• FreeAdvice has a new Terms of Service and Privacy Policy, effective May 25, 2018.
    By continuing to use this site, you are consenting to our Terms of Service and use of cookies.

Dentist didn't tell my wife that they didn't take our insurance til after her visit.

Accident - Bankruptcy - Criminal Law / DUI - Business - Consumer - Employment - Family - Immigration - Real Estate - Tax - Traffic - Wills   Please click a topic or scroll down for more.

Granolabranborg

Junior Member
I am in the Navy and my wife has medical/dental insurance through me. She has been going to the same dentists for a few years, and our insurance has always covered it. Today, when she went for a routine check-up, everything went normally until after the dentist had finished. Without mentioning, for the entire appointment, that they no longer accepted our insurance, they recommended that she come back to have some work done. They started going over how much the procedure would cost. She asked why they were writing an itemized bill, for her, when the work should be covered by insurance... At this point, they finally informed her that they no longer take tri-care. My wife asked why they hadn't told her about the change, beforehand... They said they hadn't informed anyone (as if that's a reasonable answer.)

Is there any law requiring health providers to inform patients of insurance policy changes affecting them, before providing care? Is there anyone that I could inform about this or are we liable to pay this bill? Does this fall under Virginia law § 38.2-2612 for unfair trade practices?

Thank you for your advice.
 


Ohiogal

Queen Bee
I am in the Navy and my wife has medical/dental insurance through me. She has been going to the same dentists for a few years, and our insurance has always covered it. Today, when she went for a routine check-up, everything went normally until after the dentist had finished. Without mentioning, for the entire appointment, that they no longer accepted our insurance, they recommended that she come back to have some work done. They started going over how much the procedure would cost. She asked why they were writing an itemized bill, for her, when the work should be covered by insurance... At this point, they finally informed her that they no longer take tri-care. My wife asked why they hadn't told her about the change, beforehand... They said they hadn't informed anyone (as if that's a reasonable answer.)

Is there any law requiring health providers to inform patients of insurance policy changes affecting them, before providing care? Is there anyone that I could inform about this or are we liable to pay this bill? Does this fall under Virginia law § 38.2-2612 for unfair trade practices?

Thank you for your advice.
It is your wife's responsibility to know who her insurance covers.
 

Taxing Matters

Overtaxed Member
Is there any law requiring health providers to inform patients of insurance policy changes affecting them, before providing care? Is there anyone that I could inform about this or are we liable to pay this bill? Does this fall under Virginia law § 38.2-2612 for unfair trade practices?

Thank you for your advice.
It’s the patient’s responsibility to know the details of his/her coverage and who is a participating doctor/dentist, etc. Especially when the new plan years start (usually January 1) there are changes in who will participate/accept the various insurance plans and a patient should always ask the doctor/dentist if the insurance is still accepted. Don’t just assume that because it was accepted before that it will still be accepted now.
 

xylene

Senior Member
Don’t just assume that because it was accepted before that it will still be accepted now.
That's a legitimate point, and the op has no recourse. But the dentist's conduct in this matter is reprehensible and if they do their existing tricare patients a grave dis-service by not being upfront about no longer accepting tricare and why. This is not an 'oops' situation. This is holding military families over a barrel and then trying to put the squeeze on them for treatment plans. That's some shady dental nonsense. Not that the military isn't being equally shady by not being upfront about the ramifications of reimbursement cuts making tricare insurance effectively worthless in most markets.

Blame all around!
 

Shadowbunny

Queen of the Not-Rights
The contractor for the Tricare Family Member Dental Plan changed from MetLife to United Concordia May 1, 2107. At that time, there was a huge media campaign to remind Service Members and Families that they needed to ensure that their dentist was still a Network provider.

Family Members aren't required to use a Network dentist, but will save out of pocket expenses by doing so. It is quite possible that there's not that much difference in what the Member has to pay out of pocket by using the non-network provider.

OP, if the dentist didn't file the claim with United Concordia, then you can do so now by filling out a claim form and submitting the receipt. Keep in mind: except for routine procedures (annual cleanings, for instance), you have a cost-share even if you go to a network dentist.
 
Last edited:

xylene

Senior Member
The contractor for the Tricare Family Member Dental Plan changed from MetLife to United Concordia May 1, 2107. At that time, there was a huge media campaign to remind Service Members and Families that they needed to ensure that their dentist was still a Network provider.

Sadly, the media campaign was disingenuous of the reality that many many dentist were no longer going to be participating. Ir seems many areas are now devoid of any participating providers at all, and others with no pp accepting new patients. "But check and see how these draconian cuts have wrecked your kids smile" might not have had the same ring.
 

Taxing Matters

Overtaxed Member
That's a legitimate point, and the op has no recourse. But the dentist's conduct in this matter is reprehensible and if they do their existing tricare patients a grave dis-service by not being upfront about no longer accepting tricare and why.
I don’t agree. My dentist, for example, only checks what insurance I have and what it covers after the procedure is done and they input all the stuff to spit out what my share is. If I want to know before the procedure starts whether they take my insurance and what is covered I need to specifically ask for that. I’m the one who really cares what my insurance does and does not cover and thus I am the one responsible to know the details of my insurance and who accepts it, etc. I don’t expect anyone else to do that for me as it is really not their job to watch my finances. That’s my job. Sure, it would be nice if they went out of their way to say “hey, by the way we don’t take the insurance you used last time anymore” but it’s not really their responsibility. Too many people have no real clue how their insurance works, what benefits the plans pay, or much else about their plans because they do not bother to read the plans. IMO not being truly familiar with your insurance plans is a mistake. You may miss things that are important to you, whether its benefits you didn't know existed or limitations that you need to know about. Sure, it's a pain to read those things and it takes time. But when it comes down to it, you are the one responsible for knowing that stuff because it is YOUR insurance and the benefits help YOU, not anyone else.
 

Shadowbunny

Queen of the Not-Rights
Sadly, the media campaign was disingenuous of the reality that many many dentist were no longer going to be participating. Ir seems many areas are now devoid of any participating providers at all, and others with no pp accepting new patients. "But check and see how these draconian cuts have wrecked your kids smile" might not have had the same ring.
A big part of my job is working with TRICARE coverage, both medical and dental. When the contractors switched, there was NOT a massive loss of participating (network) providers. But even if there were a loss of providers, when the service member is told, in multiple ways (letters mailed to their homes, printed on their LES, social media posts, etc) to make sure that their provider is still a network provider, then you can't blame the contractors nor Tricare.
 

Find the Right Lawyer for Your Legal Issue!

Fast, Free, and Confidential
data-ad-format="auto">
Top