Dentist "Service Fee" for Filing Insurance Claim?

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totalnoobie
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Dentist "Service Fee" for Filing Insurance Claim?

Post by totalnoobie » Sun Oct 21, 2018 6:48 pm

DS recently had wisdom tooth extraction at a dentist office. He has medical and dental insurance and the office said they would file with both to get maximum coverage allowed. Now months later, he has received multiple non-nominal charges (totaling more than $150) on his account described as "Service fee" When he called, he was told these are charges incurred for filing insurance claims. Is this typical? Was not informed of these fees prior to procedure. Insurance amounts still "pending." Any recourse here, or just pay whatever amount is charged? Seems outrageous to me as I have never incurred these fees when going to the doctor or dentist...

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Blueskies123
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by Blueskies123 » Sun Oct 21, 2018 6:50 pm

No, it not normal. Do not pay it and find another dentist.

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dm200
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by dm200 » Sun Oct 21, 2018 6:59 pm

sure seems odd.. Maybe there is more to the story??

Wonder if they go away if/when claims paid?

Big Dog
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by Big Dog » Sun Oct 21, 2018 7:09 pm

Unless the provider is under contract with your son's insurance carrier & specific plan, they file insurance reimbursement requests as a courtesy to him (and convenience to them since they can get paid faster). Given that, I'd suggest that his first call would be to his insurance company to inquire why they haven't paid for his extraction. Nine months is an awful long time for a simple procedure. Note, however, if the teeth were impacted, his medical insurance might be primary (which is why the dental insurance hasn't paid). If the dental carrier pended the claim awaiting a filing with medical, your S should have received an EOB that so stated. Regardless, a quick call to his dental carrier should be able to explain why they haven't yet paid.

fwiw: My dentist does automatically charge xx % for 'late payment', awaiting insurance reimbursement, but we just call after the insurance pays and he waives the late payment.

totalnoobie
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by totalnoobie » Sun Oct 21, 2018 7:19 pm

dm200 wrote:
Sun Oct 21, 2018 6:59 pm
sure seems odd.. Maybe there is more to the story??

Wonder if they go away if/when claims paid?
Not sure if there is more to the story. He said he hasn't had any other contact with either the dental office or the insurance...

reimann
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by reimann » Sun Oct 21, 2018 7:24 pm

Perhaps the insurance hasn't paid and he is charging for late payment, like most businesses do?

totalnoobie
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by totalnoobie » Sun Oct 21, 2018 7:25 pm

Big Dog wrote:
Sun Oct 21, 2018 7:09 pm
Unless the provider is under contract with your son's insurance carrier & specific plan, they file insurance reimbursement requests as a courtesy to him (and convenience to them since they can get paid faster). Given that, I'd suggest that his first call would be to his insurance company to inquire why they haven't paid for his extraction. Nine months is an awful long time for a simple procedure. Note, however, if the teeth were impacted, his medical insurance might be primary (which is why the dental insurance hasn't paid). If the dental carrier pended the claim awaiting a filing with medical, your S should have received an EOB that so stated. Regardless, a quick call to his dental carrier should be able to explain why they haven't yet paid.

fwiw: My dentist does automatically charge xx % for 'late payment', awaiting insurance reimbursement, but we just call after the insurance pays and he waives the late payment.
Yes, I think calling the insurance company is a good idea. There's no indication of a problem with the insurance, the correct amount appears to be "pending", just several "service fee"s. I believe the reason he called the dentist office is because they sent an official looking bill with number of days past due and was worried about getting sent to collections. Reviews of the dental office seem to indicate a pretty aggressive billing office...

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dm200
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by dm200 » Sun Oct 21, 2018 7:26 pm

totalnoobie wrote:
Sun Oct 21, 2018 7:25 pm
Big Dog wrote:
Sun Oct 21, 2018 7:09 pm
Unless the provider is under contract with your son's insurance carrier & specific plan, they file insurance reimbursement requests as a courtesy to him (and convenience to them since they can get paid faster). Given that, I'd suggest that his first call would be to his insurance company to inquire why they haven't paid for his extraction. Nine months is an awful long time for a simple procedure. Note, however, if the teeth were impacted, his medical insurance might be primary (which is why the dental insurance hasn't paid). If the dental carrier pended the claim awaiting a filing with medical, your S should have received an EOB that so stated. Regardless, a quick call to his dental carrier should be able to explain why they haven't yet paid.

fwiw: My dentist does automatically charge xx % for 'late payment', awaiting insurance reimbursement, but we just call after the insurance pays and he waives the late payment.
Yes, I think calling the insurance company is a good idea. There's no indication of a problem with the insurance, the correct amount appears to be "pending", just several "service fee"s. I believe the reason he called the dentist office is because they sent an official looking bill with number of days past due and was worried about getting sent to collections. Reviews of the dental office seem to indicate a pretty aggressive billing office...
yes

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midareff
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by midareff » Sun Oct 21, 2018 7:26 pm

Blueskies123 wrote:
Sun Oct 21, 2018 6:50 pm
No, it not normal. Do not pay it and find another dentist.
+1

totalnoobie
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by totalnoobie » Sun Oct 21, 2018 7:27 pm

reimann wrote:
Sun Oct 21, 2018 7:24 pm
Perhaps the insurance hasn't paid and he is charging for late payment, like most businesses do?
Could certainly be the case, but there has been no communication that the insurance is not paying or that there is any problem on that front. They aren't asking DS to pay the bill or anything, just several "service fee"s that when he called the billing office was described as a fee for filling insurance claims. Didn't think this was normal as I haven't ever encountered these fees and did not know if dentists charged for filing claims.

HIinvestor
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by HIinvestor » Sun Oct 21, 2018 9:36 pm

We have never had any of our providers assess a service or any fee for filing paperwork for services we received. I’m not sure such charges are allowed by insurer—I doubt it or the providers would be charging them because it does take staff time and energy to do the paperwork.

I’d call Insurer about the claim— what was (or will be) paid (and date of payment) and what is your copay.

BogleMelon
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by BogleMelon » Sun Oct 21, 2018 9:40 pm

totalnoobie wrote:
Sun Oct 21, 2018 6:48 pm
Is this typical?

I never heard of it!
"One of the funny things about stock market, every time one is buying another is selling, and both think they are astute" - William Feather

Big Dog
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by Big Dog » Sun Oct 21, 2018 9:42 pm

There's no indication of a problem with the insurance, the correct amount appears to be "pending",...
Pending for 9 months IS a problem, somewhere, somehow. If completed and filed accurately, a typical claim should be paid within ~30 days. Nine months makes no sense whatsoever.

LeeMKE
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by LeeMKE » Sun Oct 21, 2018 10:17 pm

Everyone should be prepared to see and pay fees for filing insurance claims, particularly for dental work.

Dentists are generally paid cash since many of us don't have dental insurance anymore. Ergo, their business model is based on payment at time of service, without building in overhead for filing insurance claims (not a trivial exercise, and not fill in a form and mail it -- much much more is demanded by the insurance companies in hopes the claim will be abandoned) and months of delay in payment.

I'm in the midst of filing insurance claims on our private pay medical insurance right now. The hoops we are being put through are ridiculous. I, and the hospital are on the 3rd or 4th round of answering the same questions that were covered in the original claim. It is obvious to me that the insurance carrier is putting us through the frustration in hopes I'll abandon the claim.

This is the first time the medical provider has included me in the email thread with the insurance carrier. I've heard the complaints from medical providers about insurance company reimbursements, but now I can see for myself how frustrating and time consuming this process is.

Wow. The system is seriously broken. What I am experiencing now, is only a matter of time for folks on employer paid healthcare coverage. Get ready.
The mightiest Oak is just a nut who stayed the course.

toofache32
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by toofache32 » Sun Oct 21, 2018 10:50 pm

You forgot to include the most important information....is this dentist in-network with your dental insurance? If not, then the dentist is doing a service for you that you could do yourself.
Also, the comparisons to medical insurance are irrelevant because dental and medical insurance are completely different animals.

criticalmass
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by criticalmass » Mon Oct 22, 2018 12:07 am

LeeMKE wrote:
Sun Oct 21, 2018 10:17 pm
Everyone should be prepared to see and pay fees for filing insurance claims, particularly for dental work.
No, they should not be, at least if the provider is in network. In network providers agree to charge only allowed prices for services provided.

inbox788
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by inbox788 » Mon Oct 22, 2018 1:39 am

I was asked to pay a small fee in cash to fill out forms and I was annoyed, but complied. I think it's a start of a bad trend like the nuisance small copays that now account for a large portion of the business and generating office visits seems to be the way to collect more copays. It's like the luggage fees at the airport that keep going up $5/year. It's hard to stop, like those surcharges with your cell phone bill, because some are trying recoup real costs, but it was simpler when all cost of business was absorbed in the sticker price. But since there's haggling on everything and no one is paying sticker price, some substantial costs are falling through the cracks and providers are recouping some expenses and sometimes padding their profit.

toofache32
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by toofache32 » Mon Oct 22, 2018 7:36 am

inbox788 wrote:
Mon Oct 22, 2018 1:39 am
I was asked to pay a small fee in cash to fill out forms and I was annoyed, but complied. I think it's a start of a bad trend like the nuisance small copays that now account for a large portion of the business and generating office visits seems to be the way to collect more copays. It's like the luggage fees at the airport that keep going up $5/year. It's hard to stop, like those surcharges with your cell phone bill, because some are trying recoup real costs, but it was simpler when all cost of business was absorbed in the sticker price. But since there's haggling on everything and no one is paying sticker price, some substantial costs are falling through the cracks and providers are recouping some expenses and sometimes padding their profit.
Nuisance copays? Copays are a way for the patient to have skin in the game so the insurance company can combat over-utilization of care . This is why people with NO copay go to the hospital emergency room for prescription refills and to fill out the school health forms for their children.

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bottlecap
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by bottlecap » Mon Oct 22, 2018 7:40 am

A service fee seems reasonable. There is paperwork and other trouble involved.

$150 for a service fee, however, I would fight as outrageous.

JT

quantAndHold
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by quantAndHold » Mon Oct 22, 2018 7:46 am

toofache32 wrote:
Mon Oct 22, 2018 7:36 am
inbox788 wrote:
Mon Oct 22, 2018 1:39 am
I was asked to pay a small fee in cash to fill out forms and I was annoyed, but complied. I think it's a start of a bad trend like the nuisance small copays that now account for a large portion of the business and generating office visits seems to be the way to collect more copays. It's like the luggage fees at the airport that keep going up $5/year. It's hard to stop, like those surcharges with your cell phone bill, because some are trying recoup real costs, but it was simpler when all cost of business was absorbed in the sticker price. But since there's haggling on everything and no one is paying sticker price, some substantial costs are falling through the cracks and providers are recouping some expenses and sometimes padding their profit.
Nuisance copays? Copays are a way for the patient to have skin in the game so the insurance company can combat over-utilization of care . This is why people with NO copay go to the hospital emergency room for prescription refills and to fill out the school health forms for their children.
One would assume a wisdom tooth extraction already has its own copay, as specified by the insurance plan. Adding an extra, unreimbursed fee after the service is a different thing that has nothing to do with appropriate utilization of care. Assuming this is an in-network provider, it’s an attempt by the dentist to extract more money than he contractually agreed to with the insurance company.

Dottie57
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by Dottie57 » Mon Oct 22, 2018 8:21 am

bottlecap wrote:
Mon Oct 22, 2018 7:40 am
A service fee seems reasonable. There is paperwork and other trouble involved.

$150 for a service fee, however, I would fight as outrageous.

JT
Never heard of it. Part of doing business. The Dental fees are very high already.

rantk81
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by rantk81 » Mon Oct 22, 2018 8:29 am

W.R.T. co-pays... I've seen a much more sinister (?) trend on how they are being used -- on my employer sponsored plan, at least.

The co-pays are, in many cases, a higher dollar cost amount for a lot of services, than the out of pocket cost would be with the 30/70% or 20/80% co-insurance on the procedure. A $50 co-pay for a PCP visit vs. 20/80 co-insurance? With co-pays only applying after the deductible is met? Gee, Thanks..

toofache32
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by toofache32 » Mon Oct 22, 2018 10:52 am

quantAndHold wrote:
Mon Oct 22, 2018 7:46 am
toofache32 wrote:
Mon Oct 22, 2018 7:36 am
inbox788 wrote:
Mon Oct 22, 2018 1:39 am
I was asked to pay a small fee in cash to fill out forms and I was annoyed, but complied. I think it's a start of a bad trend like the nuisance small copays that now account for a large portion of the business and generating office visits seems to be the way to collect more copays. It's like the luggage fees at the airport that keep going up $5/year. It's hard to stop, like those surcharges with your cell phone bill, because some are trying recoup real costs, but it was simpler when all cost of business was absorbed in the sticker price. But since there's haggling on everything and no one is paying sticker price, some substantial costs are falling through the cracks and providers are recouping some expenses and sometimes padding their profit.
Nuisance copays? Copays are a way for the patient to have skin in the game so the insurance company can combat over-utilization of care . This is why people with NO copay go to the hospital emergency room for prescription refills and to fill out the school health forms for their children.
One would assume a wisdom tooth extraction already has its own copay, as specified by the insurance plan. Adding an extra, unreimbursed fee after the service is a different thing that has nothing to do with appropriate utilization of care. Assuming this is an in-network provider, it’s an attempt by the dentist to extract more money than he contractually agreed to with the insurance company.
This poster was referring to copays, you are talking about service fees. Completely different.

Nowizard
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by Nowizard » Mon Oct 22, 2018 12:29 pm

If copays, that is one thing, if a service charge, it is outrageous. As one who filed insurance in my profession before retirement, such a charge was specifically disallowed in the provider agreement with insurance companies. Insurance companies also required the provider to file for the patient rather than leaving this to the patient. Call the insurance company, then the provider's office.

Tim

inbox788
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by inbox788 » Mon Oct 22, 2018 12:55 pm

toofache32 wrote:
Mon Oct 22, 2018 7:36 am
inbox788 wrote:
Mon Oct 22, 2018 1:39 am
I was asked to pay a small fee in cash to fill out forms and I was annoyed, but complied. I think it's a start of a bad trend like the nuisance small copays that now account for a large portion of the business and generating office visits seems to be the way to collect more copays. It's like the luggage fees at the airport that keep going up $5/year. It's hard to stop, like those surcharges with your cell phone bill, because some are trying recoup real costs, but it was simpler when all cost of business was absorbed in the sticker price. But since there's haggling on everything and no one is paying sticker price, some substantial costs are falling through the cracks and providers are recouping some expenses and sometimes padding their profit.
Nuisance copays? Copays are a way for the patient to have skin in the game so the insurance company can combat over-utilization of care . This is why people with NO copay go to the hospital emergency room for prescription refills and to fill out the school health forms for their children.
Abuses of the system go both ways. Healthcare shouldn't be a minefield of surprise costs. The problem themselves and following treatment can be bewildering enough.

Yes, it's a nuisance when the amount is small. When copays become the majority of the cost, it perverts the idea of cost sharing. When doctors have to spend time, money and effort to collect $2 or $5 for a $150 visit, it's a nuisance, and a lot of early plans worked that way. Today, it's not unusual to see $50 or $75 copays on negotiated fees of $100, so the patient is the major payer of the fees that you see. The worst was or is the drugs that cost less than $5 or whatever the minimum copay is, but the pharmacy is contractually allowed to collect the copay and doesn't have to tell you that you can pay less without the insurance plan.

https://www.reuters.com/article/us-heal ... SKCN1GP2P4

https://www.pbs.org/newshour/health/why ... -a-40-drug

inbox788
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by inbox788 » Mon Oct 22, 2018 1:04 pm

Nowizard wrote:
Mon Oct 22, 2018 12:29 pm
If copays, that is one thing, if a service charge, it is outrageous. As one who filed insurance in my profession before retirement, such a charge was specifically disallowed in the provider agreement with insurance companies. Insurance companies also required the provider to file for the patient rather than leaving this to the patient. Call the insurance company, then the provider's office.

Tim
You'd think so, but there are probably a lot of loopholes beginning with is this in or out of network? The copay is somewhere in the agreement, but what additional service charges is going to have to be negotiated for future contracts if it isn't settled in the current one. Fixing these agreements will be like filing holes in Swiss cheese. Insurance companies will carve out their protections and providers will also do the same, so the patient is left in the middle of it all.

There used to be a lot of meat and fat to go around, but looks like today, everyone is fighting for every little scrap they can get. Some might be getting more than their fair share.
Prescription drug copayments often exceed the retail cost of a drug, a recent USC study reveals. This means that technically an overpayment occurs, and someone—not the patient—keeps the excess payment.
Who?
Pharmacies pass the copays to pharmaceutical benefits managers, who reimburse the pharmacies a negotiated rate to cover drug costs, as well as any dispensing fees and markups.
Huh?
https://medicalxpress.com/news/2018-08- ... tient.html
Last edited by inbox788 on Mon Oct 22, 2018 1:13 pm, edited 2 times in total.

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munemaker
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by munemaker » Mon Oct 22, 2018 1:10 pm

criticalmass wrote:
Mon Oct 22, 2018 12:07 am
LeeMKE wrote:
Sun Oct 21, 2018 10:17 pm
Everyone should be prepared to see and pay fees for filing insurance claims, particularly for dental work.
No, they should not be, at least if the provider is in network. In network providers agree to charge only allowed prices for services provided.
Billing is just part of the cost of doing business. The patient SHOULD NOT be prepared to see and pay fees for filing insurance claims. This is absolutely false!

jminv
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by jminv » Mon Oct 22, 2018 1:59 pm

munemaker wrote:
Mon Oct 22, 2018 1:10 pm
criticalmass wrote:
Mon Oct 22, 2018 12:07 am
LeeMKE wrote:
Sun Oct 21, 2018 10:17 pm
Everyone should be prepared to see and pay fees for filing insurance claims, particularly for dental work.
No, they should not be, at least if the provider is in network. In network providers agree to charge only allowed prices for services provided.
Billing is just part of the cost of doing business. The patient SHOULD NOT be prepared to see and pay fees for filing insurance claims. This is absolutely false!
Normally a dentist deals with this by either taking insurance or only accepting cash and letting the insured file with their insurer themselves. Trying to outsource billing costs to the customer sounds like a great way to receive low reviews in the community. Cash only dentists do limit the patient pool, though, but some are established enough to make this work out ok. When I was in the usa, I used a dentist that took my insurance and committed to not having to pay a dime myself. Also convienent hours after work.

I no longer live in the usa and where I am in Europe it is cash to the doctor (the doctor is actually the cashier) when services are rendered. Portion that is covered by insurance is then redeposited in your bank account automatically in a couple days. Portion that wasn't is either the patients cost or the patient then files with their secondary insurance themselves. This cuts out a lot of cost in the system since the doctor has no employees to pay. Since the patient also pays the doctor when services are rendered, patients have an idea of the cost of a visit or outpatient procedure which cuts down some on cost. I suppose the point of the story is there are a lot of non-core activity employees at a doctor or dentists office that could be eliminated to reduce wasted resources.

Nowizard
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by Nowizard » Mon Oct 22, 2018 4:25 pm

Inbox: What I posted was not opinion, but fact, though things may have changed in the ten years since retirement, as mentioned. Unfortunately, you may be correct.

Tim

ralph124cf
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by ralph124cf » Mon Oct 22, 2018 6:34 pm

My dentist gives a 5% discount for payment by cash or check at time of service.

The foregone 5% could be seen as a service fee for filing insurance.

Ralph

toofache32
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by toofache32 » Mon Oct 22, 2018 8:55 pm

ralph124cf wrote:
Mon Oct 22, 2018 6:34 pm
My dentist gives a 5% discount for payment by cash or check at time of service.

The foregone 5% could be seen as a service fee for filing insurance.

Ralph
My office looked into the legalities of this for an in-network provider and we never could get a definitive answer. The insurance companies require that if a discount is given to the patient, that the insurance company must be given the same discount. So this 5% discount should really be a 10% discount forfeited by the dentist. Calculate in the 70% average overhead of a dental office and that 10% discount is actually the dentist giving up 30% of his/her cut.

We have told insurance companies that we will give them the discount if they comply with the same stipulation as the patient....pay your portion in full on the day of service. We have never had an insurance company take us up on this.

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bottlecap
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by bottlecap » Mon Oct 22, 2018 9:07 pm

Dottie57 wrote:
Mon Oct 22, 2018 8:21 am
bottlecap wrote:
Mon Oct 22, 2018 7:40 am
A service fee seems reasonable. There is paperwork and other trouble involved.

$150 for a service fee, however, I would fight as outrageous.

JT
Never heard of it. Part of doing business. The Dental fees are very high already.
It's good to have an opinion.

toofache32
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by toofache32 » Mon Oct 22, 2018 9:08 pm

bottlecap wrote:
Mon Oct 22, 2018 9:07 pm
Dottie57 wrote:
Mon Oct 22, 2018 8:21 am
bottlecap wrote:
Mon Oct 22, 2018 7:40 am
A service fee seems reasonable. There is paperwork and other trouble involved.

$150 for a service fee, however, I would fight as outrageous.

JT
Never heard of it. Part of doing business. The Dental fees are very high already.
It's good to have an opinion.
No matter the cost, many people will think it's too expensive.

TallBoy29er
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Re: Dentist "Service Fee" for Filing Insurance Claim?

Post by TallBoy29er » Tue Oct 23, 2018 8:28 pm

A service fee seems ludicrous to me. If you are in the medical field, you deal with insurance, it is part of doing business. To charge for filing a claim....wtf?

I would call the dentist office and verify that your understanding is correct. I would ask questions. Do you always do this? For all insurance? Is $150 typical for you? Etc. I like to know the story.

That said, I have never experienced this. (I just went to the dentist today, never had to pull out my card). I would move on, in a heart beat, if things are as you believe them to be.

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