Dentist called 6 months later to get their discount back

[pedr0o]

Hi

A dentist gave me a 50% discount on my co-pay to make a crown. They called me recently (After 6 months) asking me to pay the remaining 50% and deny that a discount was given. They say that paying only 50% was a miscalculation which is not true.

Any thoughts?

[CAsage]

Any paperwork on this? A statement after the crown was done showing zero balance? A pretreatment estimate? I'm assuming they were paid a portion under insurance, and this is just the patient portion?

[nalor511]

I always ask for an itemized bill at the end of my appointment - it's good to do.

[pedr0o]

Any paperwork on this? A statement after the crown was done showing zero balance? A pretreatment estimate? I'm assuming they were paid a portion under insurance, and this is just the patient portion?

I have to dig to find my receipts or paperwork. The insurance paid for them a lot already and I'm only paying my co-pay portion.
Worth mentioning that based on this discount experience, I visited them again once or twice to do more work, they never mentioned anything until now.

[pedr0o]

I always ask for an itemized bill at the end of my appointment - it's good to do.

I guess I was given a bill after settling the payment, I will have to search for it.

[aqan]

Any paperwork on this? A statement after the crown was done showing zero balance? A pretreatment estimate? I'm assuming they were paid a portion under insurance, and this is just the patient portion?

I have to dig to find my receipts or paperwork. The insurance paid for them a lot already and I'm only paying my co-pay portion.
Worth mentioning that based on this discount experience, I visited them again once or twice to do more work, they never mentioned anything until now.

I’d ask to speak with the doctor.

[bob60014]

A call? Wait for something in writing.

[bwalling]

Do you have insurance? Was the 50% an estimate of your responsibility after what insurance would pay? If you have insurance, your insurance company would have provided you an EOB (if not by mail, log in to their website and look for it).

If you don't have insurance, ask for your statement to be sent, with full account history. You can also ask for this if you have insurance, but that EOB is going to be the key if you do have insurance.

[criticalmass]

Do you have insurance? Was the 50% an estimate of your responsibility after what insurance would pay? If you have insurance, your insurance company would have provided you an EOB (if not by mail, log in to their website and look for it).

If you don't have insurance, ask for your statement to be sent, with full account history. You can also ask for this if you have insurance, but that EOB is going to be the key if you do have insurance.

The answers to your question are above:

A dentist gave me a 50% discount on my co-pay

The insurance paid for them a lot already and I'm only paying my co-pay portion.

EOB shows what insurance paid, any negotiated copay prices would not appear. Hopefully OP will find statement showing the discount write off. It’s also possible someone else noticed a balance recently and the discount was never recorded properly.

[Dregob]

Any paperwork on this? A statement after the crown was done showing zero balance? A pretreatment estimate? I'm assuming they were paid a portion under insurance, and this is just the patient portion?

I have to dig to find my receipts or paperwork. The insurance paid for them a lot already and I'm only paying my co-pay portion.
Worth mentioning that based on this discount experience, I visited them again once or twice to do more work, they never mentioned anything until now.

My dental insurance paid 50% for a crown leaving me 50%. Did they give you 50% off your 50% portion of the bill?
I think you need a bill showing zero balance. If it was their mistake and they gave youa paid recipt you can probably not pay but you'll need to find another dentist!

[tibbitts]

Hi

A dentist gave me a 50% discount on my co-pay to make a crown. They called me recently (After 6 months) asking me to pay the remaining 50% and deny that a discount was given. They say that paying only 50% was a miscalculation which is not true.

Any thoughts?

Everybody needs to know the details of this negotiation. What was the original estimate of benefits? Was this negotiation with the dentist? The office staff? The billing service? Some guy standing on the sidewalk in front of the dentist's office? Is the person you negotiated with still alive? How was the result of the negotiation communicated?

[Katietsu]

Do you remember the staff person who agreed to the discount? Hopefully, it was not the same person who called you. I am guessing the original person may not of recorded the “discount” appropriately and the amount is now showing up on a list of past due amounts. As to why you were told it was a miscalculation, for better or worse, that type of initial response seems pretty common. Did you explain the events that led to the discount during the phone call?

[bwalling]

Do you have insurance? Was the 50% an estimate of your responsibility after what insurance would pay? If you have insurance, your insurance company would have provided you an EOB (if not by mail, log in to their website and look for it).

If you don't have insurance, ask for your statement to be sent, with full account history. You can also ask for this if you have insurance, but that EOB is going to be the key if you do have insurance.

The answers to your question are above:

A dentist gave me a 50% discount on my co-pay

The insurance paid for them a lot already and I'm only paying my co-pay portion.

EOB shows what insurance paid, any negotiated copay prices would not appear. Hopefully OP will find statement showing the discount write off. It’s also possible someone else noticed a balance recently and the discount was never recorded properly.

I asked for clarification because patients often swap words interchangeably, and I'm used to trying to clarify what they're actually saying.

If you've got the original treatment plan, especially if you have a signed copy, send it to them. They should also have a copy of this in their files.

Your insurance company will also fight for you. File a grievance. The insurance company will force the provider to produce all of the information, including your signature on a treatment plan showing your discount.

FYI - their insurance contracts generally prohibit reducing the patient portion or charging something other than the contracted rate. Some still do it, because insurance companies rarely crack down on it, but it is against their contract. Same reason you usually see "for new patients without insurance" in the fine print on all those ads for free exams or x-rays on your first visit.

[pedr0o]

Hi

A dentist gave me a 50% discount on my co-pay to make a crown. They called me recently (After 6 months) asking me to pay the remaining 50% and deny that a discount was given. They say that paying only 50% was a miscalculation which is not true.

Any thoughts?

Everybody needs to know the details of this negotiation. What was the original estimate of benefits? Was this negotiation with the dentist? The office staff? The billing service? Some guy standing on the sidewalk in front of the dentist's office? Is the person you negotiated with still alive? How was the result of the negotiation communicated?

Do you remember the staff person who agreed to the discount? Hopefully, it was not the same person who called you. I am guessing the original person may not of recorded the “discount” appropriately and the amount is now showing up on a list of past due amounts. As to why you were told it was a miscalculation, for better or worse, that type of initial response seems pretty common. Did you explain the events that led to the discount during the phone call?

Before doing the work, a staff member came and explained the required work and how much is my co-pay. I hesitated to approve so the dentist (also the owner) told the staff to give me 50% on my co-pay portion. I approved the work accordingly. The nurse was also there the whole time. The person who called is the same person who was explaining the cost in July, apparently they did not properly document the verbal communication.

[Katietsu]

Before doing the work, a staff member came and explained the required work and how much is my co-pay. I hesitated to approve so the dentist (also the owner) told the staff to give me 50% on my co-pay portion. I approved the work accordingly. The nurse was also there the whole time. The person who called is the same person who was explaining the cost in July, apparently they did not properly document the verbal communication.

Start with your receipt. Maybe it has a note written in pen that did not make it into the computerized billing records. Next, I would go through this story with the “nurse”. (I put nurse in quotes because dentist offices do not usually employ nurses. Maybe it was a nurse. But could it have been a dental hygienist?) Give as many details in the story as you can. If you have already done this, ask to speak to the dentist. Again, start with how you were there in July and relay the series of events. Hopefully, that will trigger a memory and this will be easily handled.

[galawdawg]

First, review all of your paperwork, including any receipts, insurance claims, insurance EOB and bills from the dental practice.

Then, if those records indicate you owe an amount you believe should have been "discounted", write a concise letter to the dentist (since you mention he owns the practice as well) concerning the issue and asking him to resolve it in your favor.

Be aware that the practice may deny that any discount was offered or indicate that you "misunderstood". A provider who agrees to provide a discount or waiver of patient co-pays/co-insurance is taking a significant risk of being accused of, or investigated for, billing fraud (billing for procedures not actually performed to "make up" for the discount) or violation of the federal antikickback statute. At the least, a provider who is found to have done this jeopardizes their status with the effected insurer.

[CAsage]

I will add that you have stated a decent basis to argue for retaining that half-off copay. You would not have proceeded at that time with that dentist with that work without the discount. That's important, as it shows they 'got' the business in exchange for the discount. The office needs to verify that with the One In Charge.

[WannaRetire]

I would ask to speak with the person who gave you the discount. Strange to give an additional discount when you're already getting the insurance discount.

[Sho]

If you use flexible spending , a receipt might have been scanned

[eagleeyes]

I galawdawg is on to something here.

A healthcare provider has entered into a contract with your insurance company for reimbursement for approved procedures. Giving you a discount of 50 percent on your copay would be in breach of that contract and thus would be a big headache for them.

I would make clear to the dentist that you will be letting the insurance company know that you were promised a discount to get you to agree to a procedure, one that you may not have agreed to do without the discount. Ideally you would have the receipt to back up your claim, but even if you didn’t, this isn’t something the dentist will take lightly

Good luck. Please let us know how this shakes out.

[SevenBridgesRoad]

.....A healthcare provider has entered into a contract with your insurance company for reimbursement for approved procedures. Giving you a discount of 50 percent on your copay would be in breach of that contract and thus would be a big headache for them.....

This is important. The reasons are easy to understand. There are a number of resources out there. Here's one: https://www.bravadohealth.com/2021/02/0 ... aive-them/

[JDave]

It's generally illegal for a doctor to give a discount on, or waive a copay. Insurance companies hate it because it goes against the reason they have copays.

[galawdawg]

I would make clear to the dentist that you will be letting the insurance company know that you were promised a discount to get you to agree to a procedure, one that you may not have agreed to do without the discount. Ideally you would have the receipt to back up your claim, but even if you didn’t, this isn’t something the dentist will take lightly

I'm not sure if you are suggesting that the OP do this in conjunction with demanding the discount, i.e. "if I don't get the discount, I will report you to the insurance company" or not. I would not recommend that the OP take that approach. In some jurisdictions, trying to obtain property (money) by threatening to accuse someone of a criminal offense or threatening to disseminate information that would impair business repute or could cause an official to take action could be considered attempted theft by extortion.

Best to simply request the discount that was promised. Whether the OP chooses to report the matter to his insurance provider should be a separate and unconnected issue. I would recommend that the OP not communicate any such intention to the dental practice. If one is going to report wrongdoing (in any situation), just report it. There is no reason to tell the "wrongdoer" that you are making such a report. Most importantly, attempting to use the threat of such a report as "leverage" to get something in return is not wise and could lead to unintended and undesired results.

Again, I'm not saying that is what you were suggesting, but I just thought I should provide some clarity in any event...

[bwalling]

I would make clear to the dentist that you will be letting the insurance company know that you were promised a discount to get you to agree to a procedure, one that you may not have agreed to do without the discount. Ideally you would have the receipt to back up your claim, but even if you didn’t, this isn’t something the dentist will take lightly

I'm not sure if you are suggesting that the OP do this in conjunction with demanding the discount, i.e. "if I don't get the discount, I will report you to the insurance company" or not. I would not recommend that the OP take that approach. In some jurisdictions, trying to obtain property (money) by threatening to accuse someone of a criminal offense or threatening to disseminate information that would impair business repute or could cause an official to take action could be considered attempted theft by extortion.

No, you won't wind up guilty of a criminal offense. The conversation is simple and legal:

I'd like to resolve this with you directly, but I will contact my insurance company to help resolve this if you're unwilling to resolve it with me directly.

There is nothing at all illegal about that. It's not extortion.

OP - one other common thing that happens here is that many practices do 50% down, 50% on seat/delivery for crowns, dentures, etc that require taking an impression and are fully delivered at a later visit. In your recollection of the conversation, is it possible this is what was offered, and this is the source of the difference between the office and yourself?

[nisiprius]

You didn't mention a number of dollars. I'm thinking half of the copay is in two digits or the low three digits?

I say let it go and take it as a lesson.

I learned maybe thirty years ago that verbal promises are a problem. The person who makes them can be both honest and sincere--(or not!)--but human memory is fallible, and there may not be any office procedures in place to allow someone to make an off-the-cuff promise have it stick. And on the other side, I have found that my own memory is fallible and I have been astonished at times to open an old file folder and discover that what was recorded was different from what I was sure I remembered.

Before doing the work, a staff member came and explained the required work and how much is my co-pay. I hesitated to approve so the dentist (also the owner) told the staff to give me 50% on my co-pay portion. I approved the work accordingly. The nurse was also there the whole time. The person who called is the same person who was explaining the cost in July, apparently they did not properly document the verbal communication.

I believe you.

I also believe that you are not going to have any luck with this unless you can talk to either the dentist or the staffer and they remember the incident, or find supporting paper.

Some of the common and most annoying cases are those in which person A makes you a promise, and is no longer there at the business to keep it at the time it is needed. Is this the case with the "staffer?"

Do remember that from the point of view of the business they are constantly encountering examples of wishful thinking on the part of customers.

It is sometimes awkward but I now have a rule that I really follow, which is that if a verbal statement is important to my decision to buy something, I get it in writing. It doesn't need to be a formal, legal document. And it's sometimes trivially easy; for example, on a retail purchase if the salesperson says "you can return it in thirty days" I will ask them to write "thirty day return on Cheyenne Sleepmaster" and initial it. Quite often they can simply find that in a brochure or on the receipt, circle it, and initial it.

It's not something to bring up in court, it's a memory aid and a way to show someone else that the firm that the promise was really made, and it's not your wishful thinking.

[galawdawg]

I would make clear to the dentist that you will be letting the insurance company know that you were promised a discount to get you to agree to a procedure, one that you may not have agreed to do without the discount. Ideally you would have the receipt to back up your claim, but even if you didn’t, this isn’t something the dentist will take lightly

I'm not sure if you are suggesting that the OP do this in conjunction with demanding the discount, i.e. "if I don't get the discount, I will report you to the insurance company" or not. I would not recommend that the OP take that approach. In some jurisdictions, trying to obtain property (money) by threatening to accuse someone of a criminal offense or threatening to disseminate information that would impair business repute or could cause an official to take action could be considered attempted theft by extortion.

No, you won't wind up guilty of a criminal offense. The conversation is simple and legal:

I'd like to resolve this with you directly, but I will contact my insurance company to help resolve this if you're unwilling to resolve it with me directly.

There is nothing at all illegal about that. It's not extortion.

I just don't recommend such an approach as the exact wording used in such a conversation could determine whether there are any collateral consequences. After all, why invoke the involvement of the insurance carrier? The implication is "give me the discount or I will report this to the insurance company and let them get involved..." or even "give me a discount or I will report your conduct to the insurance company and you'll suffer harm as a result." The better approach IMO is to simply leave it out of the conversation; that eliminates any suggestion that the person seeking a remedy is engaged in anything improper. If the OP is unsuccessful in getting resolution from the dentist, then just contact the insurance provider. There is no reason to advertise that it what one is going to do if one doesn't receive satisfaction.

But what do I know. It isn't like I have any experience or expertise in such legal matters.

From a practical standpoint, I'm not sure that an insurer would intervene on behalf of an insured to attempt to enforce a discount negotiated without the consent of the insurer and that is likely prohibited by the the terms of the insurance provider's contracts with the provider and perhaps with the insured (or their employer) as well.

(Finally, as I noted in my first response, a written letter to the dentist would be best once the incorrect bill has been received. That eliminates any confusion or miscommunication. OP should keep it simple: On _____, your office provided a price of $____ for __________. I was unwilling/unable to pay that cost so you authorized a discount of __________ and communicated such to myself and nurse/hygenist ______________. However, the bill I received on _________ for that procedure does not reflect the discount you promised. Would you kindly assist me in having this bill corrected to reflect the agreed upon discount and send an updated bill as soon as possible. I will gladly pay as soon as I receive a correct and accurate bill. Thank you.)

[bwalling]

And from a practical standpoint, I'm not sure that an insurer would intervene on behalf of an insured to attempt to enforce a discount negotiated without the consent of the insurer and that is likely prohibited by the the terms of the insurance provider's contracts with the provider and perhaps with the insured (or their employer) as well.

Edit to add: insurance companies have a grievance process that exists specifically to intervene on behalf of subscribers in the end of billing disputes. They will demand the provider produce not only the billing history, but signed treatment plans (showing same treatment as what was billed, and expected patient financial responsibility). Depending on the treatment and the insurance company, it is also sometimes required for them to prove that they showed the patient alternate treatment options were available for a lower out of pocket amount (for example, the patient was able to receive a filling instead of a crown, and the patient chose the more expensive crown knowing the additional expense).

This hinges entirely on the paperwork. The dentist *should* have a signed copy of the treatment plan on file. This would show what financial responsibility was presented to the patient. If the discount is on there, it's over. The insurance company will side with the OP. And, the dentist will end up with a grievance on file. Too many of those, and the insurance company will drop the dentist.

If the dentist is unable to produce a signed treatment plan, this will also go in favor of the OP, as the insurance company requires the dentist to clearly present the financial breakdown to the patient. If the dentist was required to show alternative treatments, but did not or cannot produce evidence it was presented and declined, then OP will only be required to pay for the lower price treatment, and the insurance company will take back the amount they paid the provider over the covered amount of the lower cost procedure.

If the dentist produces one, and there is no discount on it, it's over for the OP. He or she signed for the full amount of the patient portion, and has no support for his/her argument of a 50% discount.

But, what do I know? I've only spent the last 20 years building dental billing systems.

[galawdawg]

And from a practical standpoint, I'm not sure that an insurer would intervene on behalf of an insured to attempt to enforce a discount negotiated without the consent of the insurer and that is likely prohibited by the the terms of the insurance provider's contracts with the provider and perhaps with the insured (or their employer) as well.

This hinges entirely on the paperwork. The dentist *should* have a signed copy of the treatment plan on file. This would show what financial responsibility was presented to the patient. If the discount is on there, it's over. The insurance company will side with the OP. And, the dentist will end up with a grievance on file. Too many of those, and the insurance company will drop the dentist.

If the dentist is unable to produce a signed treatment plan, this will also go in favor of the OP, as the insurance company requires the dentist to clearly present the financial breakdown to the patient.

If the dentist produces one, and there is no discount on it, it's over for the OP. He or she signed for the full amount of the patient portion, and has no support for his/her argument of a 50% discount.

But, what do I know? I've only spent the last 20 years building dental billing systems.

I have no knowledge of how dental billing systems work! However, I absolutely agree that a written and signed treatment plan which shows (or doesn't show) the discount would be dispositive. And if written evidence at the dental practice exists showing the offered discount, the dentist would be foolish not to honor it.

Whether a signed treatment plan is required by OP's insurer is something I know nothing about so I'll defer to your experience. But if that is indeed required, then the dentist, again, would be foolish not to honor the discount OP says he was offered if no signed treatment plan exists. If this was a legal case, the absence of such a document, if required to be created by the insurance contract, would be very problematic for the dentist.

OP was asked in the first reply about whether he had a copy of a pre-treatment estimate but OP has not indicated yet whether he has located a copy. If OP cannot locate a copy of his written treatment plan (which is likely the same as the pre-treatment estimate asked about early in the thread), then perhaps a wise approach would be for the OP to request a copy of it from the dental practice. It sounds like that would be of substantial benefit to the OP in working towards a resolution.

[dknightd]

The way I see this is you have two choices. Pay the extra cost, or, find a new dentist.

[Rotarman]

I galawdawg is on to something here.

A healthcare provider has entered into a contract with your insurance company for reimbursement for approved procedures. Giving you a discount of 50 percent on your copay would be in breach of that contract and thus would be a big headache for them.

I would make clear to the dentist that you will be letting the insurance company know that you were promised a discount to get you to agree to a procedure, one that you may not have agreed to do without the discount. Ideally you would have the receipt to back up your claim, but even if you didn’t, this isn’t something the dentist will take lightly

Good luck. Please let us know how this shakes out.

This is probably the most correct answer, but not the way I would handle it. Insurance companies make it very difficult to legally reduce the price of copay for patients. Even if you want to forego a copay to be nice or because it would cause them financial hardship, you can get in trouble for doing so. There are very specific rules on how you may write off patient liabilities or reduce the copay/deductible on a sliding fee scale. Very possible the dentist wanted to give discounts on copays to help patients out and later found out it could get him in legal trouble and had to reverse the discount. It certainly could have been handled better, but I wouldn't be so quick to assume nefarious intentions. I would discuss the discount and see if an agreement could be reached - perhaps a credit towards future dental work or something.

[snackdog]

Just explain to them that was not the deal to which you agreed. Do not pay.

[AnnetteLouisan]

I had a doctor once who did not submit the claim to my insurance for six months. Insurance companies in my state are not required to cover claims incurred that are not submitted after 180 days, and the doctor had to eat the charge. Is it possible something like this happened here? I agree with the advice to wait for a statement in writing including the amount covered by insurance. This issue at be between the Dr and your insurance company. If so, your Dr can speak to them. It’s not your problem, especially if you do not have a bill. You might want to contact your insurance company to see if they have a record of having made payment. That will show the original amount billed.

[8foot7]

Just explain to them that was not the deal to which you agreed. Do not pay.

This. It has been six months. With respect to the other posts, none of the other things matter.

[mariezzz]

Ask to talk directly to the dentist. See if you can jog his memory and get him to honor the agreement.
Also, consider filing a complaint with the attorney general if dentist doesn't honor the agreement. Since the dentist made a special deal with you, I think this falls under attorney general (essentially, he violated a verbal contract) and not insurance commissioner (this isn't an insurance issue).

It's better to try to resolve it than ignore it.

Hi

A dentist gave me a 50% discount on my co-pay to make a crown. They called me recently (After 6 months) asking me to pay the remaining 50% and deny that a discount was given. They say that paying only 50% was a miscalculation which is not true.

Any thoughts?

Everybody needs to know the details of this negotiation. What was the original estimate of benefits? Was this negotiation with the dentist? The office staff? The billing service? Some guy standing on the sidewalk in front of the dentist's office? Is the person you negotiated with still alive? How was the result of the negotiation communicated?

Do you remember the staff person who agreed to the discount? Hopefully, it was not the same person who called you. I am guessing the original person may not of recorded the “discount” appropriately and the amount is now showing up on a list of past due amounts. As to why you were told it was a miscalculation, for better or worse, that type of initial response seems pretty common. Did you explain the events that led to the discount during the phone call?

Before doing the work, a staff member came and explained the required work and how much is my co-pay. I hesitated to approve so the dentist (also the owner) told the staff to give me 50% on my co-pay portion. I approved the work accordingly. The nurse was also there the whole time. The person who called is the same person who was explaining the cost in July, apparently they did not properly document the verbal communication.

[ClevrChico]

It seems unusual to get a discount on a co-pay. Why was there a discount?

I do sympathize with you, as I've been told twice that a procedure was covered 100% for the kids by the dental office, only to get it covered at 0%. They wouldn't budge a cent. They can't understand all the quirks of everyone's insurance, so they probably also shouldn't give any indication of coverage. Our megacorp switches insurance providers every few years, which is maddening.

In the end, I paid it, claimed it on my HSA, and didn't stress about it anymore.

[Carguy85]

Without documentation stating otherwise, you are obligated to your copay. As noted above a copay itself can’t be discounted. If you feel there was deception then fire the dentist. This of course works both ways. If there was any misunderstanding that could have been from improper communication on the offices behalf, the dentist may feel the desire to write off the balance…I certainly would and have on a number of occasions over the years even though we were not in the wrong nor was there any obligation to. I wouldn’t necessarily count on this though. Otherwise pay or risk the office sending the account to collections. It’s really that simple. I’m guessing this is a newer dentist…may be a learning opportunity for them that situations like this are simply aren’t worth getting into.

[OnTrack2020]

In all my years of having dental insurance, health insurance, vision insurance, and having gone to various medical professionals, this is the first time I've ever heard of someone being offered a discount on a co-pay. Your co-pay is your co-pay. It's the fee you pay to see the individual who is going to treat your medical issue. There is no discount. Maybe they were confused.? Or the OP misunderstood.?

I would pay the remaining balance of the co-pay and move on with life. It can't be that much.

[bwalling]

In all my years of having dental insurance, health insurance, vision insurance, and having gone to various medical professionals, this is the first time I've ever heard of someone being offered a discount on a co-pay. Your co-pay is your co-pay. It's the fee you pay to see the individual who is going to treat your medical issue. There is no discount. Maybe they were confused.? Or the OP misunderstood.?

I would pay the remaining balance of the co-pay and move on with life. It can't be that much.

It happens as a "closing tool", but it's almost always prohibited by the insurance contract. The copay serves a financial purpose for the insurance company - it is an incentive against unnecessary procedures, and helps to limit what they pay out to things that were necessary. To reduce them or eliminate them isn't the purview of the doctor, as it undermines the economics of the plan.

Despite that, it happens with some regularity, mostly because the insurance companies don't receive that information. They're billed for the procedures by the dentist, but the dentist doesn't include any information about the patient charges or payments in doing so.

[8foot7]

Again, respectfully, the details of copays vs. coinsurance vs. discounts vs. courtesies and insurance contracts are frankly noise after six months. The time to have sorted that out was within 30-45 days of the service and/or claim. One doesn't get to comb through accounts months later and call to withdraw discounts provided at a (presumably vulnerable) time of service, particularly when those discounts were used to induce patients to have a service performed. One must draw a line in the sand with regard to taking people at their word and holding them accountable. This is well over my line; I hope it's over most peoples'.

[tibbitts]

I think the main takeaway is to create some kind of documentation of an arrangement like this, even if it's just a text exchange or email.

[sureshoe]

Hi

A dentist gave me a 50% discount on my co-pay to make a crown. They called me recently (After 6 months) asking me to pay the remaining 50% and deny that a discount was given. They say that paying only 50% was a miscalculation which is not true.

Any thoughts?

From an insurance point-of-view, that dentist could get in trouble.

If a Dentist has a negotiated price of $1000 with the insurance company with a 50% co-pay, but charges you $250, that likely violates the dentist-insurer contract. Technically, by only charging you 1/2 of the co-pay, the dentist is only eligible for 1/2 of the insurance payment. Meaning if it was $1000 and you paid $250, the insurer should have only paid $250. Maybe the dentist has been doing this, got caught, and is trying to clean up their books.

This is a big problem in chiropractors, dentists, and other practitioners who offer more "optional" services or those with large co-pays. I've personally been involved in forensic data research for cases like this.

Edit: and for fun I googled "Dental fraud". This link:
https://www1.deltadentalins.com/dentist ... ssues.html
2nd item: Waiving deductibles or copays.

[Starfish]

Hi

A dentist gave me a 50% discount on my co-pay to make a crown.

This is illegal, probably you understood wrong or somebody found out (insurance?).