Dentist billing issue WWYD?

[mrsbornkuntry]

Update: It pays to complain, respectfully. I just got a call from the vice president of the chain, he said that he takes care of the insurance and explained to me how it was supposed to work and where the confusion was. Long story short, they take my insuranace and are cancelling the charge to my credit card. The local office also called and apologized and said it was good that I emailed the company or who knows how many people that would have happened to who would've just paid to avoid embarassment like I did and not followed up.

I am so furious right now and I don't know if there's anything I can do about this. My DH started a new job, has new insurance. We have Blue Cross Blue Shield which includes a very measly dental plan so we also have Humana dental. I went to the website yesterday to find a participating dentist and was excited to find one in my small town, we were driving pretty far before, so I called to make appts. They actually made three of my boys' appts for cleanings and exams for today. So I did the paperwork on their website at home and printed it out, signed it all and took it in. On the phone she assured me that yes, they take Humana.

So we went in this morning, filed the paperwork, copied the insurance cards, then they called the boys back (all 3 of them). About 5 minutes later she comes over to me and says that they don't take "that" kind of Humana, that it's an HMO and they only take PPO. I don't know what that means, but I told her that I was not prepared to pay for services so she said "Do you want me to stop them from doing any more?" I said "yes". She left and I did some research, showed them where it was listed on the insurance company's website on my phone and she showed it to someone else who said "Yes, it's on there because we take the PPO and we can't tell which one you have until we see your insurance card." I said "Well, if you're aware of this discrepency then shouldn't you have waited until you looked at my insurance card to take my kids back?" She said "yes." Then nothing else.

I was told it would cost: $476 after Blue Cross Blue Shield and she asked how much I could pay today. I agreed to put $170 on my credit card and they would bill me the rest.

I still don't understand how they could have possibly gotten x-rays done and cleanings already started in the few minutes it took for her to find out about the insurance and our short conversation about it, for 3 kids.

So at this point I assume I'm responsible for it because I signed the papers that tell me that I'm responsible for anything insurance doesn't pay, but I feel scammed because they took the kids back before verifying anything. I had no way to know because as I showed her, they are on the insurance company's provider list.

Is there anything I can do at all or am I out of luck? I talked to Humana once this morning and they said I was wrong, that provider is not on their website, but it is, it's just listed under a different dentist's name, they are a chain and the insurance lists it by dentist name, not the chain name and she kept looking for the chain name so I still plan to call them back, probably when I'm less emotional about it.

 

[HLAuburn]

Maybe it's worth a call to the office manager. Since this is partially the dental office's fault for giving you misinformation, seems to me like they could "meet you half way" as far as the bill goes. What they charge insurance vs self pay patients vs actual charges varies a lot, so with what little they did, they could just write it off or at least just charge enough to cover their costs.

Good luck.

 

[brymolmom]

I would fight it. Not sure that I would 'win' but I wouldn't have paid a dime. You did a responsible enough amount of research to feel comfortable that you were indeed covered by this doctor. If they weren't 100% sure, they should have stipulated that on the phone call and ESPECIALLY when you showed up and started processing your paperwork. They should not have done any work until it was figured out to their satisfaction (you already did your own research and were satisfied on your end). It was entirely their fault that they did the work on someone not covered by their office, you gave full disclosure ahead of time about your circumstances - it was their choice to do the work at that time.

I would not pay it. Or I would only offer to pay whatever portion would have been mine to pay if they HAD taken your insurance part.

No way, IMO, should you be obligated to pay it. I would start with the office manager...and then perhaps call the BBB or maybe a state dentist agency who might be in charge of that type of office regulations?

Oh yeah - and print out the web site stuff now, and write an email or letter to the office personnel who were there when you went in asking them to verify the details of the events. To have this as your 'ammunition' - you are writing it here, but it would be nice to have in writing and agreed upon by them.

 

[cvjw]

With the uncertainty of insurance these days, (in network, out of network, etc) I always call my insurance to verify that a provider is indeed covered by my policy. These days it is buyer beware - you always need to do your homework. I would assume that you are liable for whatever work the dentist performed on your children's teeth.

 

[MSSANDRA]

I would not pay either. Their mistake. We had something like this happen with flu shorts once with a MUCH lower cost involved and I refused to pay the cost as they are the ones that said it was covered. I told them I would not pay for them as I could have gone elsewhere for free, They were ok with that!

 

[walkdmc]

If they indeed took x-rays, you should be able to get copies of those, to take to another provider (who will want to do x-rays again, unless you can produce ones from this visit).

I guess the economy is really hitting dentists hard and I've heard of some of bad billing experiences by different dentists lately. I agree with speaking with the office manager and wanting documentation from each kid's visit. For over $100 each, it seems their full dental exams and cleanings should have been completed.

Just so you don't feel bad, once I paid $75 for a dentist to brush my son's teeth...there's a story but that's the gist.

 

[QVCshopper]

First, let me say that I don't like "chain" dentistry. My FIL, BIL, and SIL are all dentists. The chain thing is mostly about making money off insurance. I also find it interesting that they could take three kids all at the same time with one days notice. Not the best sign for a good dental practice, IMHO.

That said, talk to the office manager. Try to work out a deal. Then, take your time to research a really good dental practice that you can stay with through the years. It's a longtime relationship.

Good luck. They couldn't do the x-rays and cleanings in five minutes. My FIL's office often does the cleaning/flouride on kids (20 minutes) and then the x-rays. Then the dentist comes in to look the child over. I would demand to get the x-rays for free and then never go back.

 

[mrsbornkuntry]

Thank-you for all of the replies so far.

I want to clarify something I said, after I told her to tell them to stop she left, but the kids didn't come out for awhile so supposedly they were at a point where they couldn't stop It had only been 5 or so minutes so I don't understand how they could've done any more than x-rays, but supposedly they had and they were far enough into the cleanings that they couldn't stop, I don't know. My older son who didn't have an appt. was with me so I could take him to a doctor's appt. later in the day and he kept saying "Why aren't they bringing them out yet? Didn't you just tell them to stop?" We were really confused.

cvjw, I do agree that it's my responsibility to be clear on who to go to, but I thought I had done enough research by looking them up on the website, their phone book ad said they take my insurance and the office said they take it. I didn't even know there were different kinds and I've looked at the website and paperwork again and nothing says anything like that. I won't make that mistake again.

I did just send their office an email similar to my op explaining what happened and asking for a discount, we'll see what happens. I'll wait to see if they resolve anything, if not I'm going to contact the BBB.

QVCshopper, I wish I had seen your post before I emailed them, I think asking for something specific like the x-rays for free is a good idea. I did ask for a "discount", but I think that would have been better.

Like I said, this is a small town, I won't be shy to let my friends know about my experience there.

 

[ceecee]

With the uncertainty of insurance these days, (in network, out of network, etc) I always call my insurance to verify that a provider is indeed covered by my policy. These days it is buyer beware - you always need to do your homework. I would assume that you are liable for whatever work the dentist performed on your children's teeth.

I agree! I have worked in a dental office for 20+ years and insurance is a nightmare. There used to be traditional and PPO. Now there's PPO, DMO, HMO, dental blue 100,200,300...the list goes on. We accept Delta for example (there are hundreds of plans under Delta) we are Premier and show on the website but this is not to be confused with PPO or DMO. I make sure I go to a Dr/dentist in our network and I wish every patient would do the same. The office can not be expected to know all 3000 or so of their patient's insurance plans. Some insurances you can go out of network too, so check on that.

 

[HLAuburn]

Glad to hear it all worked out!

 

[StephMK]

I'm so glad it worked out for you!! I have gotten stuck w/similar problems - I hate dealing w/health ins issues. You'd think if it's listed on the website, it would be clear but we had a similar billing issue even though I checked the insurance website before I made the appt.

I hope it was an honest mistake on the part of the office but I question why they finished service if you told them to stop. Anyway, glad it has a happy ending!

 

[cm8]

I'm glad that you were able to have that issue resolved and with no out of pocket expense to you. I have to fight with the insurance companies all the time and it really is the pits

 

[walkdmc]

What did I miss? Where did the OP say everything worked out okay?

LOL...nevermind, I see it now.

 

[mrsbornkuntry]

I'm so glad it worked out for you!! I have gotten stuck w/similar problems - I hate dealing w/health ins issues. You'd think if it's listed on the website, it would be clear but we had a similar billing issue even though I checked the insurance website before I made the appt.

I hope it was an honest mistake on the part of the office but I question why they finished service if you told them to stop. Anyway, glad it has a happy ending!

It sounded like the office didn't understand how that insurance works, when they called to get it approved they were supposed to give them billing codes for the cleanings and they didn't or something like that.

I'm still not sure why they finished the service either, but now that I'm not paying for it I'm glad they did because now I won't have to make another trip back with those 3 kids.