Dentist did not submit claim but claims that they did

[JustaFriendinTN]

What is the name of your state? TN

I went to the dentist back in October of '06 for xrays and things of that nature. I have dental insurance through my job and the premiums are taken out of my check when I get paid.

Back in January, I recieved a bill that only showed the amount owed. It said nothing about the services rendered, what the insurance paid or anything, just the amount. So, I called the dentist's office and was told that they just hadn't submitted the claim and that they would so there shouldn't be a problem.

Well, today I get a phone call from the dentist's office basically belittling me for not paying the amount due (which was still the full amount) and also saying that I needed to pay it in 5 days or else it would be going to collections. I had not received another bill since the one in January and was under the impression that this was taken care of so I called the office back and was told that they did send it to the insurance company and that they just were not paying it so now it was my responsibility. I was told that the amount owed is for all services that were rendered and that my insurance paid none of the cost. They also said that I need to pay it in 5 days and then submit my claim to the insurance company on my own to get reimbursed for the cost.

After I got off the phone with the dentist's office, I decided to contact the insurace company and after speaking with one of the representitives, I was told that I did not have any claims on my file around that date and infact, I didn't have any claims in my file after April 2006. Apparently the dentist's office either never submitted the claim or it was lost.

I called the dentist's office back and told them what the insurace company told me about never getting the claim from them and the lady began acting very friendly and claimed that she wanted to get the situation taken care of as quickly as possible. My guess is that that she didn't expect me to actually call the insurance company, I don't know.

Anyway, I plan on contacting the dentist's office and insurance company next week to make sure that everything was submitted and was taken care of however I was wondering is there anything else you all think I should or could do to make sure that I don't get a letter in a month from a collections agency saying that I owe them money?

 

[ecmst12]

You could certainly send a copy of the bill to your insurance company yourself. Is this dentist contracted with your insurance or are they out of network?

 

[JustaFriendinTN]

I requested that they send me a detailed bill since the only one that was sent to me was one that only had the total amount owed. It showed nothing about services that were rendered or anything like that, just the amount.

I believe it is an out of network dentist as I was just driving down the street (in a very sketchy neighborhood, I know bad idea), in excruciating pain and stopped at the first one I saw, however I do have out of network coverage. It may not have covered the full amount, but the insurance company told me that had the claim been submitted, with the plan that I have part of it should have been since it was mostly just xrays.

Once I receive the detailed bill I will make sure that I do send it to the insurance company though, thanks!

 

[ecmst12]

With an out of network doctor, you will be responsible not only for your coinsurance (percentage), but also for any difference between the amount charged and the amount your insurance determines to be "usual and customary". An out of network doctor is also not required to bill your insurance company first and is allowed to demand payment up front from you. I would suggest paying the bill yourself (once you get the itemized charges) and then submitting the claim to your insurance so that they can reimburse you. Don't expect to get reimbursed in full (that's what happens when you use out of network doctors), but it will be better then nothing

 

[barry1817]

dental

What is the name of your state? TN

I went to the dentist back in October of '06 for xrays and things of that nature. I have dental insurance through my job and the premiums are taken out of my check when I get paid.

Back in January, I recieved a bill that only showed the amount owed. It said nothing about the services rendered, what the insurance paid or anything, just the amount. So, I called the dentist's office and was told that they just hadn't submitted the claim and that they would so there shouldn't be a problem.

Well, today I get a phone call from the dentist's office basically belittling me for not paying the amount due (which was still the full amount) and also saying that I needed to pay it in 5 days or else it would be going to collections. I had not received another bill since the one in January and was under the impression that this was taken care of so I called the office back and was told that they did send it to the insurance company and that they just were not paying it so now it was my responsibility. I was told that the amount owed is for all services that were rendered and that my insurance paid none of the cost. They also said that I need to pay it in 5 days and then submit my claim to the insurance company on my own to get reimbursed for the cost.

After I got off the phone with the dentist's office, I decided to contact the insurace company and after speaking with one of the representitives, I was told that I did not have any claims on my file around that date and infact, I didn't have any claims in my file after April 2006. Apparently the dentist's office either never submitted the claim or it was lost.

I called the dentist's office back and told them what the insurace company told me about never getting the claim from them and the lady began acting very friendly and claimed that she wanted to get the situation taken care of as quickly as possible. My guess is that that she didn't expect me to actually call the insurance company, I don't know.

Anyway, I plan on contacting the dentist's office and insurance company next week to make sure that everything was submitted and was taken care of however I was wondering is there anything else you all think I should or could do to make sure that I don't get a letter in a month from a collections agency saying that I owe them money?

Prior to being treated did you sign insurance paperwork that would have the dentist paid for the services. If so, what they are doing it not very becoming. Not giving an itemized statement for services rendered raises a lot of red flags for me.

Because of insurance programs they are probably fully aware of what your insurance would be paying, so I have a few other questions that are red flags about the timing of their billing, but then I have a suspicious mind about situations that raise red flags.

A letter to them, explaining the situation might be very good should they not wish to work with you with this matter. That way you would be showing that you are being reasonable and they aren't. Also detail how you expect to take care of the matter and that their 5 day demand due to the circumstances is not acceptible.

[email protected]

 

[ecmst12]

If they're not contracted with OP's insurance, then they have no idea what they will pay, nor are they required to accept that amount (they can and will charge him for the difference). They are also under NO obligation to bill his insurance first, because they have no contract requiring it. If they were to bill the insurance directly, that would be a courtesy only, and since they haven't done it, OP is better off dealing with his insurance company himself. Other then the lack of itemized billing, the office's behavior is pretty typical for non-contracted providers.