Dentist having it both ways?

[am2]

What is the name of your state? California

I went to a dentist in my PPO system for the first time, got a root canal and my teeth cleaned, handed over the paperwork and thought all was ok. Then I got a call Friday from his administrator who said the rate of reinbursement by Blue Cross was inadequate and I'd have to directly pay them another $1100. But don't worry, the dentist would probably give me a discount on that. A thousand bucks? I thought I had good PPO insurance! Why was I getting thousand-dollar bills for one tooth?

I called Blue Cross up and asked why the rate of reimbursement was so lousy that i'd have to pay an extra $1100, especially since the PPO supposedly covered 90% of a routine procedure. I'd never gotten notification of owing that much from any doctor before.

They said their records showed I owed the dentist $66, not $1100, and I could pay them that $66. That was because the dentist had contracted with Blue Cross for the lower rates in exchange for the referrals, and I found his name on their Blue Cross Web site. Any extra was supposed to be written off. Written off? I asked. They said that if I had gone to a PPO non-system dentist, I'd probably owe it, but since I didn't, the dentist had agreed to these Blue Cross rates in exchange for referrals.

Can that dentist really charge me for the extra $1100, which I presume is the retail rate? It sounds like he wants the benefits of the referrals but not the rates of the referrals. It makes me mad because I could have gone to a different dentist on the list and presumably not gotten these bills, or an out-of-system dentist instead if I wanted to pay an extra $1100.

Is there anything I can show him from Blue Cross to prove these rules and show that I only owe $66? Or what should I do?

[cbg]

You don't need to show him anything. What you need to do is contact BCBS and ask to speak to someone in their Provider Relations department (they may call it something different, but it's the department that enrolls physicians onto the network). Tell them that you are being "balance billed". They'll take care of it for you.

[ecmst12]

And someone should tell that dentist that balance billing when he's contracted with your insurance is FRAUD.