Dentist Bill ... who should I be mad at?

[am_vanquish]

I had my wisdom teeth taken out last month. I went in for an exam and they wanted to take them out that day (I was in no pain at all, my regular dentist just said it would be a good move to prevent long-term damage). I refused, mostly on the basis that I needed to consider the costs. They told me it would cost $200.

So I go in to get the teeth removed a couple weeks later. I pay the $200 up front & the tech lady takes me back to hook me up on the Nitrous. A different dentist than the one who did the first exam comes in & starts looking at my x-ray. He says he's not sure about one tooth because a nerve might be too close (the other dentist was fine with it, but this guy is very young and very nervous). He suggests getting a better picture. I ask how much & he responds "Depends on your insurance, but it's never over $200." We get the fancy x-ray (the nitrous had me feeling good, so I didn't think too much about $200) & he decides it's too dangerous to take that tooth out. He removes the other 3 and we all move on.

Tonight, I get 2 statements from my insurance company in the mail. First, the dentist took TWO fancy x-rays and so I have to pay $350 out-of-pocket for those instead of the "never over $200" he said before. Next, the fancy x-rays put me over my benefit limit, so now the insurance won't cover another $200 from the extractions.

So, a procedure that was originally going to cost me $200 has turned into $750. Any way that I can get around this?

[maat55]

My daughter had a simular problem with her wisdom teeth removal. Next time I go to a dentist I will be getting my cost in writing up front.

[DRILLINDK]

I'm a dentist and I have a few suggestions for you. If you a long time patient of record, I would call and POLITELY ask to speak to the office manager. Explain the situation to her and tell her how you kinda feel like you got screwed (since they originally quoted you the $200, plus the basic xray and nitrous/laughing gas. I take out wisdom teeth quit frequently and I'll usually take the fancy xray, but write of the cost of the xray for the patient (charge the patient $0 for the fancy xray). Ask the office manager if they can write of the cost. If she doesn't know, ask the SENIOR dentist to give you a call back when he is available.

I dont see what the big deal would be for them to write off the cost of the xray. I write off quit a bit as a courtesy to my patients. Best of luck.

[DRILLINDK]

My daughter had a simular problem with her wisdom teeth removal. Next time I go to a dentist I will be getting my cost in writing up front.

The treatment plan your referring to is just an estimate of treatment. Treatment alterations do change every once in awhile. After all, we're all human, but doing our best. I always try to give the worst chase scenario for my patients or worst out of pocket expense so....if things go well...I look like the hero.

[maat55]

The treatment plan your referring to is just an estimate of treatment. Treatment alterations do change every once in awhile. After all, we're all human, but doing our best. I always try to give the worst chase scenario for my patients or worst out of pocket expense so....if things go well...I look like the hero.

Its not so much the cost as it is the insurance payout eligibility. I want to know exactly what my insurance company will pay before the work is done.

My daughters dentist told her that insurance would pay the bulk of her procedure but come to find out after the procedure she was a month away from eligibility. I expect the dentist to know this before performing the service.

[am_vanquish]

Thanks for the advice DRILLINDK. I'm calling their office today to find out what happened. I plan to be polite & civil, but I am disappointed & don't intend to hide the fact that their actions seem unreasonable to me. Unfortunately, I am not a long-time patient. I got a referral from my regular dentist because he doesn't do wisdom teeth. This is the first/only time I plan to go to this office.

I called the dental insurance company last night & got even more frustrated with the billing. They actually charged my insurance for the extraction of all 4 wisdom teeth, even though they only took out 3. Apparently the dentist's office also submitted the "Cone Beam" x-rays as optional procedures, so insurance only covered them at 50% instead of the usual 80%. Hopefully it's just a series of clerical errors and they'll fix everything. The dental insurance representative was very helpful and also suggested that I call my medical insurance company to see if they would cover any of the procedure. They might have a lower negotiated service price with the provider, cover a larger % of the x-rays, and/or it will get me back under my annual benefit limit on the dental plan.

I think the thing that bugs me the most is that the dentist thought it was okay to put me on nitrous for 5-10 minutes and then decide to have this whole conversation about whether or not we should take one of them out or if we should spend another $600. That doesn't make much sense to me. I could understand it if the teeth HAD to come out & we REALLY needed to do the x-ray THEN. But they weren't bothering me or anything. We could have waited, done everything 3 months later in 2010, stayed under the benefit limit on my plan, etc.

[DRILLINDK]

Its not so much the cost as it is the insurance payout eligibility. I want to know exactly what my insurance company will pay before the work is done.

My daughters dentist told her that insurance would pay the bulk of her procedure but come to find out after the procedure she was a month away from eligibility. I expect the dentist to know this before performing the service.

Welcome to my version of HELL. Insurance co's are the devil and are not doing the public a service. They channel patient's decisions to what is best for the insurance co., but not what's always best for the patient. Remember, insurance co's make $$$ by taking in more money than they distribute. Once again, I try to provide my patients with the best estimate of what the treatment will cost. This includes what insurance will usually cover. However, insurance co's don't always approve everything. THEY ARE VERY SNEAKY.

BTW, don't get me started on national health care!

[DRILLINDK]

Thanks for the advice DRILLINDK. I'm calling their office today to find out what happened. I plan to be polite & civil, but I am disappointed & don't intend to hide the fact that their actions seem unreasonable to me. Unfortunately, I am not a long-time patient. I got a referral from my regular dentist because he doesn't do wisdom teeth. This is the first/only time I plan to go to this office.

I called the dental insurance company last night & got even more frustrated with the billing. They actually charged my insurance for the extraction of all 4 wisdom teeth, even though they only took out 3. Apparently the dentist's office also submitted the "Cone Beam" x-rays as optional procedures, so insurance only covered them at 50% instead of the usual 80%. Hopefully it's just a series of clerical errors and they'll fix everything. The dental insurance representative was very helpful and also suggested that I call my medical insurance company to see if they would cover any of the procedure. They might have a lower negotiated service price with the provider, cover a larger % of the x-rays, and/or it will get me back under my annual benefit limit on the dental plan.

I think the thing that bugs me the most is that the dentist thought it was okay to put me on nitrous for 5-10 minutes and then decide to have this whole conversation about whether or not we should take one of them out or if we should spend another $600. That doesn't make much sense to me. I could understand it if the teeth HAD to come out & we REALLY needed to do the x-ray THEN. But they weren't bothering me or anything. We could have waited, done everything 3 months later in 2010, stayed under the benefit limit on my plan, etc.

Best of luck!

[disneysteve]

I try to provide my patients with the best estimate of what the treatment will cost. This includes what insurance will usually cover. However, insurance co's don't always approve everything.

This is something that most patients don't realize. I'm a family practice physician but I suspect the same nonsense happens in dentistry. Certain tests and procedures require my office to obtain prior authorization from a patient's insurance company before doing the test. We call or fill out a form detailing the diagnosis and reason for the test. The insurance company then faxes us written authorization approving the test. HOWEVER, in small print at the bottom of the authorization, it says, "Authorization is not a guarantee of payment." In other words, they can give you permission to proceed with the test but at some later date, they still have the right to deny payment. What is the point of having to get authorization in advance if it is not a guarantee that the claim will get paid?

[LuxLiving]

This gets me going - I've been shouting at the TV for months now, I wonder why the guys/gals in Washington can't hear me!

I don't believe we need Health Care Reform. I think you docs, dentists, hospitals, clinics, etc., do a pretty darn good bang up job of taking care of us.

It's HEALTH/DENTAL INSURANCE REFORM that we need! Geesh, can we at least get the nomeclature right????

}}Blushes{{, kicks soapbox aside!

[JBinKC]

I agree hear you on the health care debate. It irks me also they are attempting to force more people into an overpriced inefficient bureaucratic system.

Tell him you never signed a contract and wouldn't have approved of the procedure without knowing it was covered by insurance.

As a goodwill gesture I would make an offer to pay the bill at the medicare rate (28% of the bill).

[am_vanquish]

Just got off the phone with the oral surgeon's office. They were quite helpful and polite. As soon as the account specialist pulled up my file, she said "Oh, they didn't cover the scan ... we'll go ahead and write that off" and POOF --- $600 billed to the insurance company and $300 of my out-of-pocket just disappeared.

I then mention that the x-ray had originally put me over my benefit limit, and asked if writing that off would affect the insurance. At first she said no, then said yes. Somehow, she determined that I would get a $115 refund toward my out-of-pocket expenses as the result of the write-off.

Finally, I bring up the fact fact that they made me pay for getting all 4 teeth extracted before they took the x-ray and decided to only take out 3. Sure enough, they billed insurance for all 4 (and the most expensive one was the only one they didn't take out). That results in another refund to my out-of-pocket costs and an additional refund to my insurance company.

I still think something sounds fishy, but I went from having about $700 in bills to breaking even, so I'm going to let it rest. The saddest part is that they would have gladly taken my money if I hadn't called to ask.

[LuxLiving]

Great news for you. Pays to be proactive and reactive at times!

I thought about this later -- I wouldn't like that tactit of getting me doped up THEN deciding to discuss treatment options. Fishy is right.

Glad you caught a break.

[disneysteve]

The saddest part is that they would have gladly taken my money if I hadn't called to ask.

This is very true. There are millions and millions of dollars of incorrect charges that get submitted to and paid by insurance companies every year. There are also millions in incorrect charges that get paid out of pocket by patients every year. The amount of waste is incredible.

When my wife had surgery a few years ago, I did what they always advise and obtained an itemized bill from the hospital. Sure enough, I found an error of over $1,000 for an item that was billed twice (she only got one). I got it corrected and that savings went right to us since it came off our out of pocket cost.

I've also had patients tell me, after the fact unfortunately, that they received a bill for something we had done or sent them for and they paid it without questioning it. Often, it was something that their policy should have covered and was probably not submitted properly. I always tell patients to never pay a bill without calling or coming in and questioning it first.

[DRILLINDK]

Just got off the phone with the oral surgeon's office. They were quite helpful and polite. As soon as the account specialist pulled up my file, she said "Oh, they didn't cover the scan ... we'll go ahead and write that off" and POOF --- $600 billed to the insurance company and $300 of my out-of-pocket just disappeared.

I then mention that the x-ray had originally put me over my benefit limit, and asked if writing that off would affect the insurance. At first she said no, then said yes. Somehow, she determined that I would get a $115 refund toward my out-of-pocket expenses as the result of the write-off.

Finally, I bring up the fact fact that they made me pay for getting all 4 teeth extracted before they took the x-ray and decided to only take out 3. Sure enough, they billed insurance for all 4 (and the most expensive one was the only one they didn't take out). That results in another refund to my out-of-pocket costs and an additional refund to my insurance company.

I still think something sounds fishy, but I went from having about $700 in bills to breaking even, so I'm going to let it rest. The saddest part is that they would have gladly taken my money if I hadn't called to ask.