Imagine breaking up with someone… only to have them keep showing up at your house, eating your food, and still calling themselves your partner. That’s pretty much what’s happening with insurers like MetLife when you terminate a network like Dentemax. You said goodbye, you ended the relationship, you even blocked their number, but somehow, they’re still paying you under the old contract as if you’re happily in-network. Spoiler alert: you’re not.

And the worst part? They’re paying you at discounted in-network rates you never agreed to. It’s like ordering a filet mignon, getting charged for a hot dog, and being told you should be grateful you got paid at all.

The Insurance Blame Game: Dentists as the Punchline
Here’s how the circus usually plays out:

You drop Dentemax.

MetLife keeps paying you as if you’re still under Dentemax’s cut-rate fee schedule.

You complain.

MetLife says, “This is Dentemax’s problem.”

Dentemax says, “We don’t pay claims, only MetLife does.”

Months pass. Payroll dollars vanish into the black hole of follow-ups.

Finally, MetLife agrees to look into it… only to send you a refund request for thousands of dollars.

Yes, you heard that right. They underpaid you for over a year, and then demand money back. It’s like robbing your house, then sending you a bill for their gas money.

Fighting Back: The Refund Refusal Letter That Ends the Nonsense
This is where most dentists throw their hands up in frustration. But our clients don’t, because they use a powerful tool: the Refund Refusal Letter (yes, that one). It’s a beautifully legal, beautifully blunt way of saying:

“We acted in good faith, billed appropriately, accepted your payment in good faith, and exhausted the funds. Federal law, court precedents, and basic fairness are on our side. We don’t owe you a dime.”

And guess what? When MetLife and others get that letter, they usually back down. Why? Because the law is clear:

If a dentist billed honestly,

The insurer paid in error (their mistake),

The provider isn’t responsible for giving the money back.

Court cases from California to Texas to Georgia all back this up. In fact, the City of Hope Medical Center v. Superior Court of Los Angeles County case set a clear precedent: if the insurer messes up, the provider doesn’t have to fix it with their own money.

In short: don’t let insurance companies gaslight you into thinking you owe them. You don’t.

Why Dentists Are Saying “Enough”
It’s no wonder more dentists are going out-of-network. Every time insurers pull these stunts, they prove what we’ve been saying for years: insurance companies care about profits, not fairness.

Dentists are tired of:

Being paid under old, terminated contracts.
Playing customer service ping-pong between two companies.
Wasting staff time chasing money they already earned.
Getting slapped with illegitimate refund requests.

And let’s be real: you didn’t go to dental school to become a claims detective. You went to fix teeth, not chase MetLife around like it’s a bad date that won’t quit.

How to Win This Game
Here’s the playbook:

Document everything – Keep EOBs, call notes, letters, and all correspondence.

Use the Refund Refusal Letter – It’s your legal shield against bogus refund requests.

Push back on underpayments – Don’t accept “oops, we’ll fix it eventually.” Demand fair payment now.

Escalate when necessary – State insurance commissioners exist for a reason.

Consider your network strategy – If insurers can’t play fair, it might be time to leave their sandbox.

Bottom Line
Insurance plans paying you in-network when you’re not is a scam wrapped in bureaucracy and sprinkled with bad faith. But you don’t have to accept it. With the right tools (and a little bit of legal muscle) you can push back, protect your revenue, and remind insurers that dentists aren’t pushovers.

And when you need backup, that’s where we come in.

Call in the Experts
At Veritas Dental Resources, we live for this stuff. PPO fee negotiations, credentialing, contract strategy, fighting underpayments, refusing illegitimate refund requests, we do it all. And we do it with the precision of a surgeon and the sass of someone who’s just plain tired of insurance nonsense.

So the next time MetLife or any insurer tries to pay you in-network when you’re not, or dares to demand money back without proof, don’t just roll over. Call us. We’ll help you fight back and win.

Benjamin Tuinei
Founder – Veritas Dental Resources, LLC
📞 888-808-4513
Services: PPO Fee Negotiators, PPO Fee Negotiating, Insurance Fee Negotiating, Insurance Credentialing, Insurance Verifications
Websites: www.VeritasDentalResources.com, www.VerusDental.com