Dental Billing Question?

[It's A Happy Day]

I do medical billing so I would think that Dental billing works the same way but I want a little confirmation here.

DS went in to have 2 fillings done on 2 back teeth. I was quoted a price above my insurance payment (because they do not cover white fillings on back teeth only silver) of $50 total ($25 per tooth). We have a high option dental plan that covers 100% on minor cavities. I was told this was the price above the silver filling fee. Fine, fillings scheduled and done. I get a bill over the weekend for $258.00 that is supposedly my portion to pay OOP. I found out that we have a $50 per person annual deductible that I didn't realize we had so I am at (what I thought) would be $100.00 out of pocket. I emailed the dentists office for a breakdown of pricing and asked what the contracted rate is for the work done on my son - I tried to call 2x but they have weird hours at the end of the week/weekend. This morning the response I got was:

DS had White Filling
2 surfaces = 215 x2 = 430
insurance payment = 172.00
patient balance = 258.00

Silver fillings (had I chosen this route)
2 surfaces $185 x2 = 370
insurance payment = 172.00
insurance would credit = 148.00
leaving a balance of 50.00 for the patient.

The bold part is the part I am questioning. In medical billing this is called contractual allowance and we are required to write that off. We CANNOT bill the patient this amount. Is this true in dental as well?

I am planning on calling the dental office but they are at lunch right now so I am waiting for them to get back.

Any information would be helpful.

 

[bumbershoot]

Do you mean the idea of not being able to bill beyond what insurance pays a "preferred provider"?

If so, no, I think dental insurance is quite different. But calling your insurance company could clear it up quicker than the dentist's office, and if they are doing something not allowed, the insurance company I'm sure would love to know.

 

[ajk912]

I think it works different for dental. My insurance pays about the same as yours does..kind of. They cover 80% of reasonable and customary charges- but only for the basic work. So like you, I need to have silver everything for kids. I just had dental work for my kids, and IMO $258 OOP for two fillings when you did the upgrade isn't bad at all. I know not what you are expecting though. I usually budget about $100 a tooth for me and my kids for a filling. That's usually about what 20% is.

 

[Belle0101]

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.

Matter of fact, I received a letter last week stating that if I didn't pay them $96 immediately they were going to send me to collections.

Turns out it was for an appointment in Feb of 2007 that they quoted me would be 100% covered by our insurance. I left thinking it was covered and forgot all about it.

Real nice, they were wrong, and the first time I hear so is when they threaten me with collections for non-payment.

Good luck, I hope you get it straightened around.

 

[It's A Happy Day]

I think it works different for dental. My insurance pays about the same as yours does..kind of. They cover 80% of reasonable and customary charges- but only for the basic work. So like you, I need to have silver everything for kids. I just had dental work for my kids, and IMO $258 OOP for two fillings when you did the upgrade isn't bad at all. I know not what you are expecting though. I usually budget about $100 a tooth for me and my kids for a filling. That's usually about what 20% is.

My insurance pays 100% of all fillings unless major such as root canals, etc. I was told $25 per tooth prior to work being done so $258 is ALOT more than I expected to pay OOP. I know in medical we have to write off the amount over the contracted rate, we are not allowed to bill the customer legally for that amount. But I am not sure if that is the case as well with dental.

What I want to know is if it is standard to bill a patient any amount over the contracted rate. I understand the $25 difference for the type of filling I chose but not how they can bill me the contracted difference (if that makes sense)

 

[twinmommyks]

Is the dentist a Delta provider? If they are, then they should write that amount off. If they are not a contracting provider with Delta, then you must pay it. If they bill you for the amount over the contract amount and they are a providing provider through Delta, call the insurance company and indicate that this is happening.

We have Delta insurance and unfortunately, my dentist and many of our local dentists do NOT take Delta insurance so we are stuck with paying the "extra". Just went through this last month with a root canal.

Hopefully, they are a contracting provider so you don't have to pay the extra.

Let us know what you find out.

 

[It's A Happy Day]

Yes, they are a Delta provider

 

[ajk912]

Mine is never what they quote me it will be, either. I posted a few days ago about how my four fillings ended up costing me $800 AFTER my insurance. I agree, if this was a med office they would have to write off what wasn't in the contract. I am not sure why it is ok in a dental office.

 

[WDWorBUST]

Have you gotten your EOB yet? That will clear a lot up. I always get billed for more than what my part is from the dentist for some reason. But you should not be charged over the negotiated contracted rate if you went to an in-network provider (it should work the same as medical).

 

[bumbershoot]

Call the insurance company. They'll either explain it, or they'll contact the dentist's office if the dentist is doing something not allowed.

I once solved an MD doing this while on hold with the insurance company...she was a pp, shouldn't have charged over but was doing so, and the rep put me on hold while she contacted the MD and it was all sorted inside of 10 minutes.

 

[sailors_wfe]

Hi!
This is my speciality...it's what i get paid for.... i think
If your Dentist is a participating dentist with your insurance then they write off the difference between the insurance's fees and office's cash fees. The office should be able to give you a pretty decent estimate. The only time the write-off is different is when it's a difference between white and silver for cosmetic reasons. I haven't read through all the responses yet, but if you haven't gotten any answers ( i think your estimates are correct but i didn't look into it too much) feel free to PM me... like i said, that's what i do for my offices (i have 10 offices i do billing for)

 

[mamalle]

I would wait and get the EOP also. I just received a bill for ds sealants that he had in Dec. they are covered 100% and they billed me basically what was considered the write off from the insurance company. I made a copy of my EOP just in case and called. (I also made sure it was in network before I even took them there.) To make a long story short- I called and they apologized and said it was their mistake. I knew darn well I wasnt responsible for anything. I also picked the more $$$ dental insurance just for instances like this. we have 100% coverage for fillings that are white and sealants for the kids- molars and primary teeth.

 

[ilovedale3]

I'm glad to know that I am not the only person who is dealing with Delta Dental insurance issues!

I have to get two fillings and since they are on molars, Delta won't pay for the white fillings, only silver. Well, my dentist (a Delta provider) doesn't even do silver fillings anymore! So we contacted Delta and told them, they contacted the dentist, DH calls Delta about a hundred times... three weeks later and nothing has been done. Now today, DH gets a call from Delta saying that the dentist is in violation of their terms with Delta as a provider (since they no longer offer silver amalgam and they didn't inform Delta of the change) and we have to file some sort of grievance.

 

[Jenna45]

You are correct if it is a contracted provider they can not balance bill, I work for BCBS and my denitist tried to balance bill me once, I contacted provider relations and asked them to contact the provider, after that I never was billed again, but I noticed it says in bold on the front of the file BCBS EMPLOYEE. I was checking out one time and saw a freind of DS , the mom was being balanced billed, I pulled her aside and told her not to pay , and I got a dirty look but they told her it was provider write off. This is a HUGE problem with dentist offices, especially for us here in CT they average somewhere around 300 cs services calls on particpating docs a week in the call centers...
Contact your insurance company and don't pay any more then what they say you owe.. Let them work for you

I do medical billing so I would think that Dental billing works the same way but I want a little confirmation here.

DS went in to have 2 fillings done on 2 back teeth. I was quoted a price above my insurance payment (because they do not cover white fillings on back teeth only silver) of $50 total ($25 per tooth). We have a high option dental plan that covers 100% on minor cavities. I was told this was the price above the silver filling fee. Fine, fillings scheduled and done. I get a bill over the weekend for $258.00 that is supposedly my portion to pay OOP. I found out that we have a $50 per person annual deductible that I didn't realize we had so I am at (what I thought) would be $100.00 out of pocket. I emailed the dentists office for a breakdown of pricing and asked what the contracted rate is for the work done on my son - I tried to call 2x but they have weird hours at the end of the week/weekend. This morning the response I got was:

DS had White Filling
2 surfaces = 215 x2 = 430
insurance payment = 172.00
patient balance = 258.00

Silver fillings (had I chosen this route)
2 surfaces $185 x2 = 370
insurance payment = 172.00
insurance would credit = 148.00
leaving a balance of 50.00 for the patient.

The bold part is the part I am questioning. In medical billing this is called contractual allowance and we are required to write that off. We CANNOT bill the patient this amount. Is this true in dental as well?

I am planning on calling the dental office but they are at lunch right now so I am waiting for them to get back.

Any information would be helpful.

 

[sailors_wfe]

I do medical billing so I would think that Dental billing works the same way but I want a little confirmation here.

DS went in to have 2 fillings done on 2 back teeth. I was quoted a price above my insurance payment (because they do not cover white fillings on back teeth only silver) of $50 total ($25 per tooth). We have a high option dental plan that covers 100% on minor cavities. I was told this was the price above the silver filling fee. Fine, fillings scheduled and done. I get a bill over the weekend for $258.00 that is supposedly my portion to pay OOP. I found out that we have a $50 per person annual deductible that I didn't realize we had so I am at (what I thought) would be $100.00 out of pocket. I emailed the dentists office for a breakdown of pricing and asked what the contracted rate is for the work done on my son - I tried to call 2x but they have weird hours at the end of the week/weekend. This morning the response I got was:

DS had White Filling
2 surfaces = 215 x2 = 430
insurance payment = 172.00
patient balance = 258.00

Silver fillings (had I chosen this route)
2 surfaces $185 x2 = 370
insurance payment = 172.00
insurance would credit = 148.00
leaving a balance of 50.00 for the patient.

The bold part is the part I am questioning. In medical billing this is called contractual allowance and we are required to write that off. We CANNOT bill the patient this amount. Is this true in dental as well?

I am planning on calling the dental office but they are at lunch right now so I am waiting for them to get back.

Any information would be helpful.

Ok.. I re-read over your question and think I understand what has you confused right about now.. I'm a little slow today you are wondering where the $148 credit is on the white filling price (am i correct??) if so, then basically there isn't one. Basically weather you get white or silver fillings insurance pays the same amount. what you are left with is the difference between the silver price and the white price.... plus the $50 deductible. Now i'm wondering if they gave you any sort of an adjustment at all.... if you have the EOB from the ins company or have the max price that your insurance pays for the fillings (silver) then i can figure out if they are giving you the proper price or if they are doing the adjustment incorrectly (a LOT of DDS do it incorrectly)... as for Dentists only doing white fillings... this is becomnig EXTREMELY common-- my last 3 dentists i worked for only did white--there's not really anything you can do about it but either pay the difference, or find a new dentist... sure, you can become one of "those" patients and complain and they will eventually write it off probably... but there is a reason dentists are commonly doing white fillings only these days... they are much better for your teeth... you have to take out less of the tooth structure around the decay with a white filling then a silver filling... they are more likely to last longer.. there are many other reasons that I won't go into but it's one of the things I've learned over the years... Hopefully ins companies will get the drift sooner or later, but i'm not holding my breath
ok.. this was way too long... but hey, i don't get to talk dental very often on these boards and dentistry is in my blood (dad and grandpa were dentists-- now i work for a ped. dental office with 40-some offices on the east coast)


ok.. the more i look at it the more it looks wrong.... you should have had to pay $30 extra per tooth difference bet. white and silver prices... so your total should have been around $100.00 not $260.... call the office and make sure they did the adjustment correctly... if you need to get "technical" with them... ask them to tell you why they didn't make the contractual adjustments for the silver fillings and tell them you should be paying the difference between the cost of their price for the composite(white) and amalgam(silver) fillings which is $30.00

 

[TN Dreamer]

Here in Tennessee, Delta Dental has two different plans for dental providers. Premier and PPO (Preferred). The dentist I work for is a Premier provider and not Preferred so we only do "some" adjustments of the UCR or usual and customary charge. Patients that come to our office that have PPO insurance are considered out-of-network, even though we are Delta providers. Being out of network means the claims are paid a lower percentage.

The UCR is determined by your zipcode, that is how insurance companies determine how they are going to pay claims. For example, charges in a different zipcode area or maybe a larger city will be paid better than the same work done in a smaller city or town.

In our office we do not even do amalgam or silver fillings. Almost all insurance companies will give an allowance toward the white fillings on what they would normally pay on amalgam fillings. Of course amalgam restorations/fillings are somethimes cheaper than white fillings. So the patient will have more out of pocket expenses. (in our practice we charge the same for composite(white) and amalgam (silver) fillings)

We always try to do a predetermination with the insurance company for any treatment over $300.00 so there will not be any surprises for our patients. We submit to the insurance company exactly what the treatment will be and what our charges are. The insurance company will write back with the estimate as to what they will pay and what the patient/insured balance will be after insurance.

I think insurance can be so confusing.

 

[DaisyLynn]

I also work in the dental billing field. Actually, I spend my days doing insurance coverage estimates for patients.

Where I work, we take all insurance, however we may not be in network. For instance, we take carrier discounts on about 1/2 of the Delta Dental plans that are out there. Northeast Delta Dental, we do not. Delta Dental of CA we do.

With any given insurance, there are some instances when write-offs are taken, and other instances when they are not. Of course, this is very confusing. The easiest ones for myself and the patient are when we always take the write-offs. Sometimes, write-offs are only taken when it is a covered procedure (i.e. amalgam (silver) filling). Sometimes they are not taken on upgraded services (i.e. composite (white) filling). And then sometimes, the write-offs are only taken when the annual maximum has been reached. Or any combination of the above. Again, very confusing.

I would contact the dental office and ask them for a breakdown for when these write-offs are to be taken, as they understand it. And then I would follow up with your insurance company and get the same information from them. If it doesn't jive, then I would handle as however you choose. One thing I would suggest for the future is have the dental office send for a pre-determination of benefits. While this doesn't always guarantee payment from insurance companies, something like this would have come across on a pre-determination. It takes more time, but I always offer this to my patients, as it is a really helpful way for all parties involved to better understand that patient's dental policy.

Good luck!!!

 

[ceecee]

Delta Premier, Delta Preferred and Delta PPO, three in our state and they are all different. If dentist is an in-network provider there is a write off, if not there is no write off. Call the insurance and they will explain. I'm surprised your dentist's office didn't know you had a deductible. We call to verify at my office to make sure we bill patient correctly at the time of service. You should have some extra out of pockets since you went w/white filling vs amalgam for the back teeth, that is quite common.

 

[It's A Happy Day]

Delta Premier, Delta Preferred and Delta PPO, three in our state and they are all different. If dentist is an in-network provider there is a write off, if not there is no write off. Call the insurance and they will explain. I'm surprised your dentist's office didn't know you had a deductible. We call to verify at my office to make sure we bill patient correctly at the time of service. You should have some extra out of pockets since you went w/white filling vs amalgam for the back teeth, that is quite common.

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

 

[ajh88]

OK, I don't do dental billing and I don't know that what I'm going to say is correct, but it is the information I was given a few years back when I had Delta Dental and ran into a very similar problem with MY dentist! I know insurance rules change rather frequently, so do with this what you will.

I think there is a difference between UCR and whether or not the charge was accepted. Back when I had this issue, the insurance company flat out rejected the composite charge, meaning I had to pay the entire amount. It seemed that the way it was billed, they covered part of the filling, but perhaps the amalgam upcharge (for lack of a better term) was billed separately? I dunno - just a thought. Either way, I would be making some phone calls so at least this won't happen again. Good luck!