to the insurance commissioner. The sad thing is is is what I commonly hear is that when practices engage in

insurance commissioner, just like you did the first time you went to them, you were shot down and everybody gives up from there, right? And no progress is made. >> Right. >> You know, so your story is inspiring in the sense that don't give up. Like for for any practice that's out there, continue to fight the insurance well with the insurance commissioner. Um we've been hearing reports across the country that more and more people that are engaging the insurance commissioners, um they're the insurance commissioners are making

it easier for practices to work with them. Especially on issues like this where it's legitimate claims fraud on the part of the insurance companies, but nobody's been regulating the insurance companies for years. Why? It's cuz we've been accepting assignment of benefit, right? >> Yeah. >> And and we don't have time to mess with the insurance commissioner, right? So but you know, don't don't look at the negatives when it comes to fighting insurance companies. I recommend following Tessena's story and just being persistent, right? Which is the

key element to the the success in getting insurance companies to stop bullying dental practices. So, that's quite amazing, Tessena. Congratulations on on that effort. >> Yeah, [laughter] and the insurance commissioner did say that it's a problem something that we're becoming more aware of in dental. Dental offices aren't using the insurance commissioner the way that medical offices are. They just don't know that tool to use it. So, as and sorry not to take credit, but I all my training and consulting I've been pushing to use the

insurance commissioner. They are starting now to get more of an understanding and realization of what's happening in the dental industry that they weren't aware of before. So, they are asking more dental offices to start speaking up now and making it easier like you said to to put a stop to this. >> That's awesome. That's amazing feedback. >> [laughter] >> So, give that a try if you're listening and you want to check more about check out Tessena and who she is, what she provides. >> [music] >>

Of course, as she mentioned, she she does provide coaching and consulting. Check out her website. It's www.verisdental.com. That's also posted in the show notes in case you want to get a hold of her to pick her brain about all things insurance. Naturally, you can see her a fan favorite of the podcast. It's the reason why we bring her on regularly. So, Tessena, thank you again for today's episode. I know that we have several other topics lined up. One of which is I believe the next episode,

which is how to get an insurance company to stop denying build-ups. So, stay stay tuned for that, which will be posted a week from this episode. Or if you're listening to this recording a year later, the very next episode will be the build-up issue. So, thanks again, Tessena. I appreciate your time today. >> You bet. Thank you. >> And to our listeners, have a successful week. >> [music] [music]