Medical/Dental insurance underpayment?

[WhiteHawk]

I think this whole thing could go either way. It depends on what the paperwork said and what you signed. When I had my wisdom teeth out, the dentist got a pre-approval from the insurance company, but he told me up front I would have to pay the difference between what they paid and what he normally charged. Because I wanted that guy, I paid the difference. If you go to a place that is "In Plan" for Delta or one of the dental plans, then they should take whatever delta (or your plan) pays. If they are not in plan, then technically you might owe it, although they will have to justify why the original number changed.

I am shocked that your dentists did not do a pre-approval. I don;t let a dentist touch my mouth for anything other than a cleaning without one. I would look at your paperwork in detail and compare the procedure codes (not sure what the technical term is) for the pre-approval compared to what the dentist is charging you for. Your own insurance should have been sending you "Explanation of Benefits" statements too. Those should have some clues as to what the dentist is asking them for and what they actually paid for. Compare the EOB's to the dentist bills and see if they Jive in terms of costs and codes.

Also, I had a dentist recently screw up a pre-approval. They got a crown approved, but then the insurance wouldn't cover the enamel coating because it was on one of my back molars. I told them to pound sand and they ate it, because they screwed up the pre-approval. It was only $100, but I told them it was their mistake not mine and I wasn't paying.

Good luck!

-Geoff

[MarkVIII93]

I did find the original paperwork regarding the procedure estimate. Of course they include a disclaimer that states the out of pocket costs may not reflect the exact amount expressed in the estimate.

[wikdsvt]

1. get your EOB from your insurance
2. compare amounts.
3. if they accept your insurance, then they are contractually agreed to accept that amount as payment in full
4. tell your insurance company what they are trying to pull

This is called "Balance billing" and it is illegal

[MarkVIII93]

1. get your EOB from your insurance
2. compare amounts.
3. if they accept your insurance, then they are contractually agreed to accept that amount as payment in full
4. tell your insurance company what they are trying to pull

This is called "Balance billing" and it is illegal

Depending on if the amounts match. What does that determine?


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[MarkVIII93]

you sue them under the FDCA and get paid,

So this happened. Just got the notice today.

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[moneypit]

So this happened. Just got the notice today.

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check?

[MarkVIII93]

check?

Just got a collection notice Friday. I plan on disputing it with the collections agency.

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[mrvids]

Where is Dr. Teeth when we need him?

[WhiteHawk]

Good luck! It is always tough being the little guy against insurance behemoths.

-Geoff

[MarkVIII93]

Right now it's the dentist office. They improperly coded their billing when they sent the pre approval to the insurance company and gave my "X" dollar amount to pay. Four months after I paid my balance due for the procedure, the office attempted to bill me extra due to their mistake. I asked the office multiple times immediately following the procedure if the amount due was correct. I was told yes. I assume they wait 2 years to send this to collections in Hope's I'd lose my paperwork
.. I'll be submitting it to the collections agency
Hopefully they kick it back to the dentist office.

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