What are my options against what may be greedy billing? (teeth, dentist)

[ShaneCD]

I recently had two of my teeth extracted. My dentist billed my credit card $560 for two bone grafts and $360 for nitrous oxide & conscious oral sedation, in addition to charges for the extraction. The dentist also filed an insurance claim for these services without including a narrative on why the bone grafts and sedation procedures are required.

My dental insurer says if the dentist resubmits the claim with a narrative on the need for bone grafts and sedation procedures, I will pay contracted prices instead of dental office list prices since the provider is in the network. The contracted prices are roughly 50% of the dental office's list prices.

My dentist refuses to resubmit the claim with a narrative saying these are non-covered items in the dental insurance plan and that they charge dental office list prices for such services.

Although my dental plan excludes bone grafts and sedation procedures, I cannot get contracted prices since the dentist refuses to resubmit the claim with a narrative.

I have this experience of the dentist refusing to resubmit the claim with a narrative for the first time.

I am clueless if this is the standard industry practice or if I am getting taken for a ride.

Is this common dental practice in Texas?

Is there any way to get the contract prices on these non-covered items and save approximately $500?

Shane

[Ghaati]

Why would the dentist bill your credit card anything at all? The dentist should be billing you, and then you select your payment method.

The way to get contracted prices is ALWAYS to be pre-authorized for procedures like that. ALWAYS get the expected fees for procedures in writing before the appointment. The only time you wouldn't know, in advance, what they plan on charging you, is if you go in for an emergency without an appointment and they have to treat you right there on the spot. You had the work done, and apparently you already paid for it.

You can always contest the charge with your credit card company. But if you had the work done, AND if you don't have it in writing that they were going to charge you any less than what they charged you, then you'll still be on the hook for the fee they charged.

[Parnassia]

What treatment plan (description of procedures deemed necessary and estimated cost) did you agree to and when did you agree to it? Did you run any of this past your insurance provider before agreeing to the procedures? Even if pre-certification wasn't required you would have learned more about coverage and reimbursement. Your options may be very limited after the fact. Maybe the dentist is refusing to re-submit because you already agreed to the terms and then (as a popular TV judge likes to say) "ate the steak". They've already expended the time, use of equipment, supplies, support staff, etc.