#Dentist#UnexpectedBill#InsuranceCoverage#MedicalBilling
Are you dealing with an unexpected bill from your dentist months after your procedure? It can be confusing and frustrating to receive a bill out of nowhere, especially when you thought you had already paid for the services rendered. In this article, we will explore why you may be charged an additional $1250, how insurance coverage factors into the equation, and what steps you can take to address this issue effectively.
Why Am I Being Charged $1250 9 Months Later?
It’s not uncommon for dental bills to come in months after a procedure, especially if there were complications or additional treatments required. Here are some reasons why you may be facing an unexpected bill:
1. Additional Procedures: Your dentist may have discovered additional issues during your initial visit that required further treatment, resulting in an additional charge.
2. Insurance Coverage: Your insurance provider may have initially covered only a portion of the costs, leaving you responsible for the remaining balance.
3. Billing Errors: It’s possible that there was a mistake in the billing process, leading to an incorrect charge being sent to you.
Understanding Insurance Coverage
When it comes to dental procedures, insurance coverage can vary significantly depending on your provider and plan. Here are some key points to consider regarding insurance coverage:
1. Coverage Limits: Dental insurance plans often have coverage limits for certain procedures, which means you may be responsible for any costs that exceed those limits.
2. Co-payments: Even if your insurance covers a portion of the costs, you may still be required to pay a co-payment for certain treatments.
3. Pre-authorization: Some procedures may require pre-authorization from your insurance provider before they will cover the costs. Failure to obtain pre-authorization could result in you being billed for the full amount.
Addressing the Unexpected Bill
If you find yourself facing a $1250 bill from your dentist 9 months later, here are some steps you can take to address the issue:
1. Review Your Billing Statement: Take a close look at the itemized bill to understand what services were provided and why you are being charged $1250.
2. Contact Your Dentist: Reach out to your dentist’s office to clarify the charges and inquire about any additional procedures that may have been performed.
3. Speak to Your Insurance Provider: Contact your insurance company to verify the coverage details for the procedure and to ensure that you were correctly billed.
4. Negotiate the Bill: Don’t be afraid to negotiate with your dentist’s office to see if they are willing to reduce the charges or set up a payment plan.
In Conclusion
Dealing with an unexpected bill from your dentist can be a stressful experience, but by understanding the reasons behind the charges, reviewing your insurance coverage, and taking proactive steps to address the issue, you can navigate the situation more effectively. Remember to communicate openly with your dentist and insurance provider to ensure that you are only responsible for the costs that are rightfully yours.
Call your insurance company, it’s possible that the paperwork was misfiled or the claim was denied. If the claim was denied you can appeal this and typically appeal the denial of the appeal, if appropriate.
Do they have a time limit to bill you? I would question the length of time between service and billing.
Ask for a detailed statement of your account. It should include the billing at the time of service and the amount you paid. Maybe your payment was misapplied or not recorded. Also, contact your insurer and get an explanation of benefits for the claims related to the work performed. Find the receipt and bank or credit card statement from when you paid the $990. You need all the facts if you are going to argue against the bill.
Get your eob from your dental insurance. They may have accepted your insurance but not been a participating provider. I learned that distinction years ago. It’s ridiculous but after the work is done, It’s nearly impossible to get out of paying. Make sure to deduct the $990 from the amount your insurance says is your debt from the procedure.
Get an itemized bill. Also, get your explanation of benefits from your insurance company. That will tell you how much you owe the dentist based on your insurance’s contract with the dentist. If all else fails, talk to your dentist about reducing the amount or a payment plan. Some places will write off big chunks of the debt if you pay in full or they might offer you to make payments with no interest for a while.
Contact your insurer and ask what was covered/not covered. Give them the full bill you received as you want to make sure all the work “claimed” was sent to them. Sidenote dealing right now with a dentist who told my spouse “insurance doesn’t cover much” only to speak with our insurance who told us everything was covered and we were not the responsible party as they were to accept the insurance payment as payment in full. Do your homework.
I find dental billing to be very opaque on the surface. I just received a bill this week for two years of copays for dependents. Yes, you’re on the hook for them.
Maybe they owe you some money back? I would call the insurance company to get details of their payment. They can tell you the check date and number and when it was cashed. If you paid $990 then you may have actually overpaid.
What does your insurance company say you owe?
Do not pay until you get the breakdown!
Also make sure what you paid previously is posted correctly and you have a receipt.
That’s the wild part about dentists, 98% of them are out of network or just not networked. Yes they can negotiate the price and have your insurance pay a portion but they can still bill the remainder. Looks like that’s what has happened to you. I’d get an itemized list with prices, but chances are you’re probably going to have to do a repayment plan if you can’t outright pay it off.
I’d call your insurance. I work in a dental clinic & I’m guessing your insurance ended up denying a claim for whatever reason.
Dental insurance sucks ass like that sometimes.
Always call and have the bill looked at by their billing department. And if it still doesn’t seem right to you, call the next day and have someone else look at the bill. I had a medical bill over $3000 that seemed wildly off. I called billing and the lady chalked it up as an “insurance premium”. I called back a month later, and a different lady looked at my bill and saw that my insurance’s payment was never applied to the bill. So I got the bill cut down significantly.
I’m a dentist. We work off insurance estimates before we do your procedure. It also depends if you were with an in network or out of network provider. If we waited for insurance to approve things before work… we’d be waiting months for each patient. Your dentist isn’t the criminal…. Dental insurance is the criminal nowadays. They also might have denied the claim, which happens frequently. Dealing with these thieves is terrible and they only have their own bottom lines in mind….. they really don’t care about you as a patient. Sad to say. Feel free to ask me anything else or to send me a picture of the statement.
I’d call and say that I have since fallen behind on bills, and can’t afford anything. They might offer a discount, or just waive it completely. They also might sell it to a collection agency… Which is someone you don’t have to deal with.
Insurance estimations are still just estimations, especially at the time which a procedure is done. A dental office typically does their best to give you a guess as to what the insurance company will cover based on your plan and the office will submit all the paperwork on your behalf along with documentation, but once the claim is filed, the insurance company may decide, when processing the claim, to cover less than what they usually pay for whatever reason. This can, and does happen a lot, even if the work is what most dentists will deem clinically necessary. Most of the time, if this much time has passed, the dental office will usually have already tried to file an appeal on the insurance claim, because chasing the patient down to get the rest of the bill isn’t fun for anyone. Following up with the patient is usually the last resort if the insurance company refuses to pay, and given the amount of overhead it takes to run an office/lab fees/time and effort to do the work, it’s also not financially feasible for the dentist to take the hit every time.
If you take anything away from this, I hope that it’s that the insurance company is not the dentist’s friend, and the insurance company is certainly also not your friend.
My advice is to contact the dentist’s office to clarify what’s happening and review your ledger with them. Usually someone working at the front desk is familiar with these kinds of cases and can explain what your options are and try to work with you. Also see if you can contact the insurance company yourself and appeal to the directly. Sometimes it may or may not work