I am in Arizona.
My wife is getting a dental implant done. The process takes more than a year and includes 2 major surgeries with multiple checkups, X-Rays, etc between them before she goes to a general dentist for the crown.
When she started she got a treatment plan with all stages outlined and prices for all planned procedures. The office submitted pre-treatment estimate with insurance, which came mostly in line with the plan.
The only difference between the plan and the estimate was one of the procedures that the plan had as not covered and the estimate stated it is covered and the patient’s responsibility is around $450 instead of $2000. What the office did not tell is that to be covered that procedure should be done at the time the tooth extracted (surgery 1) but they perform it as part of surgery 2. The estimate they submitted all in one batch instead of splitting in stages, so this is why it came covered.
She got first surgery without any issues, then she got X-Rays and the doctor changed the plan - added more procedures. 2 of them the office said would be covered, 1 not. They did not submitted another estimate. Also, they mentioned that more anesthesia might be required - up to 5 additional 15 min blocks but this was not updated on the plan, which is Ok with me.
2 weeks later (and less than 3 days to scheduled surgery) I received a email with a new treatment plan which adds more anesthesia 15 min blocks, but also changes prices by over 1500. Added one more procedure “inject 2 or more drugs” to help come out from anesthesia (as per office). The description for this code I found online says this should not be done in relation to anesthesia, so I suspect a case of unbundling here. What I did not notice, and this was not communicated, they changed anesthesia to a different type, which is not covered.
We had to cancel the surgery to understand what is going on, but finally, 3 months later had to go ahead. The office was not cooperative at all, another doctor was not an option
for several reasons.
Once we received the claim after the surgery we learned that 2 procedures that we were told by the office are covered, are not covered in this case - according to insurance these procedures are for periodontal treatment and should be done on a natural tooth. The anesthesia was not covered - this was the first time we noticed anesthesia type change.
So total bill went up from ~1200 originally (Ok, with the procedure that we were told is not covered in the first place ~$2700) to over $5200 for this surgery only.
There were a lots of issues in the claim itself, some procedures were submitted incorrectly, one they forgot to submit and I had a very difficult time to fix the issues.
Also, they charged for 1 hr 45 min of anesthesia in 15 min blocks while by my observations my wife was in the office 1:17, their monitor record shows 1:16. It took me more a month and a half and personal visit to the office just to get a promise that 1 block will be removed. They still charge full block for 1 extra minute she was in the office. 1 block - $150.
Yesterday, I received a bill sent after we met in the office, all the charges are still there, they even started charging me interest for the remaining disputed amount.
Sorry, this is a very long story.
What are my options here?
Is the original accepted treatment plan a binding contract? Can they change prices in the middle of the treatment as they wish?
Is a charge for a service not rendered considered a fraud? If the statement with the charge sent by mail is it a mail fraud?
Is there anything I can do about procedures that (according to insurance) should not be performed in this treatment? The anesthesia type change?
My wife is getting a dental implant done. The process takes more than a year and includes 2 major surgeries with multiple checkups, X-Rays, etc between them before she goes to a general dentist for the crown.
When she started she got a treatment plan with all stages outlined and prices for all planned procedures. The office submitted pre-treatment estimate with insurance, which came mostly in line with the plan.
The only difference between the plan and the estimate was one of the procedures that the plan had as not covered and the estimate stated it is covered and the patient’s responsibility is around $450 instead of $2000. What the office did not tell is that to be covered that procedure should be done at the time the tooth extracted (surgery 1) but they perform it as part of surgery 2. The estimate they submitted all in one batch instead of splitting in stages, so this is why it came covered.
She got first surgery without any issues, then she got X-Rays and the doctor changed the plan - added more procedures. 2 of them the office said would be covered, 1 not. They did not submitted another estimate. Also, they mentioned that more anesthesia might be required - up to 5 additional 15 min blocks but this was not updated on the plan, which is Ok with me.
2 weeks later (and less than 3 days to scheduled surgery) I received a email with a new treatment plan which adds more anesthesia 15 min blocks, but also changes prices by over 1500. Added one more procedure “inject 2 or more drugs” to help come out from anesthesia (as per office). The description for this code I found online says this should not be done in relation to anesthesia, so I suspect a case of unbundling here. What I did not notice, and this was not communicated, they changed anesthesia to a different type, which is not covered.
We had to cancel the surgery to understand what is going on, but finally, 3 months later had to go ahead. The office was not cooperative at all, another doctor was not an option
for several reasons.
Once we received the claim after the surgery we learned that 2 procedures that we were told by the office are covered, are not covered in this case - according to insurance these procedures are for periodontal treatment and should be done on a natural tooth. The anesthesia was not covered - this was the first time we noticed anesthesia type change.
So total bill went up from ~1200 originally (Ok, with the procedure that we were told is not covered in the first place ~$2700) to over $5200 for this surgery only.
There were a lots of issues in the claim itself, some procedures were submitted incorrectly, one they forgot to submit and I had a very difficult time to fix the issues.
Also, they charged for 1 hr 45 min of anesthesia in 15 min blocks while by my observations my wife was in the office 1:17, their monitor record shows 1:16. It took me more a month and a half and personal visit to the office just to get a promise that 1 block will be removed. They still charge full block for 1 extra minute she was in the office. 1 block - $150.
Yesterday, I received a bill sent after we met in the office, all the charges are still there, they even started charging me interest for the remaining disputed amount.
Sorry, this is a very long story.
What are my options here?
Is the original accepted treatment plan a binding contract? Can they change prices in the middle of the treatment as they wish?
Is a charge for a service not rendered considered a fraud? If the statement with the charge sent by mail is it a mail fraud?
Is there anything I can do about procedures that (according to insurance) should not be performed in this treatment? The anesthesia type change?