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Dentist Out-of-network

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#1
Hello. I have been going to a dental clinic since last year and they recently changed the primary dentist. The previous dentist was in-network and the new dentist is out-of-network with my insurance. I only found out that the dentist is not in-network after receiving the claim from my insurance.
The clinic did not notice it at all and estimated the cost based on in-network provider. I have paid the amount they charged me for.
I contacted them recently and they now are aware of the problem. They said they did not know that this is out-of-network for my insurance (although I used the same insurance since last year). They have a copy of my insurance card.
What should I do in this case? Am I responsible to pay the balance?
Thanks!
 


Zigner

Senior Member, Non-Attorney
#2
Hello. I have been going to a dental clinic since last year and they recently changed the primary dentist. The previous dentist was in-network and the new dentist is out-of-network with my insurance. I only found out that the dentist is not in-network after receiving the claim from my insurance.
The clinic did not notice it at all and estimated the cost based on in-network provider. I have paid the amount they charged me for.
I contacted them recently and they now are aware of the problem. They said they did not know that this is out-of-network for my insurance (although I used the same insurance since last year). They have a copy of my insurance card.
What should I do in this case? Am I responsible to pay the balance?
Thanks!
This forum is for US law matters only. What is the name of your US state?
 
#4
There is no requirement that the dental office notify you. It is your responsibility to confirm that a dentist is in or out of your network just as it is your responsibility to know if a procedure is covered.
 
#5
There is no requirement that the dental office notify you. It is your responsibility to confirm that a dentist is in or out of your network just as it is your responsibility to know if a procedure is covered.
I chose them in the first place because they said they are in my network last year.
Wouldn't it be their fault that they have my insurance card and their estimate is way off? If they knew that they are out of my network and showed me the cost of the procedure based on it, I would not have done it. However, they showed my the estimate based on in-network standards...
 
#6
No it is not their responsibility to check on their network status for you. They may not even have known they were no longer in network. There is no requirement that they even file the claim for you. It is a free service they provide.
 

cbg

I'm a Northern Girl
#8
How are they supposed to know if your insurance is still in effect? Things changed for them and you didn't know it; are you saying it's impossible that things could have changed for you and they not know it?
 
#9
No it is not their responsibility to check on their network status for you. They may not even have known they were no longer in network. There is no requirement that they even file the claim for you. It is a free service they provide.
So basically what you all are saying is, if a dentist thinks that he is in your network and actually he is not, you are stuck with a out-of-network bill?
 
#10
So basically what you all are saying is, if a dentist thinks that he is in your network and actually he is not, you are stuck with a out-of-network bill?
If the patient had asked the insurer if the dentist was in-network, they likely would have received an accurate answer.
 
#11
So basically what you all are saying is, if a dentist thinks that he is in your network and actually he is not, you are stuck with a out-of-network bill?
What I am saying is that it is up to the patient to confirm that the provider is in network and that the procedure is covered,
 

cbg

I'm a Northern Girl
#12
How hard is it to pick up the phone, call the Member Services number on the back of your ID card, and confirm that the dentist is still in network? Honestly, you should be doing that regularly anyway. And if your dental carrier happens to be a national carrier whose names start with D, there's been enough news about the changes to their network that you should have known to check.
 
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