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Old 07-03-2016, 04:24 PM
 
32 posts, read 64,289 times
Reputation: 21

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I went for a check up at a new dentist, after not been to dentist in over three years. He said I needed deeping cleaning, cavities filled, a nightguard. One of the billing lady came in and gave me a quote on the treatment plan, saying it should cost me 900 out of pocket, and the rest insurance will pay. She told me if i paid up front for the treatment costs, I 'll get a 5% discount, which I did. So far, I have only done deep cleaning for left side of my mouth with antibiotic injections to 7 pockets, and scheduled appointments for the rest of the treatments next week. Today, I decided to check my claim online to see if it was processed. It's still in progress, but I was able to get some information. It looks my my insurance paid their portion of the deep cleaning and x rays, but they will not pay for the antibiotic injections, which are very expensive. So for the injections alone, it'll cost me 1000.

I looked up the dental code for the procedure, and it seems like most insurance will not pay for antibiotic injections to periondotal pockets, especially if done same day as deep cleaning. Given that this dental practice gives antibiotics to patients, I suspect they have been knowing for a long time that insurance will not cover this, and they are making big bucks charging full price for the patient.

What's the best course of action? I plan to talk to them on Tuesday, but if it doesn't go well, I'm not sure what the next step will be. Any help is appreciated.
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Old 07-03-2016, 04:59 PM
 
5,273 posts, read 14,481,360 times
Reputation: 5880
Ir may be that your insurance carrier doesn't pay for such injections. The best thing to do is keep an open mind and see what they have to say.

So you know, a dental office makes for you an estimation of what your carrier may pay for. They do it as a courtesy for you. You pay the balance.

So my best suggestion is to sit with the financial person, find out about the injections and go from there. If what you say is true (and I have a lot of doubt) perhaps they will discount them 50%.
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Old 07-03-2016, 05:51 PM
 
32 posts, read 64,289 times
Reputation: 21
I'm trying my best to keep in open mind and have a first talk with them on Tueday, though I'm still a bit upset about all of this. I've looked at his yelp reviews, most were positive, but there were also a few negative ones warning about his shady billing practices. My insurance carrier is pretty big and well known, so I can't imagine how they think think my insurance will actually cover that. So, I do feel that I was conned when they said insurance should cover this, when they knew all along that they won't. I know estimates aren't final, but when I expect something close to 100, and i get charged for 1000 instead, I find that really fishy. This was in in-network dentist and insurance carrier is pretty well known.

I've been to different in network dentist with the same insurance carrier, and so far their estimation may never be exact, but were fairly close. Never would I thought I would walk in thinking I only had to pay 100, end up being 1000.

Last edited by bea555; 07-03-2016 at 06:44 PM..
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Old 07-03-2016, 07:31 PM
 
1,652 posts, read 2,755,705 times
Reputation: 2640
I would bet lots of money you went to a corporate chain such as Monarch, Aspen, etc. Now there are smaller ones that "brand" themselves to the local area with a different name for each office to further disguise this. The dentist is a mere employee just like the hygienist and everyone else. They hire a "treatment plan coordinator" whose job is to add on every code possible and can often cross the line in ethics. The ones in my area bill a limited alveoloplasty for every single extraction.

Yes, you should be suspicious. They know very well that Arestin is not covered by dental insurance. In addition, most insurance contracts forbid the dentist to give the patient a discount without giving the insurance company the same discount.

You are wise to be suspicious:

Is Arestin® a red flag?

Last edited by toofache32; 07-03-2016 at 07:48 PM..
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Old 07-03-2016, 08:12 PM
 
13,254 posts, read 8,325,549 times
Reputation: 31422
My insurance carrier caps out at $1500 hardly enough to cover some major dental treatments.

As par the course, all services are ultimately the responsibility of the patient. Never assume it will be covered.

I made the mistake of entrusting my doctor for a medical test ... He said ohh it's covered as a standard prevention ... so I got the test. and a letter from my carrier saying: declined , not covered under plan wiiscrewu. so I paid it and stopped using that Doctor.

Even if you call your insurance company with the code of the procedure, they will not say anything that leads you to believe it will be paid. they give the standard cookie cutter response of: upon receipt of claim we will make a determination . you should know in x amount of days.
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Old 07-03-2016, 08:23 PM
 
32 posts, read 64,289 times
Reputation: 21
Quote:
Originally Posted by toofache32 View Post
I would bet lots of money you went to a corporate chain such as Monarch, Aspen, etc. Now there are smaller ones that "brand" themselves to the local area with a different name for each office to further disguise this. The dentist is a mere employee just like the hygienist and everyone else. They hire a "treatment plan coordinator" whose job is to add on every code possible and can often cross the line in ethics. The ones in my area bill a limited alveoloplasty for every single extraction.

Yes, you should be suspicious. They know very well that Arestin is not covered by dental insurance. In addition, most insurance contracts forbid the dentist to give the patient a discount without giving the insurance company the same discount.

You are wise to be suspicious:

Is Arestin® a red flag?
I think you are right, I had a feeling that may be the case. I've gone to that Arestin website before I did a post on this thread, so that's one of the reasons why I felt I got scammed. I read that most dentist charge 30-60 per pocket, with 60 being the high end. This dentist charged me 152, but the coordinator said my insurance should cover 80 percent. But reading about code d4831,I find that most insurance will not cover it. I went to my insurance website and looked up the code fee, and it was no where to be found. Basically, you need to call them up to ask about how much they would pay. The dentist wanted me to do a thursday cleaning, but since I can only do Monday appointment, they wanted me to the deep cleaning same day as the checkup. The treatment coordinator came and talk to me about the plan, her estimates and how insurance should cover this certain amount. I do not feel that she tried to give me an accurate estimation at all--- she knew fairly well they will never cover it.
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Old 07-03-2016, 08:25 PM
 
Location: Happy wherever I am - Florida now
3,360 posts, read 12,223,314 times
Reputation: 3907
I went to a dentist who wanted to charge me four times that amount just for a deep cleaning. That would have been the entire income from my part time job for a year. I nearly went out of there screaming. I actually may have I was so mad.

I found another one who did it for one tenth the price. It didn't really take much more time than a regular cleaning. They used a sonic water device. I was given prescription mouthwash to use not antibiotics.

It seems they are telling everyone these days to get this done plus the every three months cleaning as a follow up in order to guarantee it.
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Old 07-03-2016, 09:40 PM
 
1,652 posts, read 2,755,705 times
Reputation: 2640
Quote:
Originally Posted by bea555 View Post
I think you are right, I had a feeling that may be the case. I've gone to that Arestin website before I did a post on this thread, so that's one of the reasons why I felt I got scammed. I read that most dentist charge 30-60 per pocket, with 60 being the high end. This dentist charged me 152, but the coordinator said my insurance should cover 80 percent. But reading about code d4831,I find that most insurance will not cover it. I went to my insurance website and looked up the code fee, and it was no where to be found. Basically, you need to call them up to ask about how much they would pay. The dentist wanted me to do a thursday cleaning, but since I can only do Monday appointment, they wanted me to the deep cleaning same day as the checkup. The treatment coordinator came and talk to me about the plan, her estimates and how insurance should cover this certain amount. I do not feel that she tried to give me an accurate estimation at all--- she knew fairly well they will never cover it.
Out of curiosity....was this a corporate chain like Monarch, Aspen, Castle, Bright Now, Pacific Dental, Heartland, Kool Smiles, Western Dental, etc?
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Old 07-03-2016, 09:49 PM
 
32 posts, read 64,289 times
Reputation: 21
It's Spring Lake Dental, so I'm not sure how big that chain is, seems like it's not really big?
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Old 07-03-2016, 10:02 PM
 
1,652 posts, read 2,755,705 times
Reputation: 2640
Size of the chain does not matter. The point is that when a pure "businessman" instead of the dentist is making the decisions, guess what happens? This is why many states are now enacting laws that make it illegal for a NON-dentist to own a dental practice.
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