Question about medical/dental insurance

[Don Claybrook]

I'm hoping someone has some experience with this.

I have dental insurance through work. I have lots of dental work in progress, and more to be done.

My dentist requires that I pay my portion of the bill on the day of service. My dentist uses filling material that is not covered by insurance, at least on the back teeth (dentist uses tooth-colored filling material, insurance only pays for silver-colored material for back teeth).

Last time I was at the dentist, I paid something like $250 out-of-pocket. Now I've gotten a notice from my insurance company that they have paid $500 dollars (I'm rounding numbers for illustrative purposes). Further, the insurance letter says that my dentist can only charge me $100. So I've paid an additional $150 over what my insurance company says I'm obliged to pay.

A blurb on the insurance company's web site says "In-network providers agree to accept a negotiated amount that includes the member's share and Aetna's payment as payment in full for specified services."

Question: is my dentist doing something unscrupulous, or am I misreading this?

Thanks.

[Tesibria]

1. well

can't REALLY tell from this, but it's worth

1) Calling the insurance company and asking them
2) Calling the dentist and asking him/her how this is so (AND TAKING NOTES DURING THE CALL)
3) Depending on what dentist says, call the local office of your state's licensing board and ask them.

[Spinzonner]

2. Are you sure that your charge was just for one procedure ?

It's possible they were including multiple things but the insurance letter was only reflecting one particular item they had processed. Check the bill from the dentist versus the letter.

If they do match, it's also possible that someone midcoded or misread the procedure code so that you were charged on something different than the insurnce company got reported to them.

To avoid a stink, I'd call the dentist and tell them something didnt match and ask whether you possibly misunderstand something or an error was made. This gives them an out to deal with it themselves rather than getting in trouble (if indeed there is either a faulty or fraudulent billing). It also puts them on notice that you're checking these things.

[candy]

3. For heaven's sake,get the silver amalgam for the back teeth.

I only get the white for teeth that show when I smile. The amalgam will last a lot longer and your insurance will cover it.

My dental insurance works the same way that your's does---maybe you can negotiate lower prices with your dentist.

Some people have no dental coverage at all so count your blessings.

[miss_kitty]

4. silver amalgam breaks molars after a few years

they leak and allow bacteria in and cause the need for extractions and root canals. Plus the jury's still out on the health concerns over using mercury in the human body an its affects upon it.

I have no dental insurance and I am slowly paying to have all my amalgam removed-it's old school, and not really conducive to good health. amalgam has a life expectancy of 7 years (If you'll recall, they're called temporary fillings) and bonding (the white fillings) lasts 10-11 years.

[candy]

5. I have silver amalgam that's been in for at least 20 years.They

were considered permanent fillings for many years,long before bonding existed.

[sparky_in_ma]

6. Same thing happened to me

My dentist's office is honest, I've known them for 20 years. They made a mistake on the billing. It's one code for insurance patients, one for non. (They give discount to the insurance patients because it gives them group business with guaranteed payment.)

[yellowdogintexas]

7. if the insurance pd the doctor directly, he has a copy of

everything you have.

Call up the insurance lady and ask if they got their EOB yet and go over it together. Believe me, if they think something is not right they will refile it so fast it will make your head swim.

[Longhorn]

8. The dental office may have made a mistake.

When my son had to have surgery for a broken ankle, the surgery center insisted that I pay the deductible to them up front. Then other bills got to the insurance company before the surgery bill and those bills were applied to the deductible, of course. It took some doing but I finally got the money back from the hospital.

The insurance company advised me never to pay the doctor or hospital first in the future -- to wait until the bills have been run through the insurance company. Just because they ask for the money doesn't mean they will refuse to do the work if you don't pay it up front. It's worth a try.

Also, I completely agree -- take names and notes and dates of every conversation. It's amazing how long these things can go on and how hard it is to remember later.

[Don Claybrook]

9. Thanks for all the replies

I got busy with work after posting this and never got around to it again. Calling the insurance company on Monday. Thanks again.

[Sgent]

10. There is another issue here too...

The dentist may have filed a filling charge, but the filling assumed the use of amalgam. So the amount you owe would be if you had recieved almagam fillings.

Due to the bond, you may owe more than what's on your EOB, but less than if he hadn't filed it at all, or had not been in network.

Its also very possible that when they charged you your up front charge you didn't recieve the discount that the insurance companies get, and they will cut you a check for a refund.