Dentist billing policy

[Junction]

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

Not sure exactly where to post this, but since it's related to my dentist, I'll put it here.

I'm curious as to my dentist's billing policy.

Here's an example: My dentist will show he charges $2000 for a procedure on the bill. The maximum allowed by the insurance is $1200 and pays 80%, or $960. My dentist bills for $1040 in this case, the difference between $2000 and the $960 paid by insurance. Is this the typical way that folks in this field bill its patients? I ask as any medical bills I've had over the years have used the max. amount the insurance would pay as the amount owed and I would pay just the 20% or whatever the co-pay would be and never more than this. With my dentist, with a 20% copay, I always have to pay at least 50% of the cost out of pocket by the way he bills.

 

[FlyingRon]

Yes, it is typical. Sometimes the doctor has an agreement with the insurer that he will charge a lesser rate to insured customers, but it's not always the case.

 

[cbg]

It also depends on the type of dental insurance policy you have, the terms of your policy, and the terms of the contract, if any, your dentist has with the carrier.

Let's put it this way. There isn't any law that is being violated. There may or may not be a contract issue.

 

[Junction]

Thanks for the responses.

 

[ecmst12]

If your dentist is out of network, perfectly normal and legal. If you switch to a dentist in the network, they won't be able to bill you anything over the allowed amount.

 

[Junction]

It never occurred to me he could be out of network. I've had extensive dental problems, so over the last 15 years, I've had $62K in dental work, with around $42K out of pocket. He's close to retiring so I'll research my next dentist to make sure they are in-network. Thanks for your response.

 

[xylene]

Don't wait for your dentist to retire. Switch soon. You may be pleasantly surprised.

 

[eerelations]

It never occurred to me he could be out of network. I've had extensive dental problems, so over the last 15 years, I've had $62K in dental work, with around $42K out of pocket. He's close to retiring so I'll research my next dentist to make sure they are in-network. Thanks for your response.

Should have gotten that work done in Mexico. That $62K would have been $15K in Mexico + would have been done with tools and equipment too high-end and state-of-the-art (translation: expensive) for most dentists in the US.

 

[ecmst12]

That is a very long way from Minnesota.

 

[eerelations]

Still cheaper even when you factor in hotel and airfare. My friend just had dental work in Mexico that would have cost her $15,000 CAD had she had it done in Canada. She had it done in Mexico and it cost her $8,000 CAD, and that includes all the dental work + round-trip airfare, two weeks in a nice hotel, food and sundries.

 

[Jonishere5]

Dental insurance is more like a discount plan compared to medical insurance. Medical insurance will usually cover most of the cost. Dental insurance may only cover 35 to 50 percent.