Question about Harmony Dental Spa in Cary (Raleigh: insurance, buy)

[North_Raleigh_Guy]

My wife recently went to Harmony Dental Spa (broken link) in Cary for a routine cleaning. She was very happy with the care and service she recieved. They informed her that she had a minor cavity and scheduled another appointment for her to get a filling. As my wife was leaving the receptionist mentioned that their policy for fillings is to have the patient pay 100% of the cost at the time of the appointment then they will file the patient's insurance claim and the patient will be reimbursed by the insurance company for whatever their plan covers. I have never encountered this type of payment policy at any other dentist I have used. In the past they always billed me on the spot for the portion my insurance does not cover. I have never had to pay 100% of the cost then waited to be reimbursed by the insurance company. Is this typical practice for dentists in this area or is it unique to Harmony Dental?

I have state employee insurance and it is pretty cut and dry what is covered and what is not. My plan pays for 80% of the cost of a filling. I don't really like the idea of forking over several hundred dollars and then waiting months to get it back from the Insurance company. What is your dentist's policy for payment?

[lamishra]

That's how our dental billing has always been as well. I usually paid up front and then after the appointment was over, the dentist office usually gave me all of the necessary paperwork to send in to our dental insurance company. I was usually reimbursed by them in a couple of weeks.
The only thing you have to be really careful is to know your plan really well. Some insurance, while they may cover xyz% of a filling, will charge you more for certain types of materials, or for certain types of anesthesia, and the dentist will NOT know what that is. You have to be sure to know your policy front and back or you may be stuck paying a much higher percentage than you thought.

[MikeJaquish]

NRG,
We have paid the co-pay for years at our dentist.

But the insurance company does not take months to reimburse.
If they did, it would be reasonable for any small business to take 100% and assist us in getting our payment.

[saturnfan]

Our dentist subtracts expected benefits from your bill pending insurance payment.

Get a fee schedule for common procedures from the dentist and ask your insurer how these compare to the "usual and customary" charges the plan considers appropriate.

[jeannie216]

I think this is a way some dentist's operate to make sure they get paid upfront, and not have payment held up by the insurance company. I've dealt with both ways and the first is certainly better for the patient, but I know some insurance companies can be difficult in sending out payment for covering expensives, which in turn doesn't take care of the dental expenses. I'm sure your coverage is cut and dry, so to speak, but to give you an example, my college-age children got check-ups last month, and by mistake, one of them was removed from my plan. What a hassle my dentist and I had to go through to get my son reinstated and for him to get paid! Not all insurance carriers are as thorough as your's seems to be....

[JohnE1000]

Some dentists do that so they can charge much more than what the insurance pays them. If the insurance pays $70 for filling and they charge $150, then you are paying $80 out of pocket.

Try to find someone who accepts your insurance. You should pay your co-pay only, and your insurance picks up the rest of the bill.

P.S. Call you insurance company and make sure that they will reimburse you. My vision insurance company told me they won’t reimburse me if I don't buy from their designated providers.

[J_Lurk]

Our dentist has a similar policy. I was just happy that they would file insurance for me! My insurance covers 80% of basic services, but it also has a deductible and a pretty low maximum benefit cap. I understand why the dentist might not want to track where I am with that or to keep track of the multiple variations of policies that exist around here.

[saturnfan]

Some will work with you if they are familiar with your plan.

[North_Raleigh_Guy]

Thanks for the responses everyone. This dentists comes highly recommended and my wife was very pleased with the service. I will double check my coverage, but I am more comfortable with the idea of paying and waiting for reimbursement now that I have heard other places do this as well.

Thanks again for the input.

[leighbhe]

Originally Posted by North_Raleigh_Guy

Thanks for the responses everyone. This dentists comes highly recommended and my wife was very pleased with the service. I will double check my coverage, but I am more comfortable with the idea of paying and waiting for reimbursement now that I have heard other places do this as well.

Thanks again for the input.

Almost all of the ones I have gone to have filed for me. But on the flip side, I have paid more attention to the ones where I had to pay upfront! I recently went to a sedation dentist (yes, I know, but seriously I hate the dentist and I had to get a root canal and a crown) anyhow, I had to pay upfront. Well, based on my insurance, the dentist owed me 350 bucks. I probably would not have caught it but because I had shelled out tons of cash, I watched the insurance and caught the price difference. I ended up having the call the dentist, about a month after my appointment and they said, oh yes, we do owe you money, I will send it right out. A month later I had to call again, and she then they sent the check!

Just keep track of it all!


Leigh