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I thought I knew this but now I am confused. I went to a in-network dentist for a cleaning and x-rays (as a new patient). The bitewings and pano x-ray was supposed to be covered. The cleaning is covered twice a year.
However, I am looking at the claim online and I see the dentist has submitted amounts way higher than what the plan has paid. In total the dentist bill was $600, the plan has paid only $180.
I have not heard from the dentist yet but I am sure they are going to bill me for the difference. I was of the opinion that the costs for in-network coverage are already pre-negotiated and there shouldn't be a discrepancy.
This is with Delta Dental btw.
I had Lincoln Dental before and paid absolutely nothing for 2 cleanings a year, annual x-rays and a pano every 5 or so years.
There is no discrepancy. The in-network dentist accepts the plan reimbursement as payment in full.
Yeah that is what I thought too but why has the Dentist billed the insurance at 2x-3x what the plan paid? The items in question are covered 100% by the plan upto the frequency. Is this done for tax writeoffs on the Dentist's side? For instance: Panoramic xrays - Billed $270, Plan paid $82
In any case if xrays and cleanings are covered in network per the policy then I should not have to pay per my understanding.. that is how it's been in the past which is why I was surprised.
I have not received any bill from the Dentist yet since it was only a week ago but trying to understand this in case they ask me to pay the difference.
Location: East of Seattle since 1992, 615' Elevation, Zone 8b - originally from SF Bay Area
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The same applies to medical. We often see that the plan was billed far more than the plan paid, and it's a negotiated rate for their members. It's a perk for the insurance company, but helps bring more business to the hospital/doctor/lab by being in their network.
The same applies to medical. We often see that the plan was billed far more than the plan paid, and it's a negotiated rate for their members. It's a perk for the insurance company, but helps bring more business to the hospital/doctor/lab by being in their network.
so does this mean that the pre-negotiated rate (or as some say "allowable rate") is what the plan paid which the in network doctor accepts? Or can a in-network doctor/dentist bill whatever they want and whatever the insurance does not pay the client owes that? If this is the case then in-network makes no sense at all since this is what happens when one goes out of network.
I lifted this from the Blue Cross website and the "in network" concept seems pretty clear - what the plan has paid is what the doctor has agreed to accept so the patient cannot be billed anything more (unless the insurance company has not covered it at 100% cost - which in my case the items were covered 100% by the plan):
When a provider joins our network, they agree to accept our approved amount for their services. For example, a doctor may charge $150 for a service. Our approved amount is $90. So as a Blue Cross member, you save $60.
I'm sure i'm going to get some phony bill from the dentist because I've been around long enough to know that I don't trust anyone in the medical field to be transparent. Also this Dentist seems to have submitted 3 line items for x-rays that are duplicates of each other and the Insurance has denied 2 of those line items (correctly so flagging those as duplicate).
The in-network doctors know that the options are less for the patients so they are free to add extra costs to the treatment plans. Duplicate X-ray are rediculous if they are costing you.
Location: East of Seattle since 1992, 615' Elevation, Zone 8b - originally from SF Bay Area
44,642 posts, read 81,386,567 times
Reputation: 57895
Quote:
Originally Posted by Coolair
The in-network doctors know that the options are less for the patients so they are free to add extra costs to the treatment plans. Duplicate X-ray are ridiculous if they are costing you.
Yes, and insurance has limits to what they will pay for. For example checkup-xrays only once a year, or every 6 months if the patient has certain dental issues/history. If they have to do xrays 2-3 times because they had the wrong angle or it didn't catch the right tooth, it's on them, they shouldn't charge for the 2nd or 3rd times. Dentists are much like an auto mechanic - find a good one and stick with them. If they seem to be ripping you off go elsewhere. It's easier to change with a car obviously because dental records have to be transferred, but like doctors, you need to have full trust and confidence in your dentist. We have been with ours since 1993. Yes, he was very young then, but is still in practice and just took on a younger partner. His insurance woman does a great job, verifying with the insurance before any procedure, and letting us know what our cost will be, if any.
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