My daughter had $1600 worth of dental work done (a couple of crowns). I paid the 50% up front, and expected my insurance to take care of the rest. The dentist’s office even called my insurance company to make sure everything would be OK. The crown came in a week later
Today I had the crown put on, and I’m told that insurance didn’t cover, and I have to pay $800. After some discussion and more that a little anger on my part, I paid the bill.
Once I got back to my office, I called my insurance company and asked about why they didn’t cover, they said for children under ages 16 (my daughter is 14) they only cover prefabricated stainless steel or resin.
I feel like it was the dentist’s office to check that, I really think it was their mistake. I want to dispute the charge on my credit card.
I think that you should be responsible for finding out what your insurance covers, not the dentist being responsible for keeping track of the hundreds of possible plans of all of his patients.
The person in the office responsible for accounts and billing does this kind of stuff all day long. He/she should be calling your dental insurance and checking out what’s covered before the procedure is done. If that is not the case, then it should be clearly stated to you that they don’t know what is covered or not covered, and then you can call. You say they called insurance and told you everything was OK? Then I think you have a legitimate gripe.
I just had the same thing happen. Needed some work on my gums, took all my insurance papers to dentist, they called the insurance company and checked and said that $2400 of the total bill would be paid by my insurance. Still left me with about $3400 to pay, but I said, “OK, let’s do it.”
So now I am getting a bill from the dentist that says, “oh…looks like your insurance is only going to cover about $1800 of the total, not $2400.”
So suddenly I am supposed to come up with $600 more?
Isn’t this called “bait and switch”…get me in for a price and then, “aw gee, the quote wasn’t right. Here is what you REALLY have to pay” now that all the work was done.
Bait and switch is the term, yes. The fact that this happened to Enright3 in Atlanta and to DMark in … uh … wherever the hell DMark is, suggests that the source of the problem is more widespread than the dental office’s clerk mishearing the insurance agent over the phone.
Hmm, sounds like dentist’s offices work differently in the States. Here, I pay 100% of the costs upfront and I’m reimbursed, well, whatever my insurance will give me. The insurance information package we received when we first got covered said it was our responsibility alone to obtain preauthorization of coverage. The office will not even speculate on that; they simply fill out a Preauthorization form and I am responsible for mailing it to the insurance company. Insurance company then sends me an assessment via snail mail and copies the dentist.
I know the basics of my plan, but that still doesn’t tell me exactly what the insurance company will pay. For instance, my crowns were almost $2000, and major work is covered at 50%, so one might assume they would pay half of the total. Wrong. They will pay half of whatever they think is “reasonable and customary” for a regular dentist (not a specialist), and that applies to the fees for the work as well as lab fees. The dentist’s office can’t give me the lab fees until the lab submits a bill, so I get at best, a rough estimate.
Every dentist and doctor that I’ve been to has me sign an agreement before I even sit down that says I will be responsible for all charges. It probably also stipulates that it is ultimately YOUR responsibility to know what benefits your insurance offers, though I don’t have an agreement in front of me.
Your OP makes it unclear why you were under the assumption that your dental coverage would pay for 50%. If the office said this, then that is one thing. But if you just assumed this, then that’s another.
Rather than go the asshole route by calling the credit company and disputing the charges, why not simply call the office and explain the situation. Ask for them to reduce the charges. They might also allow some sort of monthly payment. In fact, the credit card company might not get involved at all until you make some sort of attempt to work it out on your own.
Well, from the OP, it seems the crowns were made of something besides the approved materials. If I had to guess, it’s that there’s some materials from which they make crowns that either isn’t as durable or doesn’t adjust to the changing mouth of a teen as well as other materials, leading to further work down the road which the insurance company doesn’t want to pay for. But it’s unreasonable to expect that the average person would even know that there would be a distinction between reimbursement for the different materials, or even that different materials for crowns exist. You actually would have to be well-informed in the field of dentistry even to know what questions to ask. I recently (sigh) had occasion to look at the benefit sheet for my carrier and all it says is Crowns – 50%.
I’d get on the phone with the dentist and say “Look, you’re the expert. You get on the phone with the insurance company and justify your choice of materials. Make it happen, OK?”
I have this sort of thing going on with my dentist too-and if he wasn’t so skilled, I’d be so gone, but I’m willing to put up with the higher-than-my-insurer-reimburses prices to get quality dentistry.
Here’s something I am thinking of doing-next time he wants to pave my mouth in gold, I will ask for a written estimate of costs, procedures and materials. Then I will send it myself to the insurer to see what they will cover. If he balks, time for dentist shopping.
Upon re-reading the OP, I see that they did indeed mislead you. My answer is still the same, though. Call their billing office, explain that you are still upset about having to pay, and see if they’ll bend. Unfortunately, you’ve already paid so it kind of leaves you without much power. However, if they did screw up they should do something to make amends with a good client.
Emphasize the fact that you’re a good, paying customer. And if you have more than one person in your family going to that dentist, I’d emphasize that as well.
My insurer has a ‘pre-determination’ form that you submit before having the work done. That way you have in writing exactly how much is covered before you agree to have it done. No use to you now, but you might want to do that in the future. I assumed that was standard practice. Any disputes as to what is and isn’t covered are best resolved BEFORE the work is done.
Also, my insurer didn’t deny a claim because they didn’t agree with the material used for the crown. They simply reduced the amount to equal what their approved material would have cost. Again, with a pre-determination, I’d know about this up front and could decide if I wanted to pay for the different material.
My dentist always gives me an “estimate” of work to be done. What the work costs and what they “expect” my insurance to pay with the caveat that actual coverage may be different. Last time I went to get my teeth cleaned I was told on check out that I owed an additional $450.
I told them that I didn’t have $450, not in my checking account, not in savings and not on a credit card. They just stared at me. I left the office telling them that I’d be in contact to make payment arrangements.
Yes, if you’re going to surprise me with a bill I didn’t expect then don’t be surprised when I can’t pay it.
I lack any dental insurance whatsoever, and the first question I asked my (sadly, former) dentist’s office when I called to make an appointment was if they would bill me when necessary. They do, and they are. I am paying off an $800 crown – I should be able to pay it off a lot faster now that my car is paid off, but it’s going to be a few more months yet.
I wouldn’t go to a dentist that wouldn’t let me do payments. Otherwise, I’d still be saving up for this crown, if the tooth hadn’t given out completely in the meantime so that the only option was for it to come out.
I feel like it was the dentist’s office to check that, I really think it was their mistake. I want to dispute the charge on my credit card.
The services were provided to your dependent and you are responsible for the cost. It isn’t the dentist’s fault that he doesn’t know your plan. It is YOURS, why don’t you know? Take some responsibility for your own mistake.
You screwed up and hopefully learned a valuable lesson. The insurance company works for you, not your dentist. The dentist performed a service and should get paid. The rest is your problem.
Read the OP again. Just like in my case, the dentist office called and spoke to the insurance company. They know the jargon. They know exactly what every procedure is. So when the dental office calls and says you need a C34 drzyyl procedure the insurance company agrees and says it will pay $340.00 for the C34 drzyyl procedure. The dental office tells you your bill should be $500 minus the $340, you will owe $160…you assume it will be in that ballpark.
You therefore have the right to be royally pissed off if they suddenly say, “oh, that’ll be $450.”
As in my case, I probably would have delayed the procedure until I had the money together. If the dentist and the insurer cannot get their shit together to give me an idea of what I will owe, I see no reason to hurry and pay some arbitrary fee, after the fact, that I never agreed to.
Ask your dental office to appeal the claim with a narrative as to why your daughter had to have permanent crowns NOW. With Xrays.
We don’t generally do permanent crowns on 14 year olds because their teeth are still moving into the mouth and my Doc feels that it is better to wait to do permanent crowns until the teeth are fully erupted into the position in which they will remain as an adult. Otherwise they have to be redone because the margins of the crown will end up too far above the gumline. This is not a GOOD thing, usually causing sensitivity to temperature and difficulty in keeping the tooth underneath the crown clean. Which in turn leads to having to have the crown redone. This is the reason for your insurance company’s restriction on coverage.
I have been in the dental field for longer than I care to think about, and today I checked with some other offices I know are trustworthy. They all have the same policy. Still, there ARE exceptions and your dental office should be able to justify them to the insurance company.
If they CAN’T justify it, email me and we’ll talk about it.