Frustrated with dentist fees

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Topic Author
Jimsad
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Joined: Mon Mar 20, 2017 5:54 pm

Frustrated with dentist fees

Post by Jimsad » Mon Oct 14, 2019 3:44 pm

I posted in past on similar topic but still cannot understand and am frustrated .
I have very good insurance - United Concordia through blue cross federal .
My dentist submitted charges to my insurance and the insurance denied part of the payment as they felt part of the services rendered were not necessary .
The dentist office wants me to pay the fees about $150 which the insurance did not pay .
When I go to other non dental doctors , they happily take what insurance pays them and also tell me that they cannot charge me for Some thing denied by insurance as they contracted with the insurance to accept their payments .
When I asked this question , the office manager was very rude and just told me they will take me to collections if I do not pay .
Why do the dentists not accept what insurance pays them like other doctors ?
Should I complain to my Insurance ?

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FlyAF
Posts: 471
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Re: Frustrated with dentist fees

Post by FlyAF » Mon Oct 14, 2019 3:49 pm

You're confused with how health insurance works. Before complaining to anyone, I would suggest reading your policy documents so that you're clear on what is and isn't covered going forward.

And yes, you owe the dentist the money. The time to figure out if it was or wasn't covered was before you retained said services.

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dm200
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Re: Frustrated with dentist fees

Post by dm200 » Mon Oct 14, 2019 3:51 pm

Jimsad wrote:
Mon Oct 14, 2019 3:44 pm
I posted in past on similar topic but still cannot understand and am frustrated .
I have very good insurance - United Concordia through blue cross federal .
My dentist submitted charges to my insurance and the insurance denied part of the payment as they felt part of the services rendered were not necessary .The dentist office wants me to pay the fees about $150 which the insurance did not pay .
When I go to other non dental doctors , they happily take what insurance pays them and also tell me that they cannot charge me for Some thing denied by insurance as they contracted with the insurance to accept their payments .
When I asked this question , the office manager was very rude and just told me they will take me to collections if I do not pay .
Why do the dentists not accept what insurance pays them like other doctors ?
Should I complain to my Insurance ?
1. Seems to me that $150 is not a large charge.
2. Do you know and understand just what the dentist did and why? You should have received (or get upon request) a detailed bill/statement by procedure codes for everything done - and what the insurance did and did not pay. Perhaps these items, while not fully "necessary", may have actually benefitted you?
3. Do you like the dentist? Do you think the dentist is good/competent?
4. Seems unusual that the office manager would be rude, etc.
5. A possibility also might be that the dentist (or office staff) coded certain procedures incorrectly?
Last edited by dm200 on Mon Oct 14, 2019 3:52 pm, edited 1 time in total.

bloom2708
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Re: Frustrated with dentist fees

Post by bloom2708 » Mon Oct 14, 2019 3:51 pm

I would pay it and try a new dentist. Life is too short. It isn't the dentist, the insurance has a cap on what they will pay.

Our insurance pays $6 short of the amount charged for a routine cleaning. I have to pay $6 after each visit for our 5 family members. :annoyed
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student
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Re: Frustrated with dentist fees

Post by student » Mon Oct 14, 2019 3:51 pm

It depends on the contract. If the contract says a participating dentist can only get what the insurance is paying, then that is the end of the payment; otherwise, you owe the amount.

BogleMelon
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Re: Frustrated with dentist fees

Post by BogleMelon » Mon Oct 14, 2019 3:53 pm

Questions:
1- What does the EOB (Explanation of benefits) of your insurance saying you should pay?
2- Is the dentist in-network? Because if he is out of network, he would have all the legal right to charge you whatever he wants.
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Topic Author
Jimsad
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Re: Frustrated with dentist fees

Post by Jimsad » Mon Oct 14, 2019 3:54 pm

student wrote:
Mon Oct 14, 2019 3:51 pm
It depends on the contract. If the contract says a participating dentist can only get what the insurance is paying, then that is the end of the payment; otherwise, you owe the amount.
I did not understand why dentists do not follow same rules as other medical doctors .
Are there any dentists who will accept what insurance pays them and not charge extra ? Should I call around to find out ?

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samsoes
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Re: Frustrated with dentist fees

Post by samsoes » Mon Oct 14, 2019 3:56 pm

That rude staff member who threatened collection action would cause me to find a new dentist post-haste, while leaving behind an online review regarding the office staff.
Last edited by samsoes on Mon Oct 14, 2019 3:56 pm, edited 1 time in total.
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HomeStretch
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Re: Frustrated with dentist fees

Post by HomeStretch » Mon Oct 14, 2019 3:56 pm

If this was for a non-routine service like filling, in the future you can ask for a pre-treatment estimate to be submitted to your insurer to see whether it’s covered or not. Prevents surprises.

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Tamarind
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Re: Frustrated with dentist fees

Post by Tamarind » Mon Oct 14, 2019 3:59 pm

Jimsad wrote:
Mon Oct 14, 2019 3:54 pm
student wrote:
Mon Oct 14, 2019 3:51 pm
It depends on the contract. If the contract says a participating dentist can only get what the insurance is paying, then that is the end of the payment; otherwise, you owe the amount.
I did not understand why dentists do not follow same rules as other medical doctors .
Are there any dentists who will accept what insurance pays them and not charge extra ? Should I call around to find out ?
The insurance rules b/w dental and medical are not at all the same. For example, the law does not require any coverage of dental procedures, and dental insurance plans can and usually do impose annual caps on coverage.

My insurance doesn't cover fluoride treatments for adults, but my dentist recommends them as a new leading practice. I choose to fork over the extra cash.

The dental insurance market is a great reminder of how painful the medical market used to be (for patients). Not that it couldn't stand to be better...

runner3081
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Re: Frustrated with dentist fees

Post by runner3081 » Mon Oct 14, 2019 4:02 pm

Tamarind wrote:
Mon Oct 14, 2019 3:59 pm
Jimsad wrote:
Mon Oct 14, 2019 3:54 pm
student wrote:
Mon Oct 14, 2019 3:51 pm
It depends on the contract. If the contract says a participating dentist can only get what the insurance is paying, then that is the end of the payment; otherwise, you owe the amount.
I did not understand why dentists do not follow same rules as other medical doctors .
Are there any dentists who will accept what insurance pays them and not charge extra ? Should I call around to find out ?
The insurance rules b/w dental and medical are not at all the same. For example, the law does not require any coverage of dental procedures, and dental insurance plans can and usually do impose annual caps on coverage.

My insurance doesn't cover fluoride treatments for adults, but my dentist recommends them as a new leading practice. I choose to fork over the extra cash.
Another data point, our plan (finally changing in 2020) ONLY covers Amalgam (silver) fillings, not the white ones. The dentist we go to doesn't even to amalgam anymore, this was a costly surprise!

Topic Author
Jimsad
Posts: 194
Joined: Mon Mar 20, 2017 5:54 pm

Re: Frustrated with dentist fees

Post by Jimsad » Mon Oct 14, 2019 4:06 pm

runner3081 wrote:
Mon Oct 14, 2019 4:02 pm
Tamarind wrote:
Mon Oct 14, 2019 3:59 pm
Jimsad wrote:
Mon Oct 14, 2019 3:54 pm
student wrote:
Mon Oct 14, 2019 3:51 pm
It depends on the contract. If the contract says a participating dentist can only get what the insurance is paying, then that is the end of the payment; otherwise, you owe the amount.
I did not understand why dentists do not follow same rules as other medical doctors .
Are there any dentists who will accept what insurance pays them and not charge extra ? Should I call around to find out ?
The insurance rules b/w dental and medical are not at all the same. For example, the law does not require any coverage of dental procedures, and dental insurance plans can and usually do impose annual caps on coverage.

My insurance doesn't cover fluoride treatments for adults, but my dentist recommends them as a new leading practice. I choose to fork over the extra cash.
Another data point, our plan (finally changing in 2020) ONLY covers Amalgam (silver) fillings, not the white ones. The dentist we go to doesn't even to amalgam anymore, this was a costly surprise!
I was not told upfront that I will have to pay if insurance does not cover . Hence I was not expecting it and the rude staff further aggravated me

strafe
Posts: 964
Joined: Sat Mar 03, 2007 12:49 pm

Re: Frustrated with dentist fees

Post by strafe » Mon Oct 14, 2019 4:13 pm

Jimsad wrote:
Mon Oct 14, 2019 3:44 pm
I have very good insurance - United Concordia through blue cross federal .
My dentist submitted charges to my insurance and the insurance denied part of the payment as they felt part of the services rendered were not necessary .
The dentist office wants me to pay the fees about $150 which the insurance did not pay [...]
Should I complain to my Insurance ?
If this is good insurance, I’m curious what you would define as bad insurance?

Did the insurance company examine your mouth?

I get your frustration. But it is misdirected. The problem seems to be the insurance plan.

HomeStretch
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Re: Frustrated with dentist fees

Post by HomeStretch » Mon Oct 14, 2019 4:14 pm

Jimsad wrote:
Mon Oct 14, 2019 3:54 pm
Are there any dentists who will accept what insurance pays them and not charge extra ? Should I call around to find out ?
Have you reviewed your plan coverage? Is your dentist in-network (not just “accepts your insurance”)?

For example, my dental plan covers preventative (6-month cleaning/exam and periodic x-rays) at 100%. Any other covered procedure (filling, crown, etc.) has a 20% - 40% co-insurance and the policy has an annual limit paid by the insurer of $xx per family member per year.

If I go to an in-network dentist, my preventative work is no charge to me. Any other covered procedure, I will pay 20-40% out-of-pocket of the contract charge up to the annual limit, after which I pay 100% of the contract charge. Any procedure not covered by the plan (example - orthodontics), would be 100% billable to me at market price.

If I go to an out-of-network dentist, the dentist will usually bill my insurer (as a courtesy to me) the market price. I am expected to pay the difference between the price billed and the reimbursement from the insurer. The market price can easily be 20-60% higher than the discounted contract rate that in-network dentists agree to. As a result, my out-of-pocket can be high.

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HueyLD
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Re: Frustrated with dentist fees

Post by HueyLD » Mon Oct 14, 2019 4:16 pm

JIm, you are not alone.

I think the main problem you encountered was the rude office personnel. If you like the dentist, please let him know that his employee did a dis-service to the patients.

Our health care system is pretty screwed up as you know.

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dm200
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Re: Frustrated with dentist fees

Post by dm200 » Mon Oct 14, 2019 4:19 pm

Over the decades, I have never encountered any "rude" office staff.

My current (new to me in early 2019) seems to be a good dentist, as well as explaining everything he does - and why. I have had quite a bit of dental work done this year - and more to come in late 2019 into 2020.

His billing seems to be 100% consistent with my insurance coverage. :happy
Last edited by dm200 on Mon Oct 14, 2019 4:21 pm, edited 1 time in total.

Topic Author
Jimsad
Posts: 194
Joined: Mon Mar 20, 2017 5:54 pm

Re: Frustrated with dentist fees

Post by Jimsad » Mon Oct 14, 2019 4:21 pm

strafe wrote:
Mon Oct 14, 2019 4:13 pm
Jimsad wrote:
Mon Oct 14, 2019 3:44 pm
I have very good insurance - United Concordia through blue cross federal .
My dentist submitted charges to my insurance and the insurance denied part of the payment as they felt part of the services rendered were not necessary .
The dentist office wants me to pay the fees about $150 which the insurance did not pay [...]
Should I complain to my Insurance ?
If this is good insurance, I’m curious what you would define as bad insurance?

Did the insurance company examine your mouth?

I get your frustration. But it is misdirected. The problem seems to be the insurance plan.
Are you a Dentist?

strafe
Posts: 964
Joined: Sat Mar 03, 2007 12:49 pm

Re: Frustrated with dentist fees

Post by strafe » Mon Oct 14, 2019 4:22 pm

Jimsad wrote:
Mon Oct 14, 2019 4:21 pm
strafe wrote:
Mon Oct 14, 2019 4:13 pm
Jimsad wrote:
Mon Oct 14, 2019 3:44 pm
I have very good insurance - United Concordia through blue cross federal .
My dentist submitted charges to my insurance and the insurance denied part of the payment as they felt part of the services rendered were not necessary .
The dentist office wants me to pay the fees about $150 which the insurance did not pay [...]
Should I complain to my Insurance ?
If this is good insurance, I’m curious what you would define as bad insurance?

Did the insurance company examine your mouth?

I get your frustration. But it is misdirected. The problem seems to be the insurance plan.
Are you a Dentist?
No

Topic Author
Jimsad
Posts: 194
Joined: Mon Mar 20, 2017 5:54 pm

Re: Frustrated with dentist fees

Post by Jimsad » Mon Oct 14, 2019 4:26 pm

strafe wrote:
Mon Oct 14, 2019 4:22 pm
Jimsad wrote:
Mon Oct 14, 2019 4:21 pm
strafe wrote:
Mon Oct 14, 2019 4:13 pm
Jimsad wrote:
Mon Oct 14, 2019 3:44 pm
I have very good insurance - United Concordia through blue cross federal .
My dentist submitted charges to my insurance and the insurance denied part of the payment as they felt part of the services rendered were not necessary .
The dentist office wants me to pay the fees about $150 which the insurance did not pay [...]
Should I complain to my Insurance ?
If this is good insurance, I’m curious what you would define as bad insurance?

Did the insurance company examine your mouth?

I get your frustration. But it is misdirected. The problem seems to be the insurance plan.
Are you a Dentist?
No
I do not agree with you . I agree that I should have checked with my Insurance first what they would cover .
But the dentist Office led me to believe that Insurance covered the Sevice fully And then hit me with a surprise bill and when I asked for an explanation , threatened to Send me to collections .

runner3081
Posts: 2566
Joined: Mon Aug 22, 2016 3:22 pm

Re: Frustrated with dentist fees

Post by runner3081 » Mon Oct 14, 2019 4:32 pm

Jimsad wrote:
Mon Oct 14, 2019 4:06 pm
runner3081 wrote:
Mon Oct 14, 2019 4:02 pm
Tamarind wrote:
Mon Oct 14, 2019 3:59 pm
Jimsad wrote:
Mon Oct 14, 2019 3:54 pm
student wrote:
Mon Oct 14, 2019 3:51 pm
It depends on the contract. If the contract says a participating dentist can only get what the insurance is paying, then that is the end of the payment; otherwise, you owe the amount.
I did not understand why dentists do not follow same rules as other medical doctors .
Are there any dentists who will accept what insurance pays them and not charge extra ? Should I call around to find out ?
The insurance rules b/w dental and medical are not at all the same. For example, the law does not require any coverage of dental procedures, and dental insurance plans can and usually do impose annual caps on coverage.

My insurance doesn't cover fluoride treatments for adults, but my dentist recommends them as a new leading practice. I choose to fork over the extra cash.
Another data point, our plan (finally changing in 2020) ONLY covers Amalgam (silver) fillings, not the white ones. The dentist we go to doesn't even to amalgam anymore, this was a costly surprise!
I was not told upfront that I will have to pay if insurance does not cover . Hence I was not expecting it and the rude staff further aggravated me
Neither was I. However, I blame myself for not knowing my plan and its coverage. Obviously, no excuse for the rude staff.

Starfish
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Re: Frustrated with dentist fees

Post by Starfish » Mon Oct 14, 2019 4:35 pm

It's hard (maybe impossible?) to know in advance what insurance will cover.
Do you want the dentist to take the best action for your health or the action insurance wants him too? Because I can tell you that insurance does not care a bit about you, they care about the minimum payment and their bottom line.
People don't understand that dental insurance is against their interest (health) and it pushes dentists into performing bad procedures.
Jimsad wrote:
Mon Oct 14, 2019 3:54 pm
student wrote:
Mon Oct 14, 2019 3:51 pm
It depends on the contract. If the contract says a participating dentist can only get what the insurance is paying, then that is the end of the payment; otherwise, you owe the amount.
I did not understand why dentists do not follow same rules as other medical doctors .
Are there any dentists who will accept what insurance pays them and not charge extra ? Should I call around to find out ?
It's not the dentists. The dental insurance has different rules from medical insurance. On the plus side is much easier to understand.

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dm200
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Location: Washington DC area

Re: Frustrated with dentist fees

Post by dm200 » Mon Oct 14, 2019 4:39 pm

Starfish wrote:
Mon Oct 14, 2019 4:35 pm
It's hard (maybe impossible?) to know in advance what insurance will cover.
Do you want the dentist to take the best action for your health or the action insurance wants him too? Because I can tell you that insurance does not care a bit about you, they care about the minimum payment and their bottom line.
People don't understand that dental insurance is against their interest (health) and it pushes dentists into performing bad procedures.
Just as with almost any kind of Physician or Dentist, I suspect that such providers cannot be expected to know the details of every patient's insurance coverage. With Physicians, it seems to me that if, say, a Physician saw 25 patients in one day - each of the 25 might have, at least, some differences in their insurance coverage.

student
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Re: Frustrated with dentist fees

Post by student » Mon Oct 14, 2019 5:41 pm

Jimsad wrote:
Mon Oct 14, 2019 3:54 pm
student wrote:
Mon Oct 14, 2019 3:51 pm
It depends on the contract. If the contract says a participating dentist can only get what the insurance is paying, then that is the end of the payment; otherwise, you owe the amount.
I did not understand why dentists do not follow same rules as other medical doctors .
Are there any dentists who will accept what insurance pays them and not charge extra ? Should I call around to find out ?
As far as I know, dental insurance and medical insurance are quite different. Some useful info are available
https://blog.solsticebenefits.com/solst ... -insurance
https://www.dentistryiq.com/front-offic ... procedures

At this point, I think you should contact your insurance company and ask for its assistance and guidance; in particular, whether the contract allows the dental office to bill you.

nydoc
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Joined: Mon Jul 22, 2019 5:57 pm

Re: Frustrated with dentist fees

Post by nydoc » Mon Oct 14, 2019 5:47 pm

My office staff very clearly tells patients in polite way that it’s theirs responsibility to know the minute details of their insurance plans. They bought the insurance not me. Read the fine print before you sign something. Apart from that I wish I was a dentist and not a surgeon and would be paid a fair value of my work.

remomnyc
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Re: Frustrated with dentist fees

Post by remomnyc » Mon Oct 14, 2019 6:01 pm

I don't know your plan, but my plan has in-network and out of network dentists. The in-network dentists accept whatever insurance pays and I'm only required to pay whatever the insurance (not the dentist) deems I should pay based on the EOB (explanation of benefits). Before I do any procedure, I get an EOB to make sure it's covered. If it's not, it's my dime. If I go out of network, my insurance pays 80% of what they deem customary for the procedure and I am required to pay the balance, but again, this assumes that the procedure is covered. I always request that my dentist/oral surgeon/endodontist/etc, whether in or out of network, request an EOB from the insurance company before we start any procedure.

Trader Joe
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Re: Frustrated with dentist fees

Post by Trader Joe » Mon Oct 14, 2019 6:52 pm

Jimsad wrote:
Mon Oct 14, 2019 3:44 pm
I posted in past on similar topic but still cannot understand and am frustrated .
I have very good insurance - United Concordia through blue cross federal .
My dentist submitted charges to my insurance and the insurance denied part of the payment as they felt part of the services rendered were not necessary .
The dentist office wants me to pay the fees about $150 which the insurance did not pay .
When I go to other non dental doctors , they happily take what insurance pays them and also tell me that they cannot charge me for Some thing denied by insurance as they contracted with the insurance to accept their payments .
When I asked this question , the office manager was very rude and just told me they will take me to collections if I do not pay .
Why do the dentists not accept what insurance pays them like other doctors ?
Should I complain to my Insurance ?
I would find and use another in-network dentist.

MiddleOfTheRoad
Posts: 242
Joined: Fri Jul 21, 2017 11:19 am

Re: Frustrated with dentist fees

Post by MiddleOfTheRoad » Mon Oct 14, 2019 7:38 pm

1. Dental and medical insurance are completely different.

2. I am pretty sure you have agreed to this if you remember all the disclosure papers you signed when you become a patient of that practice.

3. It almost does not matter in network vs not. If the dentist is not in network you may need to pay cash for everything and then you have to submit for reimbursement yourself

Good luck

Katietsu
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Re: Frustrated with dentist fees

Post by Katietsu » Mon Oct 14, 2019 7:47 pm

I am confused by the idea that a medical provider can not charge you if you receive a service that is denied by the insurance company. This is usually not true. You usually can be on the hook for services that insurer does not pay for. I do recall something about traditional Medicare where the provider must get consent in advance to be able to bill if Medicare does not pay. But that is very specific to Medicare rules.

bankle
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Re: Frustrated with dentist fees

Post by bankle » Mon Oct 14, 2019 7:55 pm

student wrote:
Mon Oct 14, 2019 5:41 pm
Jimsad wrote:
Mon Oct 14, 2019 3:54 pm
student wrote:
Mon Oct 14, 2019 3:51 pm
It depends on the contract. If the contract says a participating dentist can only get what the insurance is paying, then that is the end of the payment; otherwise, you owe the amount.
I did not understand why dentists do not follow same rules as other medical doctors .
Are there any dentists who will accept what insurance pays them and not charge extra ? Should I call around to find out ?
As far as I know, dental insurance and medical insurance are quite different. Some useful info are available
https://blog.solsticebenefits.com/solst ... -insurance
https://www.dentistryiq.com/front-offic ... procedures

At this point, I think you should contact your insurance company and ask for its assistance and guidance; in particular, whether the contract allows the dental office to bill you.
Just to add another link that discusses medical vs dental insurance:
https://www.nbcnews.com/better/health/r ... ncna813666

As others have mentioned, your best bet is to find a dentist in your dental plan, ask about fees in advance of any work (in my own experience, dentists are much more forthcoming about this than medical docs).

And practice good habits - brush and floss, cleanings every six months (not saying you don't do this of course, and there are many other factors that can effect dental health, I know.). Just my inner school marm gets activated when dental issues are discussed.

After I gave my sister $600 for a root canal because she ran out of benefits one year, I asked, "Do you floss?". "No, hahaha.". And I found out she doesn't brush regularly either. :oops:

DaftInvestor
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Re: Frustrated with dentist fees

Post by DaftInvestor » Mon Oct 14, 2019 7:58 pm

Jimsad wrote:
Mon Oct 14, 2019 3:54 pm
student wrote:
Mon Oct 14, 2019 3:51 pm
It depends on the contract. If the contract says a participating dentist can only get what the insurance is paying, then that is the end of the payment; otherwise, you owe the amount.
I did not understand why dentists do not follow same rules as other medical doctors .
Are there any dentists who will accept what insurance pays them and not charge extra ? Should I call around to find out ?
In my experience both doctors and dentists follow the same rules - both charge me for the amounts not covered by my insurance and expect me to pay the difference between what they charge and what insurance covers.

AlohaJoe
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Location: Saigon, Vietnam

Re: Frustrated with dentist fees

Post by AlohaJoe » Mon Oct 14, 2019 8:00 pm

HueyLD wrote:
Mon Oct 14, 2019 4:16 pm
I think the main problem you encountered was the rude office personnel. If you like the dentist, please let him know that his employee did a dis-service to the patients.
samsoes wrote:
Mon Oct 14, 2019 3:56 pm
That rude staff member who threatened collection action would cause me to find a new dentist post-haste, while leaving behind an online review regarding the office staff.
It is hard to know whether the staff member was actually rude when we only hear one side of the argument. The OP started a nearly identical thread in January about dental insurance.

Mr. Rumples
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Joined: Sun Aug 25, 2019 7:16 am

Re: Frustrated with dentist fees

Post by Mr. Rumples » Mon Oct 14, 2019 8:10 pm

My dentist is not "in network" so I expect to pay more. They do file for me and now that I have been going to her for a few years, they bill me for the difference if its large (she charged about triple what the insurance would pay) and for the regular cleanings she just writes it off. That said, they run the claim with the codes before a procedure so I know what I will owe. I don't know why other dentists who are in a network won't do that. My dentist is in a practice by herself and of course with her assistants and two office staff people.

Its not based on anything but my impression, but I have been to two dentists in my life who were not "in network." I felt they were better dentists and did not rush through cleanings.
Last edited by Mr. Rumples on Mon Oct 14, 2019 8:16 pm, edited 1 time in total.

HomeStretch
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Re: Frustrated with dentist fees

Post by HomeStretch » Mon Oct 14, 2019 8:10 pm

Looking at your Jan 2019 post about dental fees, my guess is that your dentist is not in-network for your plan. Sometimes dentists say they “accept” your insurance. That doesn’t mean the dentist is in-network. It just means the dentist will bill and collect from the insurance company then expect you to pay the difference between what was billed minus what was paid by the insurance company. The biggest problem with a dentist not in-network is that you don’t get the lower contract discounted price that you would get with an in-network dentist.

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JoeRetire
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Re: Frustrated with dentist fees

Post by JoeRetire » Mon Oct 14, 2019 8:17 pm

Jimsad wrote:
Mon Oct 14, 2019 4:26 pm
I agree that I should have checked with my Insurance first what they would cover .
But the dentist Office led me to believe that Insurance covered the Sevice fully And then hit me with a surprise bill and when I asked for an explanation , threatened to Send me to collections .
Pay the bill. Then find a new dentist. You don't need to accept rudeness if you don't want to.

Make sure to check with your insurance company before every procedure what will be covered and what will not. Then you can choose to go ahead with the procedure or decide that you don't want your teeth fixed. You learned earlier in the year that only 50% of orthodontia was covered. You need to learn what is covered for each procedure by asking United Concordia before you have treatment.

From the United Concordia website:
"Predetermination of benefits
If you expect your dental service to cost more than $500, it might be wise to ask your dentist to submit a predetermination of benefits to us to calculate how much of your dental services will be covered. This allows you to know up front what you can expect to pay out of pocket."

I don't know of any dentist who will agree to charge you only what your insurance will pay, unless they have agreed to do so as part of accepting a particular dental plan. Check with your insurer about that.

You need to understand that office managers can estimate what is covered in your plan and what is not, but that is your responsibility (along with your insurer), not theirs. If you aren't sure I'm correct, you can ask if the office manager if they will guarantee to charge you only for what they estimate (they won't).

Do you have a PPO plan? Or a DHMO plan? Is this dentist in-network or not?

From the United Concordia website:
"What happens if I visit a non-network dentist?
If you have a PPO plan, then your benefits will apply, but you may have to pay the difference between the fees our network dentists have agreed to accept and the non-network dentist’s full fees. Also, you will need to pay any coinsurances or deductibles that apply (just like you would at a network dentist).

If you have a DHMO or the iDental Discount plan, you will not have coverage for any services received from a non-network dentist. That means you would be responsible for the entire cost of the service."
Last edited by JoeRetire on Mon Oct 14, 2019 8:48 pm, edited 5 times in total.
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orhkaf
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Re: Frustrated with dentist fees

Post by orhkaf » Mon Oct 14, 2019 8:25 pm

I've had my fair share of dentist's try to scam me.

I now keep a PDF version of the fee schedule on my phone and I pull it up to "double check" the charges.

If you have an HMO dental insurance the fee should usually be stated as a $ amount in the fee schedule.

If it's a PPO dental plan then it wont be as clear as the service is usually expressed as a % of the contracted rate. You can always double check the EOB to verify you were billed properly once it posts on your account.

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dratkinson
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Re: Frustrated with dentist fees

Post by dratkinson » Mon Oct 14, 2019 8:29 pm

After military retirement, I solved my dental insurance problem (in/out of network, not/covered procedures,...) by opting-out. I've self-insured for 20yrs. Most recently:
--New patient exam, x-rays, and cleaning: ~$400. (Old dentist closed office.)
--Root canal and temporary crown: ~$1100. (My last root canal was >20yrs ago.)
--New crown: ~$1400. (My last crown was >20yrs ago.)
--Regular cleaning: ~$150.

I'm never frustrated. I can either afford the service, or it gets delayed until I can.

My new dentists (separate specialties, shared offices and staff) are friendly, do good work, give a 10% discount for cash, and occasionally don't charge for small services.

I suspect I'm paying more for services than paid by insurance---and that makes my dentists happy and is okay by me---as I believe I'm savings money by self-insuring. (I always know the cost before any procedure, ask for a cash discount when I pay, and thank them when I receive it.)

At the time I opted-out, full-coverage dental insurance was ~$100/mo, so ($100 x 12 x 20 =) $24K saved over 20yrs.

More recent $30/mo quotes for partial-coverage dental insurance ($30 x 12 = $360) is more than I pay for an annual cleaning. So I'm still saving money. (Not expecting another root canal/crown for ~20yrs, so expecting ~$7K (= 360 x 20) saved vs. ~$3K root canal/crown.)



If OP does not like his dental insurance, he has the option to buy better insurance or opt-out. Works for me.
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cheese_breath
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Re: Frustrated with dentist fees

Post by cheese_breath » Mon Oct 14, 2019 8:31 pm

DaftInvestor wrote:
Mon Oct 14, 2019 7:58 pm
Jimsad wrote:
Mon Oct 14, 2019 3:54 pm
student wrote:
Mon Oct 14, 2019 3:51 pm
It depends on the contract. If the contract says a participating dentist can only get what the insurance is paying, then that is the end of the payment; otherwise, you owe the amount.
I did not understand why dentists do not follow same rules as other medical doctors .
Are there any dentists who will accept what insurance pays them and not charge extra ? Should I call around to find out ?
In my experience both doctors and dentists follow the same rules - both charge me for the amounts not covered by my insurance and expect me to pay the difference between what they charge and what insurance covers.
+1
They might accept what the insurance will pay for covered services, but you have to pay for any uncovered ones. And it's your responsibility to know what your policy will cover, not the doctor's or dentist's.
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james3547
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Re: Frustrated with dentist fees

Post by james3547 » Mon Oct 14, 2019 8:41 pm

Warning this will be disjointed. You need to look at your EOB and figure out what your charged for.
It could be the ins co

1. Denied coverage (doesn't mean the procedure is unescasssry) we have to appeal legitimate claims often.
2. Downgraded to lesser fee code
3. Doesn't have coverage (if your in network the densitst should di best to verify coverage for procedures)
4 others ins is the worst

If they denied the dentist might help appeal but its your responsibility. You likely signed a form in your new patient paperwork that treatment fees with insurance are estimated only. Your required for the balance ultimately. If downgraded is some states the dentist can charge the difference in the codes but not all do, its usually office by office. If no coverage, ultimately your problem but depending on the office they might help you out.

And this constant verbiage if only taking what ins pays is insurance fraud. If the dentist doesn't charge and collect your portion but takes the ins portion that's fraud. You should just call or go in and ask again. The accounts get fairly complicated and most people are just trying to help you out.
Last edited by james3547 on Mon Oct 14, 2019 8:43 pm, edited 1 time in total.

O2sats
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Re: Frustrated with dentist fees

Post by O2sats » Mon Oct 14, 2019 8:42 pm

I wouldn't be surprised if the front desk staff was direct in saying if there is an outstanding bill it will be sent to collections. I doubt it was rude. If it was, vote with your feet and find a new dentist. Your insurance is probably not "good insurance" and actually doesn't pay the dentist a fair rate for their work. So they have to charge patients the difference. That's an insurance problem, not a dentist issue

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Re: Frustrated with dentist fees

Post by james3547 » Mon Oct 14, 2019 8:46 pm

Also, Concordia is the worst insurance company that I deal with (used to i dropped them). They have the lowest fee schedule and deny legitimate claims all the time.

Also somebody mentioned pre determinations, while yes that will say what they will pay, if you read the fine print they can charge their mind you might get approval on pre d and denied in the real claim.

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unclescrooge
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Re: Frustrated with dentist fees

Post by unclescrooge » Mon Oct 14, 2019 8:47 pm

HomeStretch wrote:
Mon Oct 14, 2019 4:14 pm
Jimsad wrote:
Mon Oct 14, 2019 3:54 pm
Are there any dentists who will accept what insurance pays them and not charge extra ? Should I call around to find out ?
Have you reviewed your plan coverage? Is your dentist in-network (not just “accepts your insurance”)?

For example, my dental plan covers preventative (6-month cleaning/exam and periodic x-rays) at 100%. Any other covered procedure (filling, crown, etc.) has a 20% - 40% co-insurance and the policy has an annual limit paid by the insurer of $xx per family member per year.

If I go to an in-network dentist, my preventative work is no charge to me. Any other covered procedure, I will pay 20-40% out-of-pocket of the contract charge up to the annual limit, after which I pay 100% of the contract charge. Any procedure not covered by the plan (example - orthodontics), would be 100% billable to me at market price.

If I go to an out-of-network dentist, the dentist will usually bill my insurer (as a courtesy to me) the market price. I am expected to pay the difference between the price billed and the reimbursement from the insurer. The market price can easily be 20-60% higher than the discounted contract rate that in-network dentists agree to. As a result, my out-of-pocket can be high.
Sounds like your dental insurance is just a prepayment of work you would get done anyway?

Now that I think about it, I think I have the same insurance. :mrgreen:

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TexasPE
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Re: Frustrated with dentist fees

Post by TexasPE » Mon Oct 14, 2019 8:50 pm

dratkinson wrote:
Mon Oct 14, 2019 8:29 pm
I've self-insured for 20yrs. Most recently:
--New patient exam, x-rays, and cleaning: ~$400. (Old dentist closed office.)
--Root canal and temporary crown: ~$1100. (My last root canal was >20yrs ago.)
--New crown: ~$1400. (My last crown was >20yrs ago.)
--Regular cleaning: ~$150.
Interesting - I am also self insured
x-rays and cleaning $124
cleaning only $74
temp and new crown (no root canal) $650
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Ztx
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Re: Frustrated with dentist fees

Post by Ztx » Mon Oct 14, 2019 8:51 pm

As many people already mentioned, it's not easy to know beforehand what insurance will or will not cover. Even if dental office calls insurance and tries to get that information, it's not always fully correct. It happens all the time that insurance representative says that a service will be covered, but then when the time comes to pay the bill they don't cover that (and either tell to charge the patient or suck it up - it depends on a specific contract)

And the worst thing - there is almost no recourse in this situation. Insurance companies are interested in paying as little as possible

The staff should have not been rude of course, that is unacceptable.
Last edited by Ztx on Mon Oct 14, 2019 8:52 pm, edited 1 time in total.

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JoeRetire
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Re: Frustrated with dentist fees

Post by JoeRetire » Mon Oct 14, 2019 8:51 pm

Never mind.
Last edited by JoeRetire on Mon Oct 14, 2019 8:57 pm, edited 1 time in total.
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james3547
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Re: Frustrated with dentist fees

Post by james3547 » Mon Oct 14, 2019 8:54 pm

JoeRetire wrote:
Mon Oct 14, 2019 8:51 pm
james3547 wrote:
Mon Oct 14, 2019 8:46 pm
Also, Concordia is the worst insurance company that I deal with
Hmm, you wrote "I have very good insurance - United Concordia through blue cross federal ."

Seems like you are contradicting yourself here.
Also somebody mentioned pre determinations, while yes that will say what they will pay, if you read the fine print they can charge their mind you might get approval on pre d and denied in the real claim.
You haven't complained about getting a pre-determination from your insurer after which they changed their mind, so I'm assuming this hasn't actually happened. Sounds like you are just looking to rant.

Good luck.
I'm not the OP

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JoeRetire
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Re: Frustrated with dentist fees

Post by JoeRetire » Mon Oct 14, 2019 8:56 pm

james3547 wrote:
Mon Oct 14, 2019 8:54 pm
JoeRetire wrote:
Mon Oct 14, 2019 8:51 pm
james3547 wrote:
Mon Oct 14, 2019 8:46 pm
Also, Concordia is the worst insurance company that I deal with
Hmm, you wrote "I have very good insurance - United Concordia through blue cross federal ."

Seems like you are contradicting yourself here.
Also somebody mentioned pre determinations, while yes that will say what they will pay, if you read the fine print they can charge their mind you might get approval on pre d and denied in the real claim.
You haven't complained about getting a pre-determination from your insurer after which they changed their mind, so I'm assuming this hasn't actually happened. Sounds like you are just looking to rant.

Good luck.
I'm not the OP
Oops - my apologies to both of you!
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J295
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Re: Frustrated with dentist fees

Post by J295 » Mon Oct 14, 2019 9:06 pm

Frustrated with dentist fees
Post by Jimsad » Mon Oct 14, 2019 2:44 pm

I posted in past on similar topic but still cannot understand and am frustrated .
I have very good insurance - United Concordia through blue cross federal .
My dentist submitted charges to my insurance and the insurance denied part of the payment as they felt part of the services rendered were not necessary .
OP ... Which services did the insurance company find "necessary" and pay, what was this total? .... and which did they find "unnecessary" and decline to pay (the $150)?

These details may be pertinent in preparing a reply.

socaldude
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Re: Frustrated with dentist fees

Post by socaldude » Mon Oct 14, 2019 9:26 pm

"Why do Doctor's call Dentist's...?...to borrow money."

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Re: Frustrated with dentist fees

Post by LadyGeek » Tue Oct 15, 2019 6:52 am

An off-topic rant about dental insurance has been removed. As a reminder, see: General Etiquette
We expect this forum to be a place where people can feel comfortable asking questions and where debates and discussions are conducted in civil tones.
This thread was temporarily removed for moderator review.
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rkhusky
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Re: Frustrated with dentist fees

Post by rkhusky » Tue Oct 15, 2019 7:35 am

I have found that the dentist office often puts the wrong code in for a procedure, which gets the claim rejected. The dentist will then re-submit with the correct code. Sometimes, I've called the insurance company to find out why a claim was rejected, because I like our dentist and want them to get reimbursed. I also make sure that I know what is covered and what my contribution should be.

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