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Old 12-04-2008, 06:04 AM
 
Location: Stuck on the East Coast, hoping to head West
1,924 posts, read 4,289,347 times
Reputation: 2454
Default can my dentist bill me for this?

I recently went to see a periodontist who is in network with my dental insurance. I called his office before I went in for the first visit to get the dental codes that I'd be billed. Got them. Called insurance and found out they're covered at 100% so I'm good to go.

A few weeks letter get the explanation of insurance benefits and a bill from my dentist---for over $200 in noncovered fees. What? So I look at my dentist's website/call them. What they are doing is charged a $200 consult fee for the first visit. The way that they do this is bill customers for codes that will be denied by the insurance company. I am so mad right now. I mean they can't do that, can they?

In dealing with the insurance company, they won't release much information just saying that his reimbursements are part of his contractual agreement with them. Grrrr. Don't I have some recourse here?

Anyone have any suggestions?
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Old 12-04-2008, 06:09 AM
 
11,853 posts, read 11,150,452 times
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Nope... somebody has to pay for your dental procedure... did you think it would be the dentist paying you to come to his/her office to do the procedure?
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Old 12-04-2008, 06:34 AM
 
Location: Southwest Missouri
1,921 posts, read 4,048,346 times
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Quote:
Originally Posted by evilnewbie View Post
Nope... somebody has to pay for your dental procedure... did you think it would be the dentist paying you to come to his/her office to do the procedure?
I think you're missing the point. From what I can tell, the OP called his/her insurance company PRIOR to the visit and found out that he/she would be covered 100% on the visit, based on the billing codes that the dental office provided.

Quote:
Originally Posted by bande1102 View Post
I recently went to see a periodontist who is in network with my dental insurance. I called his office before I went in for the first visit to get the dental codes that I'd be billed. Got them. Called insurance and found out they're covered at 100% so I'm good to go.
When you called the dentist, did the office explain why different billing codes were used than what you were quoted before the visit?
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Old 12-04-2008, 07:10 AM
 
6,586 posts, read 16,178,790 times
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Insurance companies usually tell you they will not predict or promise what will be covered and not covered in advance of an appt.

Did you sign something at the dentist office saying you will pay for anything the insurance company doesn't cover?

I don't think a verbal statement of will or won't be covered is binding.
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Old 12-04-2008, 07:19 AM
 
Location: Pittsburgh, PA
2,868 posts, read 6,111,216 times
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Call your insurance company and tell them what he is billing you for. Dentists enter into a contract with insurance companies they participate with. See if that billing code is covered or even a billable code.

I honestly have never heard of a Dentist giving a consult fee. But I have only had the standard care done. What did you have done? Was in a cosmetic procedure? What exactly did he consult you on?
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Old 12-04-2008, 08:09 AM
 
Location: Stuck on the East Coast, hoping to head West
1,924 posts, read 4,289,347 times
Reputation: 2454
Thanks for the replies. I just got done talking to the insurance company. This is what's going on:

When a dentist is in network, they're in network. They can't decide they're in network for some things and out for others. Also, they're not bound by what they tell you they "think" the codes will be unless you're get a pre-treatment plan. Even then, they really aren't bound to that. In my case, my out of pocket is only $100 b/c the dentist used the wrong codes so I suppose that's good news.

But here's the scary part: the dentist CAN bill for "administrative fees" and the insurance company won't help you with that. In other words, if your dentist wants to bilk you for more money, good luck.

No, my procedure wasn't cosmetic.

As far as the dental office, ha hahaha. The billing people know less than I do. The dentist doesn't know what's going on, he refers you to billing. It's seriously gotten to the point, where I've been picking dentists based on how good their office staff is in dealing with insurance.

What's that saying? If you ignore your dental problems eventually they'll go away.....
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Old 12-04-2008, 04:02 PM
 
Location: Houston
529 posts, read 778,605 times
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I have a problem with my dentist too.

The dentist told me that I needed a special kind of cleaning because my gums were bad, I paid like $300 for part of it and the rest was going through insurance, they actually never told me how much was the whole thing. The insurance rejected it saying that the X-Rays they sent showed that I actually didn't need this procedure. Now the dentist is charging me another $400. I'm like wtf???
I'll probably end up paying it but they are not going to see the money for 3 more months at least.
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Old 12-05-2008, 03:42 AM
 
339 posts, read 905,702 times
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Quote:
Originally Posted by bande1102 View Post
It's seriously gotten to the point, where I've been picking dentists based on how good their office staff is in dealing with insurance.
I think customers would benefit greatly if they actually picked dentists, doctors, etc. not just on the reputation of the specialist, but also the admin staff who work with the billing and insurance companies. Let me tell you from someone whose been there, when there is a billing mistake and you are charged for ongoing bills that are NOT yours, it can take FOREVER - and literally I do mean years - to rectify. I would never wish this on anyone!
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Old 12-06-2008, 10:35 AM
 
41,641 posts, read 44,854,191 times
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With my insurance they always submit a plan of treatment thur the insurance comp0nay before theatment electronicly unless its a emergency. I am really surprised that they disallowed a deep cleaning if that what you got. If so no X-0ray can tell if its necessary ;it rtakes measurements with probe to determine the depth of pocket at each tooth. Sounds like you have a crummy insurnace insurance company to me.The dentist shopuld ahve been able to preclear the treatment and given you a exact list of the procedure and you exact cost on a electronic treatment plan.It might be the network also as if they only pay netwroik dentist some og them can be lacking in patients for a reason.
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Old 10-11-2011, 08:52 PM
 
1 posts, read 6,810 times
Reputation: 10
Unhappy I know what you are going trough...

I just had the same problem! Went to the dentist because I have a cavity, when I got there with my insurance card, the dentist told me that I had a problem with my gum and I would have to solve that before my main problem. Had to pay $250 out of my pocket and a week later got also a $720 bill. WTF???? I'm so mad!! Trying to come down before call them tomorrow to try to understand what's going on! This is unacceptable!!! Still have my cavity, no money and a huge bill to pay? Doesn't have law for that???
Sure... before I they would do anything, I told them that I wouldn't do if my insurance wouldn't cover, unless they would let me know before the procedure. Is that possible???? I thought it would against the American Constitution.

Quote:
Originally Posted by elikhom View Post
I have a problem with my dentist too.

The dentist told me that I needed a special kind of cleaning because my gums were bad, I paid like $300 for part of it and the rest was going through insurance, they actually never told me how much was the whole thing. The insurance rejected it saying that the X-Rays they sent showed that I actually didn't need this procedure. Now the dentist is charging me another $400. I'm like wtf???
I'll probably end up paying it but they are not going to see the money for 3 more months at least.
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