Dental Billing Question?

[mom2twinz3]

I have the hardest time understanding dental billing and related insurance. I think like you do and the "above" portion should be written off like with medical insurance. However, it never is with our dentist either and I don't understand why.

I have yet to go in and have any procedure end up costing what they quote. I'm always out of pocket more than what they quote.

Same here. It's always more and they don't tell you until a bill arrives in the mailbox out-of-the-blue. I have come to realize that when it comes to paying for dentistry, expect the unexpected.

Mary

 

[squirrlygirl]

What we have is called "high option" Delta Dental and the dentist we go to is an in network dentist. Minor dental work including fillings are covered 100% BUT white fillings are not covered on molars, we would have to pay the difference. Last year I paid for 1 white filling on a molar - what was above the silver filling which was to the tune of $25.

The EOB states - both are 2 surface post resin:
$215-111 (contracted rate for silver) -50 annual deductible = 154.00 patient payment

$215-111 (contracted rate for silver) = 104 patient payment

= $258 that the office billed me.

Now my question is had we had silver fillings (which given that this was a baby tooth and had they been up front with the charges of $260 vs $50 we probably would have done), they bill $185 and Delta pays $111. The dentist office "writes off" $74 per tooth = $148 as a contractual allowance because the insurance co. only pays the contracted rate. I would not be liable for that $$$. Why are they not applying that to this bill? Why am I liable for the whole balance including contractual allowances, not just the difference between filling types which was the original estimated amount given by their staff. When I question last year vs. this year they said that it is 1 surface vs. 2 surface post resin.

Thanks for the help with this....talk medical billing to me and I can understand it all but the dental

That is what our dentist does. If the silver filling is billed at 150, and the white one is billed at 180, then I am liable for an extra 30 for the filling plus my 10% copay of the contractually allowed amount. I do not have to pay the entire difference between billing and allowed.

But I don't know if it's just because I have a great dentist or that's the way it's supposed to work!

 

[ceecee]

With the high option and since he is in network, you would have been fine with what delta allows. However, since this was an alternative procedure even if he is over the UCR, I don't think he has to write it off (that seems a little high for a 2 surface composite to me) maybe call the office and see if the price is the same for permanent vs deciduous teeth. The fillings are lower at our office when we do baby teeth (really I don't know why, since it takes the same time, maybe a tad less material?)

 

[It's A Happy Day]

I got an email from the dental office today letting me know that the dentist was informed of our situation and they will allow a 1 time write off of the $148 leaving us with the $110 balance - $50 annual deductible & $60 above silver filling difference. They will from here on out send a coded quote to the insurance company for work to be performed BEFORE anything is actually done so we have a more exact amount PRIOR to doing it.

 

[angierae]

The problem I have with my dentist constantly is that if they do a billing cycle before they get payment from my insurance company, they send me a bill that includes the insurance portion! So if I pay it, they then 'credit' my account once the payment comes in from the insurance company.

Drives me BATTY when I think I'm going to have a $20 bill and I get one for hundreds of dollars. And EVERY TIME I call and they say "Oh, don't worry, your insurance company just hasn't paid us yet" and I'm like THEN GET BETTER SOFTWARE that can break out my balance from theirs instead of giving me a heart attack constantly!

But they don't, and now I just ignore the bills and call them the next day and say "Can you tell me what my actual balance is?" I figure if I drive them nuts enough calling all the time they'll figure it out.

(There are three of us, we all get cleanings at different times of the year, plus sometimes we need fillings or whatnot, so it semes like we're dealing with them 8 months out of 12.)

 

[Sadie22]

I got an email from the dental office today letting me know that the dentist was informed of our situation and they will allow a 1 time write off of the $148 leaving us with the $110 balance - $50 annual deductible & $60 above silver filling difference. They will from here on out send a coded quote to the insurance company for work to be performed BEFORE anything is actually done so we have a more exact amount PRIOR to doing it.

It's good that they worked with you on this matter. It is different with every dentist. We moved to a new community and DS had a new dentist. When he turned 18 our insurance at that time stopped paying for fluoride. At the office DS received a printout showing amount insurance would have paid, and I paid that. We later received a balance billing amount for the difference between that and full no-insurance cost, and when I called to inquire about the assumed mistake I was told that they were allowed to charge reasonable and customary for the area, and that was it and we were expected to pay the difference.

I did finally get them to write it off. DS went there one more time at which visit they did not apply fluoride. We asked why and they said it was because it was not covered by our insurance and they just assumed we didn't want it anymore, which was not true.

DS found another dentist. He has his own insurance now and the new dentist does not participate but they handle the billing for him.

 

[vicki_c]

People - this 2.5 year old post was pulled up by a spammer! I have reported that post - please do not go to the link posted!