Coverage changes

[Lyta]

VA
I was with the same dentist for about 2 years (same insurance company also). My visits were not very frequent, but 2 -3 times a year at least. I had no problems with billing until 2 months ago when I got a bill for the last services they did. The bill is for the full amount for the services (standard filling) - my insurance did not cover anything! Then I found out that the dentistry broke the agreement with my insurance company, but no one notified me about it. And the estimate that they gave me after the services were done was what I usually paid for the same type of service. What should I do?

[cbg]

Who was supposed to notify you?

Was the dentist supposed to go through all his records looking for patients with policies with that particular insurance carrier?

Or was the insurance carrier supposed to run through all their claims looking for patients of that dentist?

Which one are you saying had a duty under the law to tell you about a contract that you are not a party to?

[Lyta]

Well... If the coverage stayed the same for over 2 years and suddenly changed, then someone supposed to know about it, right? So, maybe, when they were giving me an estimate for the price I had to pay for the services they should have mentioned that I'm not covered anymore, or at least not lie about the price. I though that the price they give you is being calculated according to the current coverage...

[cbg]

No, the price is not determined by what coverage you have available. The price is what the price is. Your coverage takes care of whatever portion of it is allowed by the coverage in place at the time. The doctor may or may not be able to bill you for the difference depending on whatever contract HE has in place with the insurance carrier.

[lkc15507]

This sounds like a network issue. I think. I certainly understand the angst of the poster. If a network contract is not renewed, one might have a reasonable hope that the provider would notify one of such. But, alas, a pitfall of managed care is that the responsibility always falls upon the patient. Wouldn't stop me from giving my provider ( not the insurer ) what-for. I absolutely do believe that providers could and should provide current network information to clients. Wrangle the provider to off-set some or all of these charges. Negotiage with them to pay the par (participating provider) rate. He can keep your business or not. Think of it as a sheister selling you a knock off pair of designer shoes. You wouldn't take that **** would you? This is not any different. Patients are way too timid with their healthcare. Best to you lkc15507