Am I responsible for that payment?

[destin]

State: Nevada

State: Nevada

About 5 months ago I went to see a dentist and I had a dental insurance at that time. They recommended 2 fillings and a crown and I was told that I am going to have to pay 330.80 $ out of my pocket at the end of that visit and that is all (I signed a paper for that amount)

As I was looking at the print out with the information regarding my account they have made a mistake because my dental plan was not covering crowns so they denied a payment of 287$. When I paid that 330.80 it was 50% of that crown - 287$ plus some little additional charges.

I understand that dental treatment is not cheap, however I do not feel responsible for that payment because if I would be told that it is going to be more than 600$ out of my pocket I just would not do that and probably wait for a year (there is a waiting period of 12 months on that policy I have and then they pay 50%)

What do you think I should do. Is it a good idea to write a letter requesting a validation of that debt asking them for any kind of proof that I agreed too pay, which in fact they do not have, etc... What would be the bst thing to do in that situation?

 

[thepenster060]

First of all, it is recommended that you should get a predetermination of benefits for work over 300.00, why did this not happen?
Second, it is the patients responsibility to know what your insurance benefits are, not the dental office.
Third, you probably sighned an agreement for your estimated deductable and estimated copay.
fourth, yes it is your respnsibilty. Pay your dentist for services rendered.

 

[barry1817]

State: Nevada

State: Nevada

About 5 months ago I went to see a dentist and I had a dental insurance at that time. They recommended 2 fillings and a crown and I was told that I am going to have to pay 330.80 $ out of my pocket at the end of that visit and that is all (I signed a paper for that amount)

As I was looking at the print out with the information regarding my account they have made a mistake because my dental plan was not covering crowns so they denied a payment of 287$. When I paid that 330.80 it was 50% of that crown - 287$ plus some little additional charges.

I understand that dental treatment is not cheap, however I do not feel responsible for that payment because if I would be told that it is going to be more than 600$ out of my pocket I just would not do that and probably wait for a year (there is a waiting period of 12 months on that policy I have and then they pay 50%)

What do you think I should do. Is it a good idea to write a letter requesting a validation of that debt asking them for any kind of proof that I agreed too pay, which in fact they do not have, etc... What would be the bst thing to do in that situation?

With so many plans, dental insurance can be confusing even for offices that process so many claims.

The question would be what would you want done if you made an honest mistake and somebody didn't pay you your fees for service?

The fact that you might have delayed the treatment until you were covered would have been an option that could have been discussed, and might have been a viable option.

But coming from a place where offices seem too concerned about the bottom line, and put forth estimates that seem to completely ignore patients, I would write to the office and state your case. See what the response is and go from there.

[email protected]

 

[loveumms]

In the end you are responsible – when you go to the doctors office, you sign a form stating that you are responsible for services rendered in the event your insurance company denies the claim (re-read what you signed).

Barry has a good idea - write to the office, explain your situation and they might be able to set up a payment schedule that will make it a little easier then one large sum. Remember they want to get paid and will likely work with you so that you don’t go broke in the process. Also, if dental billing is like medical billing, the insurance may not be paying it b/c the procedure was coded incorrectly. Call your insurance and find out the reason they denied the claim.

Since there are so many different kinds of insurance it would be impossible for the office staff to know exactly how much your insurance will pay and honestly they shouldn't have to. You should have called your insurance company to make sure the procedures were fully covered. I know whenever I am having an expensive procedure/lab work/diagnostic test, and b/c I'm so poor even a routine office visit, I call the insurance company and verify that the doctor/procedure/lab test is covered and if not then how much I am responsible for (I even write down the name of the person I spoke to). It has saved me a few times from some pretty serious charges.

 

[barry1817]

dental fees

I have seen offices that routinely will place patients in financial binds by giving false estimates, highballing what insurance will pay and making wild claims about what insurance will cover.

So in a follow up on my last post, when treatment can be delayed until coverage is there, it is extremely important that the pre authorization be done.

If the office made the claim, of what you are owed, without the preauthorization of treatment, shame on that office, and you should mention that as well. Most insurance want preauthorization for crowns.

So again, get the letter to the office, cite that you told them that you would wait for insurance coverage, but were assured that the insurance and your patient co-payment were what is on your estimate, and ask them why their estimate changed.

If they didn't get the preauthorization, it is a problem, and again I am really disappointed in offices that place patients in this bind in order to get immediate treatment done.

And I would not be hesitant should you get an answer that isn't what you expect to make a complaint to the state dental board citing the billing practices that are suspect to say the least.

[email protected]

 

[thepenster060]

how do you figure that this deserves a complaint to the state dental board?
the patient has a contract with the insurance company, and should know what their benefits are. I do agree about the pre-d, as I said in my earlier post.