Provider Charge vs Allowed Amount

My wife and I have been going to the same dental office since we moved our current city 2 years ago. I looked up the dentist on my insurance’s website and they are in network. When we first started it was just dental cleaning and x-ray, the insurance always covered 100% and we never had to pay out of pocket.

Knowing that my wife had quite a few things to be done with her teeth, she opted for her work’s dental plan as primary, with my plan as secondary. Her plan is not in network with the dentist, but we like the dentist and didn’t want to switch.

For the past year, my wife had about $5,000 (provider charge) worth of work done, her insurance paid about $2,000, and we paid $1,900 out of pocket. For some reason my insurance only paid about $200. So, according the dental office she has $900 balance that she needs to pay.

But when I looked through my insurance’s EOBs. Since the dental office filed the claims as in network, there was a difference between provider charge vs allowed amount, and this amount is also called PPO savings on the EOBs. In total this amounts to $1,300. If I understand correctly, we actually overpaid by about $400.

Here is the twist, now the dental office claims that they are not in network with my insurance. The front desk lady has sent us several bills and called me several times about my wife’s balance. She has been really rude on the phone, demanding that we pay the balance. When I asked her why on the EOBs they are shown as in network, she just repeats and they are not in network and my insurance is wrong. When I asked why in the first year, when we did the dental cleaning, there was also a difference between provider charge and allowed amount, but they didn’t say anything, she just repeats that we should have been charged. She kept on insisting that they are not in network and they do not accept the PPO savings. She said she is done with contacting my insurance and we need to pay up or else she is turning the balance over the debt collector. I said okay do it then.

I called my insurance and explained my situation. CS rep said that the dental office filed the claims in network, and it was processed as in network. If the they have a problem with it then they need to refile as out of network, which I don’t understand how that works. If they do not refile, and keeps coming after me about paying the balance, they are committing fraud. The CS rep asked me if I would like to file a compliant against the dental office, and I said yes. But I am also not sure how that works.

I am not really worried about the debt collector, but I just want to get an opinion in this sub on who is wrong, and what should I do in this situation. If the PPO savings are legit, do I have a chance of getting the money we overpaid back? How?