Am I getting the runaround from my dentist?

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knightrider
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Am I getting the runaround from my dentist?

Post by knightrider » Wed Apr 17, 2019 9:29 am

I had a dentist cleaning on 3/25'th. In past they file a claim with my insurance company and I get a check from the insurance. This time I have not received any check yet and do not see any claim when I log into my dental insurance platform. I emailed my dental office and they sent a curt reply:

"The claim has in fact been filled. Insurance can contact us themselves if they need anything from us."

Are they giving me the run-around or is this now entirely the responsibility of my insurance company to find this claim?
Last edited by knightrider on Wed Apr 17, 2019 9:34 am, edited 1 time in total.

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dm200
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Re: Am I getting the run-around from my dentist?

Post by dm200 » Wed Apr 17, 2019 9:31 am

knightrider wrote:
Wed Apr 17, 2019 9:29 am
I had a dentist cleaning on 3/25'th. In past they file a claim with my insurance company and I get a check from the insurance. This time I have not received any check yet and do not see any claim when I log into my dental insurance platform. I emailed my dental office and they sent a curt reply:
"The claim has in fact been filled. Insurance can contact us themselves if they need anything from us."
Are they giving me the run-around or is this now entirely the responsibility of my insurance company to find this claim?
I would just do exactly what they said - ask the insurance company to contact the dentist's office - if the insurance company has no record of the claim.

Topic Author
knightrider
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Re: Am I getting the run-around from my dentist?

Post by knightrider » Wed Apr 17, 2019 9:36 am

dm200 wrote:
Wed Apr 17, 2019 9:31 am
I would just do exactly what they said - ask the insurance company to contact the dentist's office - if the insurance company has no record of the claim.
I guess so. Just seems a bit inefficient, when in all likelihood they made a mistake with filing my claim. They could have just double checked and corrected it. But instead they want me to talk to my insurance to talk to them to do the same thing...

student
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Re: Am I getting the runaround from my dentist?

Post by student » Wed Apr 17, 2019 9:55 am

I see the issue here. Basically you pay the dentist directly, his/her office files a claim on your behalf and you receive a check from the insurance. So the dentist has no skin in it and it may not be his/her office's top priority to fix it. I would call the insurance company.

Dottie57
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Re: Am I getting the runaround from my dentist?

Post by Dottie57 » Wed Apr 17, 2019 9:58 am

Amazing how different dentists work. The process at my dentist is:

For a cleaning I pay nothing until claim s processed. For dental work, the dental office estimates insurance payment. I pay the part not covered immediately. I get a statement/bill/refund when claim is processed.

Maybe a different dentist handles things differently. Or your insurer is not common.

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knightrider
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Re: Am I getting the runaround from my dentist?

Post by knightrider » Wed Apr 17, 2019 10:00 am

student wrote:
Wed Apr 17, 2019 9:55 am
I see the issue here. Basically you pay the dentist directly, his/her office files a claim on your behalf and you receive a check from the insurance. So the dentist has no skin in it and it may not be his/her office's top priority to fix it. I would call the insurance company.
That is correct. I just hope I don't get the runaround from the insurance company. They could say, we have no claim so can't help, so contact your dentist directly..

That's why I am posting here to understand who really has responsibility for this, the insurance company or the dentist office.. I am bit frustrated with my dentist because they've made billing mistakes in the past .. That's why I feel they are just giving me the runaround.
Last edited by knightrider on Wed Apr 17, 2019 10:01 am, edited 1 time in total.

Dottie57
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Re: Am I getting the runaround from my dentist?

Post by Dottie57 » Wed Apr 17, 2019 10:00 am

student wrote:
Wed Apr 17, 2019 9:55 am
I see the issue here. Basically you pay the dentist directly, his/her office files a claim on your behalf and you receive a check from the insurance. So the dentist has no skin in it and it may not be his/her office's top priority to fix it. I would call the insurance company.

I ended up changing dentists whem I paid and received reimbursement from insurer. The current dentist is just as good or better.

student
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Re: Am I getting the runaround from my dentist?

Post by student » Wed Apr 17, 2019 10:06 am

knightrider wrote:
Wed Apr 17, 2019 10:00 am
student wrote:
Wed Apr 17, 2019 9:55 am
I see the issue here. Basically you pay the dentist directly, his/her office files a claim on your behalf and you receive a check from the insurance. So the dentist has no skin in it and it may not be his/her office's top priority to fix it. I would call the insurance company.
That is correct. I just hope I don't get the runaround from the insurance company. They could say, we have no claim so can't help, so contact your dentist directly..

That's why I am posting here to understand who really has responsibility for this, the insurance company or the dentist office.. I am bit frustrated with my dentist because they've made billing mistakes in the past .. That's why I feel they are just giving me the runaround.
When you call the insurance company, I suggest that you request them doing a 3-way call.

HomeStretch
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Re: Am I getting the runaround from my dentist?

Post by HomeStretch » Wed Apr 17, 2019 10:10 am

Sounds like your dentist is out-of-network and filed the insurance claim on your behalf as a courtesy. If you want more control over the reimbursement process, an alternative is to ask for an itemized bill and submit the claim yourself.

fposte
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Re: Am I getting the runaround from my dentist?

Post by fposte » Wed Apr 17, 2019 10:25 am

Dottie57 wrote:
Wed Apr 17, 2019 9:58 am
Amazing how different dentists work. The process at my dentist is:

For a cleaning I pay nothing until claim s processed. For dental work, the dental office estimates insurance payment. I pay the part not covered immediately. I get a statement/bill/refund when claim is processed.

Maybe a different dentist handles things differently. Or your insurer is not common.
Or it's local/regional custom. Around here it's standard for the patient to wait for reimbursement; even the endodontist I go to, who used to do it the way you describe, has joined the "full payment from patient at time of service" crowd. I suspect that this is not unrelated to the high number of state employees in town, whose reimbursements can be highly irregular in their timing.

I too would follow up with insurance and see what they recommend; with some providers I actually send in the claim myself, and it might be something the OP could do at this point if the dentist will provide the info.

megabad
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Re: Am I getting the runaround from my dentist?

Post by megabad » Wed Apr 17, 2019 2:47 pm

fposte wrote:
Wed Apr 17, 2019 10:25 am
Dottie57 wrote:
Wed Apr 17, 2019 9:58 am
Amazing how different dentists work. The process at my dentist is:

For a cleaning I pay nothing until claim s processed. For dental work, the dental office estimates insurance payment. I pay the part not covered immediately. I get a statement/bill/refund when claim is processed.

Maybe a different dentist handles things differently. Or your insurer is not common.
Or it's local/regional custom. Around here it's standard for the patient to wait for reimbursement; even the endodontist I go to, who used to do it the way you describe, has joined the "full payment from patient at time of service" crowd. I suspect that this is not unrelated to the high number of state employees in town, whose reimbursements can be highly irregular in their timing.

I too would follow up with insurance and see what they recommend; with some providers I actually send in the claim myself, and it might be something the OP could do at this point if the dentist will provide the info.
Interesting. I have never heard of "reimbursement" in this manner. Seems pretty odd and is certainly not in line with typical medical insurance claim processing. Obviously it strongly favors the dentist/doctor and strongly disadvantages the patient so I can understand why a dentist would prefer to do things this way. In any case, my insurer posts "claim in process" on their website in timely fashion so I can check with insurer and make sure everything is ok. Perhaps, you can institute this into your process and log in and check to make sure dentist files claim?

fposte
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Re: Am I getting the runaround from my dentist?

Post by fposte » Wed Apr 17, 2019 3:39 pm

megabad wrote:
Wed Apr 17, 2019 2:47 pm
fposte wrote:
Wed Apr 17, 2019 10:25 am
Around here it's standard for the patient to wait for reimbursement; even the endodontist I go to, who used to do it the way you describe, has joined the "full payment from patient at time of service" crowd. I suspect that this is not unrelated to the high number of state employees in town, whose reimbursements can be highly irregular in their timing.

I too would follow up with insurance and see what they recommend; with some providers I actually send in the claim myself, and it might be something the OP could do at this point if the dentist will provide the info.
Interesting. I have never heard of "reimbursement" in this manner. Seems pretty odd and is certainly not in line with typical medical insurance claim processing. Obviously it strongly favors the dentist/doctor and strongly disadvantages the patient so I can understand why a dentist would prefer to do things this way. In any case, my insurer posts "claim in process" on their website in timely fashion so I can check with insurer and make sure everything is ok. Perhaps, you can institute this into your process and log in and check to make sure dentist files claim?
I think it's more common with solo practitioners, and not many doctors are that these days; it takes office time to handle the insurance and office resources to support the float (over a year in some cases with our insurance), and it's just too costly for professionals without bigger operations behind them.

sport
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Re: Am I getting the runaround from my dentist?

Post by sport » Wed Apr 17, 2019 4:05 pm

My dentist, who is very expensive and out of network, does not require any payment at the time of service. He sends a claim to the insurance, and sends me a bill. The bill and the insurance check come to me at about the same time. I then send payment to the dentist. My last bill was about $1100 for cleaning, xray, exam, and three fillings.

Yooper16
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Re: Am I getting the runaround from my dentist?

Post by Yooper16 » Wed Apr 17, 2019 4:31 pm

Dottie57 wrote:
Wed Apr 17, 2019 9:58 am
Amazing how different dentists work. The process at my dentist is:

For a cleaning I pay nothing until claim s processed. For dental work, the dental office estimates insurance payment. I pay the part not covered immediately. I get a statement/bill/refund when claim is processed.

Maybe a different dentist handles things differently. Or your insurer is not common.
Works very similar for us.

We actually have 2 payees-- our traditional health benefit has a very modest payment schedule and our supplemental dental/optical has their own schedule. They are pretty accurate with their estimates.

toofache32
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Re: Am I getting the runaround from my dentist?

Post by toofache32 » Wed Apr 17, 2019 9:36 pm

megabad wrote:
Wed Apr 17, 2019 2:47 pm
fposte wrote:
Wed Apr 17, 2019 10:25 am
Dottie57 wrote:
Wed Apr 17, 2019 9:58 am
Amazing how different dentists work. The process at my dentist is:

For a cleaning I pay nothing until claim s processed. For dental work, the dental office estimates insurance payment. I pay the part not covered immediately. I get a statement/bill/refund when claim is processed.

Maybe a different dentist handles things differently. Or your insurer is not common.
Or it's local/regional custom. Around here it's standard for the patient to wait for reimbursement; even the endodontist I go to, who used to do it the way you describe, has joined the "full payment from patient at time of service" crowd. I suspect that this is not unrelated to the high number of state employees in town, whose reimbursements can be highly irregular in their timing.

I too would follow up with insurance and see what they recommend; with some providers I actually send in the claim myself, and it might be something the OP could do at this point if the dentist will provide the info.
Interesting. I have never heard of "reimbursement" in this manner. Seems pretty odd and is certainly not in line with typical medical insurance claim processing. Obviously it strongly favors the dentist/doctor and strongly disadvantages the patient so I can understand why a dentist would prefer to do things this way. In any case, my insurer posts "claim in process" on their website in timely fashion so I can check with insurer and make sure everything is ok. Perhaps, you can institute this into your process and log in and check to make sure dentist files claim?
This is DENTAL not medical insurance. Completely different.

toofache32
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Re: Am I getting the run-around from my dentist?

Post by toofache32 » Wed Apr 17, 2019 9:38 pm

knightrider wrote:
Wed Apr 17, 2019 9:36 am
dm200 wrote:
Wed Apr 17, 2019 9:31 am
I would just do exactly what they said - ask the insurance company to contact the dentist's office - if the insurance company has no record of the claim.
I guess so. Just seems a bit inefficient, when in all likelihood they made a mistake with filing my claim. They could have just double checked and corrected it. But instead they want me to talk to my insurance to talk to them to do the same thing...
They file the claim as a courtesy but they don't have to. If this does not yield satisfactory results then you should file it yourself and fight the insurance yourself.

bampf
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Re: Am I getting the runaround from my dentist?

Post by bampf » Wed Apr 17, 2019 10:01 pm

I am always amazed at the "I do it but I don't have to and if you don't like it you can go.... do it yourself" response. I think if anyone, much less someone I trust to work on my body said this to me I would tell them to go ...jump in the lake.

Guy obviously cares about the reimbursement. Telling him to lump or do it himself is a bit hard nosed. I wouldn't want to affiliate myself with someone that is supposed to have empathy telling me to lump it.

Also stinks that to you have to "fight the insurance policy" folks. Both for the MD /DDS as well as the patient. Think everyone sort of loses in that environment.

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HueyLD
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Re: Am I getting the run-around from my dentist?

Post by HueyLD » Thu Apr 18, 2019 6:41 am

toofache32 wrote:
Wed Apr 17, 2019 9:38 pm
They file the claim as a courtesy but they don't have to. If this does not yield satisfactory results then you should file it yourself and fight the insurance yourself.
That is the kind of healthcare provider I will never use. I am lucky in that I have never encountered a health professional so full of himself. Yes, it is a courtesy and the vast majority of providers are smart enough to know that good service (including filing insurance as a courtesy) keeps customers happy and that leads to profitability.

UpperNwGuy
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Re: Am I getting the runaround from my dentist?

Post by UpperNwGuy » Thu Apr 18, 2019 6:58 am

HomeStretch wrote:
Wed Apr 17, 2019 10:10 am
Sounds like your dentist is out-of-network and filed the insurance claim on your behalf as a courtesy. If you want more control over the reimbursement process, an alternative is to ask for an itemized bill and submit the claim yourself.
^^^ This is what I do.

toofache32
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Re: Am I getting the run-around from my dentist?

Post by toofache32 » Thu Apr 18, 2019 7:11 am

HueyLD wrote:
Thu Apr 18, 2019 6:41 am
toofache32 wrote:
Wed Apr 17, 2019 9:38 pm
They file the claim as a courtesy but they don't have to. If this does not yield satisfactory results then you should file it yourself and fight the insurance yourself.
That is the kind of healthcare provider I will never use. I am lucky in that I have never encountered a health professional so full of himself. Yes, it is a courtesy and the vast majority of providers are smart enough to know that good service (including filing insurance as a courtesy) keeps customers happy and that leads to profitability.
I do file claims for patients. And provide much higher service than any other, which I agree leads to profitability.
My point is that this is no different from everything else in life....if you are unhappy with someone else's process then do it yourself and see if you can do better. Take control instead of complaining.

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