Dentist Question

[ldawg317]

What is the name of your state (only U.S. law)? California

My wife had some work done earlier this year that had come recommended by a friend. Before he began the work, his nurse had told us that she had contacted my insurance company and listed the procedures and the standard "insurance" fees for the work done and told us that our copay would be $1100. Never having had major dental work performed before, and trusting our friend's referral, we agreed to have the work done. During her last visit, we ensured with the doctor that all copays had been paid. Well, last week I received a bill for an additional $200! The nurse told me that the insurance had not paid as much as they expected so I was liable for the difference. I called my insurance company and received my explanation of benefits which told me my copays should have only been about $600. So either he is double billing or basing my copays off of his standard costs, not the insurance costs. My insurance company has tried to contact him but he refuses to talk to them. Should I continue to have my insurance company take care of this or should I file with small claims? I also want to make sure that this dentist does not put the unpaid $200 on my credit report. Any advice would be greatly appreciated.

[ecmst12]

Is the dentist contracted with your insurance company? If not, then they are not required to write off the amount your insurance company designates as "over usual and customary charge". So if they bill 1000, and your insurance says U&C is 800, and they pay 700 leaving you with 100 copay, the dentist can still bill you for that extra 200.

If the dentist IS contracted, then their contract requires them to write off anything over the contracted rate for each procedure, and they CAN'T bill you for the overage. But I'm betting you went out of the network for this dentist and that is why you are getting a bill. ALWAYS call your insurance company to make double-sure that any doctor you choose is in the network - don't take the office's word for it, there are far too many different plans out there for them to be able to keep track of.