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Old 01-19-2018, 08:33 PM
 
14 posts, read 6,782 times
Reputation: 10

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Hi All,

Six months back I did my root canal. At the clinic, I clearly mentioned that I have a Aetna Dental Discount Card and not Insurance.
The front desk told me to see the doctor and in mean while she followed up with the Insurance company. Later she told me that it is accepted and they can move ahead with the treatment. I paid almost 40-50% of the money as co-pay(arnd $450 plus)

Fast forward 6 months, I get a call from the same person about the Insurance company not paying up and they want me to pay the bill.

Question -
- Is it correct for them to ask me to pay up, when in the first place they say they accept the discount card and now they are denying it?
- Is it ethical for them to say "Yes" to get business and then doing a U-turn and get me to pay the bill? Arent they suppose to do any due diligence?
- Can I raise a dispute anywhere?

I had other dental clinics in my area supporting the discount card and I could have easily saved the money. which they are now trying to extort it from me.

Any help\guidance would be greatly appreciated.

Regards,
Sam
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Old 01-19-2018, 10:59 PM
 
Location: on the wind
22,831 posts, read 18,124,688 times
Reputation: 74000
No one may be to "blame". Call Aetna and get info from the horse's mouth. FWIW, if I was planning an expensive procedure for the first time with a discount card I'd call them beforehand to make sure I knew what their actual coverage and my deductible would be. You won't know until you call them.
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Old 01-20-2018, 09:04 AM
 
629 posts, read 920,600 times
Reputation: 1164
Sigh....do your homework before throwing around serious accusations like"extortion". Dental services are rendered to YOU, not your insurance company. YOU are always responsible for the entire bill if the insurance company denies YOUR claim.

As far as the dental office telling you the procedure was "covered", they called the insurance company to verify coverage. They do this is as a courtesy to give you an ESTIMATE of your co-pay at that time. When they call YOUR insurance company on YOUR behalf (note that they are not required to do this at all), the first thing the insurance recording tells them is "This call is not a garuntee of coverage. Benefits will only be determined after a claim is submitted." This means that anything the insurance company told them may not be true and you have to actually get the dental work done first before YOUR insurance company decides if they want to cover it or not. Now who is the extortionist - the dentist or YOUR insurance company?

Bottom line - yes YOU are responsible for paying the dentist, not YOUR insurance company. Services were rendered to YOU and YOU need to pay for it. YOU signed up for the insurance policy, not the dentist. It is YOUR responsibility to know the limits of YOUR coverage. The responsibility for "due diligence" that you speak of falls on YOU, not the dentist. It is YOUR job to know the details of the insurance policy YOU bought, not the dentist's.

Check the paperwork YOU signed at the dental office and then call YOUR insurance company. They will tell you the exact same things I have written.

Pay YOUR bill. Learn from this experience.
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Old 01-23-2018, 01:05 PM
 
14 posts, read 6,782 times
Reputation: 10
Thanks AllisonHB and bart0323 for the response.

Bart - This is my understanding of Discount Card and how it works.

There is a predefined discount price agreed by clinic and insurer. So if there is no agreement by the clinic with the insurer, then why did they charge me a discounted fee in first place? Just to get the business?

It is not a insurance claim. So the clinic has to be very sure whether they support it or not. It should be black & white.
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Old 01-23-2018, 01:24 PM
 
629 posts, read 920,600 times
Reputation: 1164
Quote:
Originally Posted by ssam70 View Post
It is not a insurance claim. So the clinic has to be very sure whether they support it or not. It should be black & white.
Something is not adding up. If there is no insurance claim, then why did you have a "40-50% co-pay" and also why did the office call you saying the insurance did not pay? You can't bill an insurance company without submitting a claim.

If you had an HMO/DMO plan, then yes there would be no claim to file as you would pay 100% of the fee (which is discounted) directly to the office and that's the end of it. If you only paid 50% of the fee (no matter what kind of discount was given) and the office billed the insurance for the rest, then there was definitely a claim involved. If the insurance doesn't pay, the responsibility falls on you. You got the root canal, not your insurance company.

Last edited by bart0323; 01-23-2018 at 01:36 PM..
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Old 01-23-2018, 02:56 PM
 
14 posts, read 6,782 times
Reputation: 10
Sorry If I was not clear enough.

I have Aetna Vital Savings Discount Plan, not an insurance. It is a discount plan, as you know, it gives me a discount rates for the dental services. The rates are pre-determined by dental office and insurer.

If the dental office does not support a particular discount card, then they should have flat out rejected me. However, this clinic, did took a fee from me.

I believe it was a mis communication on the dental clinic part. However this dental clinic shows up on vital savings " Search Page" . So the clinic/ doctor is "In Plan Network".

It could be a genuine miscommunication or a bad way of getting business. In either way, is there a way for me to raise any dispute with them?
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Old 01-23-2018, 03:00 PM
 
Location: Denver CO
24,204 posts, read 19,020,768 times
Reputation: 38265
I'm very confused. If you have a discount card, not insurance, how is anything going to be covered by your insurance since you don't have any? If the dentist agrees to give you the discounted rate based on that card, that should be the end of it, there's no insurance to call for pre-authorization or to submit a claim to. And there's no co-pay, just what you owe at the discounted rate.
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Old 01-23-2018, 05:06 PM
 
Location: Southern California
29,267 posts, read 16,557,815 times
Reputation: 18901
Quote:
Originally Posted by emm74 View Post
I'm very confused. If you have a discount card, not insurance, how is anything going to be covered by your insurance since you don't have any? If the dentist agrees to give you the discounted rate based on that card, that should be the end of it, there's no insurance to call for pre-authorization or to submit a claim to. And there's no co-pay, just what you owe at the discounted rate.

That's how I understood it to when I had a Smilesaver discount membership...back then it was like $70 yr membership and then a schedule what services and what was paid. Like a cleaning for some time cost me $27. There were no additional charges. Used it for a couple other things too. Then Smilesaver changed and I never rejoined another group. Everyone got a directory of participating dentists. Now I'm dental visit free for I hope a Long Time.
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Old 01-23-2018, 05:40 PM
 
13,975 posts, read 25,820,403 times
Reputation: 39851
Quote:
Originally Posted by ssam70 View Post
Hi All,

Six months back I did my root canal. At the clinic, I clearly mentioned that I have a Aetna Dental Discount Card and not Insurance.
The front desk told me to see the doctor and in mean while she followed up with the Insurance company. Later she told me that it is accepted and they can move ahead with the treatment. I paid almost 40-50% of the money as co-pay(arnd $450 plus)

Fast forward 6 months, I get a call from the same person about the Insurance company not paying up and they want me to pay the bill.

Question -
- Is it correct for them to ask me to pay up, when in the first place they say they accept the discount card and now they are denying it?
- Is it ethical for them to say "Yes" to get business and then doing a U-turn and get me to pay the bill? Arent they suppose to do any due diligence?
- Can I raise a dispute anywhere?

I had other dental clinics in my area supporting the discount card and I could have easily saved the money. which they are now trying to extort it from me.

Any help\guidance would be greatly appreciated.

Regards,
Sam
I would call Vital Savings and let them talk to the dentist. If that dentist is listed on the plan, they have to accept it. We used that plan for years, without any problem. We saved about 1/3rd on every procedure. Not shabby for a family of 4 @ $125/yr.
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Old 03-08-2018, 04:49 PM
 
14 posts, read 6,782 times
Reputation: 10
Here is the Update -

Aetna - Vital Savings REJECTED all the claims -as it is a DISCOUNT CARD. They are correct.

Dental Clinic - Agreed it was a MIS INFORMATION communicated to me. They ASSUMED it was an INSURANCE and charged and claim accordingly. Even though they had my Member ID information.

I spoke to the Billing dept and they are going to come by to me with a 'discounted bill'( if possible)

What are my options? Can i logged a complaint about it anywhere?
Because I feel, I could have gone to some other provider who had better rates than them, had they told me outright.

Any suggestion would be helpful.
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