Normal or shady orthodontist practice?

[MommyMK]

My DD10 has been under the care of an ortho for about two years now. She has not yet had braces, but has had a bite plate (similar to a retainer) to correct a deep bite. When we originally got the bite plate, we paid the fee which was around $500 (ins covered half) and since then we have not had to pay anything else at any of the other appointments.

Back in February we went for a regularly scheduled appointment and it was decided that DD no longer needed to wear the bite plate, basically the (baby) teeth that were holding it in were falling out, so she could no longer wear it. The ortho said she wanted to see her again in May to see if she would be ready for braces yet.

So we go back a few weeks ago in late May to see the ortho and they take a bunch of pictures and x-rays and it's determined that she's not quite ready for braces yet and that she probably will be in the fall so give them a call to make an appointment when she finally loses her last 4 baby teeth.

Never once was anything mentioned about charges or payment for this appointment and I just assumed that this appointment would have no charge just like all of the other appointments from the last two years. Well yesterday we recieved a bill from the ortho for $375!!! For the X-rays ($150 each) and the photos ($75). It appears they have not attempted to submit these charges to our insurance company either. I will be calling on Monday but I wanted to know if this was normal practice or not for an orthodontist.

Further backstory on this ortho - there are 3 different orthos in our town and when we were first looking a few years ago we went to all 3 for consults. The first one had a free consult so I assumed this Dr would be a free consult too which was my mistake. We get there and they want to take a $150 X-ray before we even see the Dr. I said no and was ready to just leave (calmly, no anger just wouldn't get a consult from this doc) and they agree to do the X-ray for "free". Ok fine, weird but whatever. We end up choosing this doc because we like her treatment plan best.

Fast forward to getting the bite plate - the ones they showed us in the initial appointments were all removable so I assume that's what we are getting. They make the thing and we go to get it and it turns out they made her one that is permanently cemented in her mouth which we never discussed and I wasn't comfortable with. They said it was because too many kids were losing the removable ones. I tell them I'm willing to take that risk, that I have a very responsible kid and we want the removable kind. They agree to remake it, but they charge me $100 for a new one. I was pissed, but went along with it. This latest bill with no upfront explanation feels like the last straw. While the X-rays and photos are their standard and helped with the diagnosis you can tell just by looking at her mouth that she still has 4 baby teeth and we don't need $375 worth of photos and X-rays to see that. This feels like the last straw for me and this practice. Every time I go to the dentist they are very upfront with costs so this ortho is throwing me for a loop. Is this normal or out of line?

 

[tvguy]

It certainly sounds like they need to do a better job disclosing their fees.
The Ortho my wife used, and that we used for our kids years later is on the other extreme. They spend a lot of time explaining costs and exactly what we got for that money.
My wife got her braces on in 1980, and off in 1983 and the fee we paid included all the costs and 20 years of adjustments for her retainer. So when she went in this year for a retainer adjustment, it was past the 20 years, so she had to pay a $35 office visit fee. And yes, she still wears her retainers every night, 33 years after she got the braces off.

But to the fees you are being asked to pay, those seem entirely in line with what I would expect to pay.

 

[MommyMK]

Ironically my youngest also went to the dentist on the same day and got one of the same kinds of X-rays (panoramic) and I just got the EOB for that visit. The dentist's office charges $100 for a pano and the ins company pays $66, ortho charges $150. I suspect the billed me before the insurance to see if I would just pay the full charge. Also wondering if insurance does not cover these charges do I need to pay the full rate or the contracted rate with the ins? I.e. $150 or $66?

 

[jrt1176]

I'm not up-to-date with orthodontic practices, but they seem to be putting on braces at an earlier age.

They should, as a courtesy, disclose the fees upfront. I suppose they don't have to...

Personally, after you got burned the first time, I would make them tell me everything before they do anything else!

 

[zoo2tycoon]

I always thought it was up to the patient to find out what insurance covered and what it doesn't. The word you keep using is ASSUME. You can't assume anything with any medical professional. You assumed something about a bite plate. Doctors can charge different rates for the same services so if the ortho charges a higher rate than family dentist for X-rays he can do that. I would not assume an appointment after the bite plate was removed would be covered since it was out and you weren't being seen for that.

I recently had a medical issue. Dr set up test at hospital that wasn't emergency. I just went and had it done, got bill after insurance I paid OOP $1300. Needed another test done, found off site medical imaging charged $350 where hospital was $1000 for same test. Dr wrote for me to have at offsite place, they even gave me DVD to take.

We all need to inform ourselves on medical costs and can't assume anything anymore! There are lots of sites that will estimate costs, etc. We have United Healthcare and I can get estimate and different tier doctors are different prices.

Sorry you are going through this, might be a valuable lesson not to assume. I'm not trying to be mean, but sometimes we need to open our eyes! Maybe call ortho and explain your confusion and nicely ask about it.

 

[tvguy]

I always thought it was up to the patient to find out what insurance covered and what it doesn't.

I'm double covered, Delta and Cigna Dental. At least with them, they will not tell me directly what they will pay. They WILL tell the Dentist either when the Dentist requests Prior Authorization, or when the Dentist submits a claim. When it is all done, I get an Explanation of Benefits. But they won't tell me if I ask.

 

[momto3pirates]

Is this orthodontist in your insurance network? If not, you may be responsible for the whole fee. How much does your insurance allow for ortho coverages? Some insurance only allow ortho treatment once, meaning their maximum is a lifetime amount they will cover.
It sounds like that office doesn't do free consults. Many orthodontists are putting kids in braces before all the permanent teeth are erupted. It depends on what the X-rays look like so, yes, X-rays are necessary. It's not shady to charge for your services but they need to let the patients know what the fees are.

I would call the office and let them know you are unhappy and thought the visit was covered. I would be concerned about the lack of communication.

 

[princess barbara]

Having gone through 2 kids with braces, I think it's extremely important for you to feel comfortable with whatever practice you choose as it will be a long road. There will probably be appointments for braces tightening etc. at least every 4-6 weeks for several years for your child. You will get to know the office staff as well as the orthodontist very well so it helps if your first impressions are listened to. We also got 3 different opinions and quotes and plans but what really helped was asking what doctor other parents I knew in town were using and what their experience had been like so far. Good luck

 

[NinaBella]

I'm double covered, Delta and Cigna Dental. At least with them, they will not tell me directly what they will pay. They WILL tell the Dentist either when the Dentist requests Prior Authorization, or when the Dentist submits a claim. When it is all done, I get an Explanation of Benefits. But they won't tell me if I ask.

Both Delta and Cigna list their percentages they pay on their website by plan. I have had both companies and researched both as far as having two insurance plans (one under me, one under my husband) and the way it would work is one company is primary, the other secondary. From there you should be able to figure out the approximate percentages they will pay. From what I understand how they determine which is primary and secondary an fall under several items, like who was older (me or DH), etc.


As far as the OP. I have a fabulous Ortho. But all ortho's I know give you a treatment and payment plan that lists out what the insurance pays and you would be responsible for. If you didn't get this, you should have a talk with your ortho. Also, all ortho's I know puts appliances in as a permanent fixture because the kids lose them or do not wear them as they are suppose to. Insurance companies I have had only pay for x-rays once every three years. So if your normal dentist has taken x-rays within three years, I wouldn't expect that they would pay for the ortho's x-ray.

 

[MommyMK]

Thanks all. The thing is in the past they did disclose the fees upfront - both at the consult, which they then waived and then again when we got the bite plate, they disclosed the fees and let us know what the insurance would cover vs what we would have to pay oop. After nearly two years of appointments every 4 months or so with no charge it simply didn't occur to me to ask if there was to be a charge for the latest appointment, I just thought it was part of the monitoring process. I'm also taken a little aback that the fees for this one appointment were almost as much as we paid for the original appliance and all the appointments that came with it. Yes we have dental insurance, and yes this doctor is in network. I also feel like if they are going to take x-rays that might not be covered because our dentist has recently taken some that they should have brought that up and perhaps given us the chance to produce x-rays from the dentist that would have given them the same information. Getting ready to call them in a bit and see what they have to say.

 

[Thing 1]

I think that your initial contact was your FREE consult. This appointment was reassessment for further treatment and was billed as such. I do think a better explanation would have been helpful. Our ortho was very good about laying out the cost factor completely the first contact and there was no questions left. Otho and dentist are filed differently on most policies and one will not effect the other. Most plans are going to cover 1/2 of all Ortho up to a set amount so you will most likely end up paying 1/2 of those cost.

 

[Anthony1971]

while it is nice when any doctor/dentist/ortho etc tells you the fees....
They are not obligated to. It is up to you to understand YOUR coverage first and if the person you are seeing is a preferred provider meaning there is an agreed price as to what you can be charged above what is paid. Non preferred meaning they can bill you for the full amount over what the insurance company pays. Out of network which can range from 0 coverage and up but usually you will pay the most. You then need to understand what your plan will cover... most will cover filling, cleaning, X ray's (maybe only once a year) etc.
NEVER assume a doctor will tell you what you will pay. You should call your insurance to find out preferred etc (and this changes form time to time so do not assume next year....) Then find out the coverage rates... then what the doctor will do... You can also ask the Doctor what your fees will be as well but expect to then make another appointment for later as they may or may not tell you on the spot... We all get burned at some point with this and it is a BIG pain in the .... but if you care about paying unexpected bills for a few hundred or a lot more you need to ask...both your insurance company and provider and on a regular basis....

 

[Melwhit16]

My DD11 is going through her second round of braces and we love our ortho. They provided us with a detailed quote, called our insurance company to see what was covered and have never slipped in any hidden costs.
If you are not comfortable with the way they are handling things go with your gut and get another opinion and see if you feel more comfortable with them.

 

[Sagginit]

its often the office and the people doing the billing that can be the problem. we had a great dentist and used him because he was so flawless in his work, but always had trouble with the girls at the front desk who did the billing. they did in fact forget to tell my mother once she needed a referral and when she wouldn't pay the bill they negotiated down but wouldn't waive the bill as they said she should have called her dental insurance directly to find out their procedure (fair enough in my opinion as the dentist is there to provide services, not an insurance consultation). i would say most people don't ask fees up front with doctors or dentists, so i don't think they are in the practice of disclosing their costs.

in this case i would think that they would be correct in billing as this is a consultation for braces, not a follow up to the bite plate as he stated she was done with that. if the agreement was all visits for the bite plate were free then i would think once you start the brace process they would charge you. a teeth cleaning at my dentist with xray (no prints all digital in their system) is $270 without insurance, with it they may bill more, so the fee seems about right.

 

[LilyWDW]

Reading as I have here, I would have expected the visit in question to NOT be covered under the original treatment. That treatment is done with (the plate). The consult you went to was for a different treatment (braces), thus not under the original contract.

 

[MommyMK]

Update - I called the office and before I could even say anything they told me to disregard the bill, that it shouldn't have been sent to me, but to my insurance company instead. So I guess I will have to wait and see what the insurance company says and then we'll go from there.

 

[danielw888]

Dont forget that most dental plans have a lifetime maximum for Ortho work. Typically this is only a few thousand dollars. So all these bills the ortho place is sending will typically lower the amount your insurance will end up paying when its time to get braces since you will hit the lifetime cap.

 

[disneymom0104]

I'm glad you figured it out. In my experience (4 years straight so far of ortho appts. with my older 2), they never charge for those 6 month "check and see how things are looking" appts. My 2nd child started going at 8 and went every 6 months (with x-rays) for 3 years until they determined she had lost enough baby teeth to get started. We never paid a penny until the braces went on. Our ped. dentist even uses the x-rays from the ortho (they just call over to get them) to save them from having to get double x-rays- and we don't have to pay for the ones at the ortho (which obviously comes later when you pay for the actual braces- I'm sure all of that is factored in). Paying for the bite plate makes sense, too. Glad you got it straightened out!