#DentalInsurance #UnexpectedBill #Responsibility
Hey there! It can definitely be frustrating to receive a bill unexpectedly, especially when you no longer have insurance. While it can feel unfair, there may still be some options available to you.
It’s worth reaching out to your dentist’s office to see if they offer any kind of payment plan or discount for patients in your situation. You can also inquire if they are willing to work with you to come up with a manageable payment arrangement. 🦷💸
In the future, it’s always a good idea to double-check with your healthcare providers about any potential billing issues after your insurance coverage ends, just to avoid any surprises down the line. And if you’re still unsure about your rights and responsibilities in this situation, it may be helpful to consult with a healthcare billing advocate or legal professional for further guidance.
I hope this helps, and best of luck sorting out this unexpected situation!
You need to find out why insurance didn’t cover it. It doesn’t matter that you left your job and your insurance is no longer valid now. What matters is that you had that coverage at the time of service.
It goes by date of service. Not the date of bill.
Claims like this are processed based on the date of service and since that date was before you left your job, insurance was still valid at the time.
Now, that being said, it’s possible your dentist didn’t submit the claim in a timely manner or may have used the wrong date of service. The dentist needs to follow up with the insurance company clarifying that this was for service 5 months ago when the policy was still active.
You should first log into your old insurance portal that was active at the time and view your EOB.
If you dont have an EOB, then the dentist messed up by not submitting it. If you do have an EOB, then itll tell you why the claim was denied.
Dental insurance is known to not cover very much and we don’t know any details of of your insurance or the procedure, especially more expensive procedures.
Just call the insurance company/dentist and see if you can figure out why it was denied. But yes, more than likely you’ll be on the hook for the remaining bill. You can not pay, but they’ll just sell it to a collections agency and it will go on your credit report like most other unpaid medical debt.
If your insurance didn’t pay for it and you’re not covered, then yes indeed you’d owe them. It’s like leaving the office and saying daddys got it, but daddy wasn’t there, so you still left without paying.
Date of service yes, but they still only have a set number of days to submit claim otherwise the dental firm is on the hook
Some insurance is claims made, some occurring. You need to speak to the insurer
What kind of service did you receive?
Either, the office or insurer errored and used the wrong service date -> easy fix
Or the services you received are not covered by your insurance. Then yes, you have to pay. Even with the above option, you’d have to pay, but it’s likely to be corrected.
You should have received an EOB (or similar? Not sure if it’s the same with Dental.) This comes from your insurance and will say why the claim was denied/not covered.
Here’s a life lesson that I wish employers and insurers did a better job educating people on.
You are ALWAYS responsible for the services you receive. ALWAYS. Every place you go to will have you sign a form that says this. The wording varies, “we will bill your insurance as a courtesy,” but you are still responsible.
There will be times that you are not charged an amount you see on the EOB by the provider (in-network, ACA-required preventative services, etc.). But this is not the same as “not being responsible.”
Outside of errors and shady providers, you’re responsible for the bill, even if you disagree or were misinformed.
I wouldn’t blindly pay it. You can always appeal, ask for financial relief, etc, etc, but, the bill is yours.
It gets billed to the insurance you had at the time.
Email them back along the lines if “hello, what was the denial reason from the insurance company? I had valid insurance at the time of service. Is there a reference number associated with the claim sent to insurance?”
Once you have a reference/claim number you should be able to call the insurance provider and get a straight answer.
You are covered for Date of service until the insurance has cancelled. It sounds like they might have billed insurance too late per the contract. I would demand to see the denial. You also can call your old insurance provider and ask them for the EOB.
If you had a contract with an insurance provider and they had/have a contract with the insurance company. Then they must accept what the contract specifies. But still contact the insurance company. They should be able to handle it.
I managed a dental office for years.
The dentist has 12 months to bill your policy.
Doesn’t matter if your policy is now canceled. If the policy was active during the date of your service, it can be billed.
*Most likely what happened*
Your claim may have denied for “frequency”. If this is a new dental office and they did a comprehensive exam – and you have already had a comprehensive exam in the last year – the claim is denied even though you had coverage.
The same for if they took a complete set of x-rays- not just the check up x-rays. You can only get a full set every 5 years. If they said something to you while you were in the chair like “The doctor wants to take a few more x-rays than we planned” and you say yes, they took more than check up x-rays so your claim was denied.
Yeah I was going to say insurance covers you for the period in which you were covered. So if the services were done in that period of time they would be covered. There has to be another reason why it can’t be because two or three months later you lost the insurance. I mean I totaled a car in 2019 and in 2022 I got a notification that the state where I had wrecked finally calculated the damage and they sent me a letter saying I owed them about $10,000. I called the insurance company who I had not been with for several years and I told them I got this. In regards to that incident in 2019, I believe you need to take care of it. They said send it over and the matter was settled. I know that’s car insurance but wanted to give you my reasoning is to why I think it’s very similar. It’s covered liability
My last dentist had a computer problem and lost my x-rays. I then got an EOB that denied a payment because they didn’t provide the x-rays. The dental clinic tried to bill me for 6 months. I told them I wasn’t paying for their computer problem. They literally told me they had lost my x-rays. They then tried to rip me off by saying I had “active decay” and needed all new fillings. I called bullshit and got a second opinion. No decay, fillings are fine. Fuck corporate dentist offices. If the office doesn’t have the dentist’s name in the title, skip it. And fuck the insurance companies that try to push you to these fucking asshole Corporate dental clinics. I went thru 4 dentists in the 3 years I went there.
I’d call the doctor first and ask why they didn’t bill the insurance, date of service was still under coverage, so perhaps they just need to resubmit the claim. Or maybe whatever treatment you got is not covered or it’s the difference you are liable for. Either way start with their billing person before you go to insurance.
I just went through my dentist submitting two years worth of charges because they were coming back and they just billed me instead. I had to keep hounding not the insurance and the dentist about billing in a timely manner and not charging my HSA.
Look at your insurance contract, usually there will be a clause stating that you have x days beyond contract termination to submit outstanding claims, beyond that time period they will not reimburse even if the expense occurred while covered. Why did they not submit the claim at the time you got the service?
>they tried to charge my insurance and that the claim was denied.
Was the coverage product in effect at the time the billing events occurred?
>I left my job 2 months ago and my insurance ended then
Has the “timely filing limit” the insurance seller determines, sets, and enforces been exceeded for these billing events?
If the answer to both is no, the insurance seller is down 2 excuses for not reimbursing what it was always going to reimburse this vendor.
Ask the payer why it didn’t pay the vendor.
Do be aware that you are the payer in payer pole position #1 and irrespective of any amount(s) paid and/or payable by any other payer(s). It says so on the “financial responsibility” agreement you agreed to before any chargeable service was delivered.
If the vendor has tried to bill the 3rd party payer and failed, billed the 3rd party payer and been denied some, any, or all of the reimbursement it’s due, received reimbursement from the payer only to have it snatched back because reasons, the vendor is coming to you for payment.
Maybe you had limitations on your insurance coverage. Dental insurance is different than medical, it’s broken down into codes and frequencies. Each procedure has a code. For example, your plan could have either not covered what they billed for, or another claim went through at the same time as theirs, or you just used up your frequency (i.e.: 1 per 12 months, and you used 1 already). If that makes any sense? Or you could have been covered at not 100%, so you’re responsible for the remaining %, if your insurance covered 40% or something. Hope that makes sense. But if you had coverage for the procedure and your insurance was active at the time of service, maybe they denied if they need explanation from dentist. Did you get an EOB (explanation of benefits) in the mail?
If the dentist office billed the insurance too late and the claim was denied for timely filing, it is 110% NOT ur responsibility! The office eats it up. If the claim was denied for something else then I would get more info and confirm with your insurance if the balance is patient responsibility or not.
It should be billed or submitted with a DOS. The plan will still cover it as long as the plan covered the procedure. It’s likely a clerical error at this point.
If you had insurance on the date of service, it should be paid as long as it was a covered benefit.
If you has insurance at the time of the appointment then the insurance is still responsible for it. It’s not your fault your dentist bills too slow.
Insurance coverage is active for all valid claims that occurred during the coverage period. It is not the date you are billed but the date you incurred the charges. If that was five months ago and you terminated insurance 2 months ago, you were “covered” the day of the incident. Now you need to figure out why you were denied.
If you were covered during the date of service insurance should pay for it. You’ll have to call them.