Beat the quirks of dental billing to save hundreds
March 7, 2016
I hate the phone. I hate talking on the phone. I hate making calls. I hate waiting on hold, all of it. But darned if I won’t get over all of that in a right hurry to save myself $515.
Here’s what happened.
I had some fillings last December and the hygienist and receptionist encouraged me to get everything done in 2015 so everything would be covered by my annual deductible. I know, I know, the dentist in December, does anything scream poor planning! louder? When I have my act together, I visit the dentist in March and again in September for twice yearly cleanings and avoid all scheduling disasters to do with holidays, school being out, high season at work, all of it. 2015 was not the year of any part of my act being in the same vicinity as any other part of itself. Thus, I found my way to the dentist’s chair, garbling away, in December.
Post-filling comes the billing ordeal.
I’m not afraid of dental treatments but I sure do hate what comes after.
The secret I learned the hard way about dental insurance and billing waaay back in ought-2: Unless your insurance pre-approves all of your expected treatments, do not pay the estimated patient owes amount before your treatment is done.
Heck, don’t even pay it immediately after treatment if they haven’t already pre-billed the insurance or gotten pre-approval. They really want you to do. Every dental office here in California that’s taken our basic Delta Dental plan has patients sign a quote agreeing to pay anything the insurance doesn’t cover. If they can get you to pay the hundreds in advance, promising to reimburse you when the insurance comes back, then you’ve adhered to the letter of that agreement, but they will not adhere to the letter of theirs and you will be out of luck.
This is what I mean
Delta Dental (DD) has negotiated rates and set percentages that they’ll pay for every service. After a visit, Dental Office (DO) sends me a bill, and bills DD. The submitted claims are reviewed, DD determines both what they’ll pay and what I should pay, then mails me their statement.
My twice yearly exams are covered 100%. Patient pays column says $0.
My xrays are covered 100%. Patient pays column, again, says $0.
My filling on surface 30 was done in the last 2 years, so DD won’t pay them for that. Patient pays column says $0. DD’s notes say:
*You’ve already been paid once in the allowed 2 year timeframe for that, so we’re not paying again.
**DO may only bill what DD lists according to their pre-established agreement.
My fillings on surfaces 20, 22, 28 were approved and paid at 80%, leaving me with the other 20% to pay.
All told, DD said my bill was $95. Meanwhile, DO is over here sending me a bill asking for $610.
Now, according to my agreement with them, disregarding all else, I was responsible for $610 because DD didn’t cover it. However, because they accepted my insurance plan with the accompanying rate plan and rules, they are first subject to billing according to those rules. My plan specifically says they cannot charge me anything that DD doesn’t agree with, even if it’s something DD will not pay. If DD says they won’t pay it but I must, then DO may bill me.
Back when I was 20 years old and didn’t know about the DD to DO agreement, I thought I had to pay up in full so I did. My poor wallet. Much older, and a little wiser now, I know better.
Somewhat reluctantly, on the principle that this is the year 2016, should we not be able to handle all our bills online without having to talk to a person yet?? I called DO and asked to speak to someone about billing.
I politely suggested that we go over the discrepancies between the bill they sent and DD’s statement. Would you believe that before I could finish pointing out the problems, the office manager was striking out charges left and right? That’s right. She knew they were trying to get around their agreement with DD by billing me the full amount and was quick to rectify this, but only after being called out.
Line by line, we fixed all the “discrepancies”, and lo, my correct remaining balance was $95, NOT $610.
Protecting our cash: all part of a good day’s work.
Does your health or dental insurance work similarly or is this a quirk of California providers? Are your dentists reasonable and not scary? Do they recommend work too often? (PiC thinks my dentist always wants to be billing. He may be right.)
Late Note: This isn’t to demonize dental providers, mind you. The same one that got me to pay over hundreds that I shouldn’t have was also the one that cut their costs to only their own costs when they were aware that I had been laid off and was paying everything in cash. So they have their good and bad, in somewhat equal measure.
*Part of Financially Savvy Saturdays on brokeGIRLrich, Disease Called Debt and Dream Beyond Debt*
Wow interesting! I’m supposed to get a crown next week and a couple filings replaces so this is very timely advice for me and I need to look into this! Thanks!
Tonya@Budget and the Beach recently posted…Stop Settling for Just Feeling OK
It’s very much worth a call to your insurance provider to confirm it works the same way, if you don’t have DD!
Some dentists in our area take our insurance and the agreement but some aren’t in the network and will take what they pay and ask for more on top.
Nicoleandmaggie recently posted…How do you communicate with your spouse about money?
That’s very true, being in network is a huge thing.
Not sure how it works, since my last plan was a dental discount plan more than an actual insurance — though it was through my insurance. For whatever reason, the offices I went to never tried to charge me more than the stated amount on the insurance as far as I know.
I’m still trying to figure out what to do about dentistry on my new plan. Its dental plan isn’t worth the monthly premium I’d have to pay — around $40 and only about $1,000 payout. Then again, if it means discounted dental costs… My dentist’s office says online that it’ll work with people without insurance. Then again, if I need a root canal or something, I’m SOL. But I also wasn’t able to find a discount dental plan that included my dentist so… Gah.
Abigail @ipickuppennies recently posted…Get $3 and double cash back at Swagbucks!
Ooh I hate how confusing that gets! I wish a simple spreadsheet comparing costs would clear it up but they don’t really do that, do they?
Could you get a quote for most of the work you might have done? Maybe that’d help you figure whether the discount’s worth your time / money.
Yeah, I’ll call them and find out what my next appointment will entail: does a six-month checkup include a cleaning and x-rays? If so, what rate would I get without insurance? Even so, I’m beginning to doubt my switching to this new insurance. Then again, now that I have a night guard I’m a lot less at risk for cracking another tooth. Still…
Abigail @ipickuppennies recently posted…Get $3 and double cash back at Swagbucks!
Crossing my fingers for a good quote!
I had similar issues with dental, where almost all of my “totally covered cleanings” ended up with extra bills of about $30 per cleaning. I wasn’t smart enough to challenge it though. Good info!
Well, they also don’t make it seem like it’s possible to challenge it, which is why I didn’t back in the day.
I’ve never encountered this situation, but I always chose a dentist that is part of dental insurance network. My plan covers a check up and cleaning at least twice a year (it may be three times a year, but I only go every 6 months.) I seem to have inherited some awesome teeth genes because so far I haven’t had to get any fillings in my adult teeth. (And now I’ve probably doomed myself to suffering a cavity in the near future!)
The only time I had to deal with a dental-related expenses was a few years ago when I had some periodontal work done. The insurance company at first rejected the claim and said they required x-rays. Uh…x-rays for *soft tissue work*?! Are you freaking kidding me? X-rays only work on bone, not gums. The periodontist office manager seemed to be pretty used to this excuse and they pushed back and the claim was finally paid. Whew!
In talking with others, I understand this delaying tactic is pretty common with insurance carriers. I had some out of pocket costs on those treatments, but it wasn’t ridiculous, as I recall.
So far, all of my dental offices have been part of the network but we still have to do this little dance.
That’s an amazing track record, I hope you didn’t break your streak 🙂
Between the office and the insurance delays, it’s no wonder we get caught in the middle.
This is super interesting. I just got new dental insurance and have been trying to decipher the benefits; they’re honestly very confusing. I really appreciate this advice because I think it’s likely that I may have to deal with some “discrepancies” in the relatively near future (one of my fillings, done under the old insurance, is hurting me, and I’m not sure if the new insurance is going to want to pay for a visit that’s related to something that happened under the old insurance…we’ll see though).
Nice job using the phone! (I hate it too.)
Sarah Noelle @ The Yachtless recently posted…Full Circle
I hope this is helpful, let me know how it goes!
In my experience, they shouldn’t quibble over fixing up work that’s been done elsewhere, they should only be billing based on the work they do. Say, the other dentist did a filling and it’s now hurting you, there’s no call for them to not fix it or not cover it just because they didn’t do the work. That’s my understanding anyway!
Great advice! Dental care is the one area that I’ve often paid without thinking, or not gotten a second opinion and then really regretted it.
I did the same for a LOT of years!
We have DD. Baguette’s dentist doesn’t take it, but they will file for us. After the first visit, the dentist’s office sent us a bill for the remainder that seemed reasonable, so I paid it. Then DD paid, and the dentist’s office SENT THE CHECK BACK TO ME.
I’m still amazed. Good with my autistic child *and* honest? We’re keeping this dentist.
Then again, I didn’t pay the second bill, because I figured I’d wait to hear if there was a charge after DD paid up. Nothing yet, although we do have an intensive visit involving anesthesia coming up later this month. We already know the anesthesiologist is expensive, and that’s in addition to wherever the dental charges wind up.
Tragic Sandwich recently posted…Doing What Works, Because It Works
I am VERY impressed – either one of those qualities is hard to find, much less together.
Good luck with the upcoming appointment, I hope it goes well/
Well done (on the savings and the timing–I literally just dropped $130 at my teeth cleaning an hour ago.)!
Not that I can use it in NZ, but I didn’t know about this dentist-insurance agreement at all. Thanks for spreading the word.
Thanks! Is your routine cleaning covered by any insurance? I don’t know much about how these things are handled outside of the US. Mostly what I do know applies to rural Asia 🙂
No, as an NZ resident, I don’t have any dental insurance coverage (private or public). I was astounded to discover that private vision and dental insurance can be more expensive than the rest of medical insurance in NZ!
I choose not to buy private insurance. It’d cover the basic cleanings, etc., but is just as expensive as paying for a basic check up and cleaning once a year. I have really good teeth and take care of them, so it’s really not worth the cost. Just a basic exam and cleaning costs me $215 a year for an EXCELLENT dentist, still cheaper than the cheapest plan which doesn’t even cover much: http://www.scoop.co.nz/stories/GE1410/S00110/new-1-a-day-dental-care-plan-unique-to-new-zealand.htm
As a consequence of the cost, Kiwis have horrible dental hygiene–after the age of 18 (I think), you’re on your own so hardly anyone goes to the dentist after that age, until there is a major problem.
Dental accidents are 100% covered by the government accident insurance plan.
One thing that I was astonished to discover upon moving to NZ was that going to the dentist twice a year really isn’t necessary. I’ve found excellent dentists here, very trustworthy, and more than one of them have discouraged me from coming in for twice a year cleanings, as is the custom in the US. They have nothing to gain and everything to lose by telling me that, but I was still skeptical at first–after years of teenage orthodontry, I’m obsessed with my teeth! I have slowly converted to going only once a year. My appointment yesterday revealed that I have basically no build up on my teeth and have super healthy gums.
They reckon the US dentists and insurance companies are just greedy. If you have a healthy mouth and consistently take care of it, 1x/yr is enough!
Now, that’s really interesting. I wonder how much of the twice yearly cleanings are because of the money and how much is because of what American dentists believe is medically best.
I often find that medical and dental providers send bills for amounts they aren’t entitled to and I believe they hope patients will just pay and not question it. I always verify each bill to make sure it is correct,that the insurance requires that I pay it, and that I haven’t already paid the provider, for just this reason. Right now my wife is jumping through hoops because she needs a medical procedure done and we can’t find a simple answer to how much it will cost. The insurance says to call the provider, the provider says to call the insurer, and we have a bad feeling this is going to end up with a big bill for us. We’re grateful to have coverage, but it shouldn’t be this complicated.
Gary @ Super Saving Tips recently posted…Is Your Spending Out of Control? Compulsive Buying Disorder
I agree. I can kind of understand they want to recoup their costs, but not at our expense!
I wish you the best of luck with your wife’s procedure and the related costs.
I’ve never paid enough attention to the dental agreement. However, I have noticed that the DO often bill you before submitting the claim to insurance, which makes no sense. They purposely make it complicated and hope that most people don’t notice or don’t want to deal with it.
Your post reminds me that I just got a $200 bill for my son’s dental visit, saying we did not submit a referral. I’m sort of waiting for it to sort out because I know that we submitted a referral to the specialist before the visit. Most likely though, I’ll have to deal with this at one point. Sigh…
middle class revolution recently posted…I Lost My 2016 Resolutions
Right! Get the insurance to pay first, please.
Good luck with the billing mess, I hope they get themselves in order.
Yeeeeeesh. I am so overdue for the dentist – haven’t been since I had my wisdom teeth out 2 years ago. You gotta pay on the same day here so it’s a bit of an ouchie.
Oof, I think our cleanings and x-rays run over $100 for routine stuff. That’d be a punch in the arm, same day or not.
I used to have a terrific dentist, but he retired and the guy I went to last time I needed a cleaning definitely felt like he was telling me I needed more dental work than I did and spent a long time trying to get me to buy some really expensive toothpaste. I’m probably going to go somewhere else next time.
Mel @ brokeGIRLrich recently posted…Financially Savvy Saturdays #133