Dental billing question: Should I pay 20% of submitted by dentist, or 20% of allowed costs? (effect, problems)

[Mike_2012]

Hi there,
I have Delta Dental insurance in Massachusetts. I went to the dentist to get a crown cemented back in after it came loose. They charged me $38.22 when leaving the office, they mentioned I was responsible for 20% of the bill (which would thus be $191.65). I received a receipt of the credit card payment on the spot but no formal bill form the dentist.

One week later I received the "explanation of benefits" from the insurance company. It said:
Submitted by dentist: $141
Approved: $91.12
Plan coverage: 80%
Deductible: $0
Patient pay: $18.22 [which is of course 20% of $91.12]
Adjustment: $51.20
Plan pay: $71.58

Currently, the insurance company paid $71.58, and I payed $38.22. That means the dentist made $109.80 and I effectively payed 35% of that. That seems unfair to me.

I think I should get 38.22-18.22 = $20 back from the dentist.

Can anybody explain if I should expect some money back from my dentist or that this is normal practice? It's not a whopping amount but it is a matter of principle to me.

Thanks for any thoughts on this,
Mike

[Flamingo13]

Sound to me like the Dentist owes you the difference.

[howard555]

Originally Posted by Mike_2012

Hi there,
I have Delta Dental insurance in Massachusetts. I went to the dentist to get a crown cemented back in after it came loose. They charged me $38.22 when leaving the office, they mentioned I was responsible for 20% of the bill (which would thus be $191.65). I received a receipt of the credit card payment on the spot but no formal bill form the dentist.

One week later I received the "explanation of benefits" from the insurance company. It said:
Submitted by dentist: $141
Approved: $91.12
Plan coverage: 80%
Deductible: $0
Patient pay: $18.22 [which is of course 20% of $91.12]
Adjustment: $51.20
Plan pay: $71.58

Currently, the insurance company paid $71.58, and I payed $38.22. That means the dentist made $109.80 and I effectively payed 35% of that. That seems unfair to me.

I think I should get 38.22-18.22 = $20 back from the dentist.

Can anybody explain if I should expect some money back from my dentist or that this is normal practice? It's not a whopping amount but it is a matter of principle to me.

Thanks for any thoughts on this,
Mike

It was not dental, but back in 2010 after my Father died, we got several refunds from the hospital and doctors. It seems to be the same as your case. My Father paid X dollars but Medicare and his other insurance only covered Y dollars. You may get a refund from someone, at some point.

In your case, when you were out of the dental chair and headed to the checkout window, you maybe should have asked:
"how much is the total today?"
Would they have said $141.00 or $191.65?

I'd go back and ask a simple, non inflammatory question.
"My bill was $141 and my copay was 20%. When should I expect to get the refund of $10.02 ($38.22 -20% of $141.00)? Don't ask if, ask when.

I know that is not all that you think you should be getting, but it will quietly open the conversation such that the clerk at the checkout desk looks at the actual numbers, and they see how you paid 20% of more than $141.00, and you paid more than 20% of the amount approved by the insurance.

If the doctor billed the insurance company $141 and they only covered $91.12, then the dentist is taking a write down too.
He loses $49.88 but you paid $20 too much, if the math is correct.

Next time, ask the total before you pay and also ask what happens if the insurance only pays X dollars for the services you received. Maybe they say that you'll get a refund.

[Padgett2]

Often in cases like this, the dentist (or doctor or whatever) knows that you will probably be returning. So rather than going to all the office and accounting problems involved in a refund, the office will keep the amount as a credit balance on your account until you return, or until you ask for it.

It's the easy way to keep the patient accounts.

So, call or go by, check the balance to see if they have credited your account. Then, if they have, ask for it or let it ride for the next time.

[texdav]

Originally Posted by sargasso

Most insurance companies reimburse dentists, doctors, etc... after discounting their fees down to what the insurance company says is the customary fees for that procedure/s. The health professionals agree to this discounting when they accept your insurance. If they did not agree to their costs being discounted they should've advise that they do not accepts your dental plan at their office. Since the dentist was reimbursed by your insurance company at the agreed rate between his/her office and the insurance company; and since you paid 20% at the full cost of the procedure, you may be entitled to a discount. Check first with your insurance company. See if a copay is required, as well.

If you need any more help email me:
diversearch@yahoo.com

It alldepends if they have a contracted price with the insurance compnay/ Otherwise they are just acceptig it as partial pamen t with no contracted price.