What is the name of your state? California
I went to a dentist in my PPO system for the first time, got a root canal and my teeth cleaned, handed over the paperwork and thought all was ok. Then I got a call Friday from his administrator who said the rate of reinbursement by Blue Cross was inadequate and I'd have to directly pay them another $1100. But don't worry, the dentist would probably give me a discount on that. A thousand bucks? I thought I had good PPO insurance! Why was I getting thousand-dollar bills for one tooth?
I called Blue Cross up and asked why the rate of reimbursement was so lousy that i'd have to pay an extra $1100, especially since the PPO supposedly covered 90% of a routine procedure. I'd never gotten notification of owing that much from any doctor before.
They said their records showed I owed the dentist $66, not $1100, and I could pay them that $66. That was because the dentist had contracted with Blue Cross for the lower rates in exchange for the referrals, and I found his name on their Blue Cross Web site. Any extra was supposed to be written off. Written off? I asked. They said that if I had gone to a PPO non-system dentist, I'd probably owe it, but since I didn't, the dentist had agreed to these Blue Cross rates in exchange for referrals.
Can that dentist really charge me for the extra $1100, which I presume is the retail rate? It sounds like he wants the benefits of the referrals but not the rates of the referrals. It makes me mad because I could have gone to a different dentist on the list and presumably not gotten these bills, or an out-of-system dentist instead if I wanted to pay an extra $1100.
Is there anything I can show him from Blue Cross to prove these rules and show that I only owe $66? Or what should I do?
I went to a dentist in my PPO system for the first time, got a root canal and my teeth cleaned, handed over the paperwork and thought all was ok. Then I got a call Friday from his administrator who said the rate of reinbursement by Blue Cross was inadequate and I'd have to directly pay them another $1100. But don't worry, the dentist would probably give me a discount on that. A thousand bucks? I thought I had good PPO insurance! Why was I getting thousand-dollar bills for one tooth?
I called Blue Cross up and asked why the rate of reimbursement was so lousy that i'd have to pay an extra $1100, especially since the PPO supposedly covered 90% of a routine procedure. I'd never gotten notification of owing that much from any doctor before.
They said their records showed I owed the dentist $66, not $1100, and I could pay them that $66. That was because the dentist had contracted with Blue Cross for the lower rates in exchange for the referrals, and I found his name on their Blue Cross Web site. Any extra was supposed to be written off. Written off? I asked. They said that if I had gone to a PPO non-system dentist, I'd probably owe it, but since I didn't, the dentist had agreed to these Blue Cross rates in exchange for referrals.
Can that dentist really charge me for the extra $1100, which I presume is the retail rate? It sounds like he wants the benefits of the referrals but not the rates of the referrals. It makes me mad because I could have gone to a different dentist on the list and presumably not gotten these bills, or an out-of-system dentist instead if I wanted to pay an extra $1100.
Is there anything I can show him from Blue Cross to prove these rules and show that I only owe $66? Or what should I do?
