I asked a dental question a while back. It was my first time at that office, and the first time using my new dental insurace too.
The receptionist told me the insurance required a specific order to the way I was seen... they wouldn't let me do all things in one day, so I had to do them in 2 appointments (x-ray, check-up, cleaning, then cavity filling.)... even though I really tried to work with them to get them done all on the same day b/c I was afraid of insurance billing things incorrectly, and for conveinance too, but the dental office reassured me that all the scheduling was done per the insurnce's requirements and I had nothing to worry about.
Well, the receptionist screwed up my appointments and scheduled cleaning for my second apointment. It turns out, that now my insurance is denying coverage for xrays done at my first appointment, because they require the cleaning to be done first.
So, on top of the money I already paid (the $100 deductible, plus about $75 for services)... they are now asking for $95 for the x-rays... that they promised me wouldn't cost me anything out of pocket, but aren't now b/c insurance wouldn't cover it.
This really sucks, we are financially having a very hard time. I know $95 doesn't seem like a lot, but I already have about $2000 in auto repair and medical bills I am behind on that is really diffucult for us to pay.
Should I call the insurance company about this and state it was the office's fault for a scheduling error, and ask for it to be waived.. should I call the office about this and complain it shouldn't all fall on my shoulders due to their error? Should I suck it up and is it my fault for not following up better on the scheduling? The awkward thing, is the dentist is someone we know personally and we really like, and we have a lot of common friends and see them frequently, but we aren't *close* enough to talk business/money/finances with him either, so I'm really just going to avoid that. So would complaining to the office make it really, horribly awkward?
I would talk to the office manager. They made the mistake, they should eat the cost of their issue. They should also have an in-service for that staff person for messing up.
I agree with Cheryl O.
I would talk with the billing person and explain the situation. I've NEVER had xrays done without a cleaning being done the same day. I don't understand why they'd even do that to you.
I believe it's "normal" to have a routine check up that includes a cleaning, (optional - 1x per year) xrays, and complete dental exam.
Now, being told you need to come back to have a filling taken care of, I do understand. They don't usually do the fillings at the same appointment.
So I would definitely take this issue up with the dental office. It's THEIR mistake to fix.
call the dentist's office and speak to the billing manager.
Tell her what you have told us and make them fix it. The problem is at their end and they need to fix it.
Your dentist is a friend - well - he operates a business and at this point you don't need to talk to HIM about it - you need to talk to his billing manager. If she/he doesn't get fixed - then you talk to him at his office - not at home about this business issue.
I am not saying this because there is no way I would know *coughIworkbythepeoplethatdocough* but I have "heard" that they can change up the service codes and resubmit the claim so that neither you are the dental office are out the money. I haven't "heard" of changing the actual dates so this may not help you.
But you didn't hear that from me.....
I would find out how to argue the claim. Sometimes they will give you a pass if you explain (in writing) that you did what you were told to do and that's why it was done the way it was. I would also talk to the dentist and tell him/her that you cannot pay the $95 at this time, you are asking the ins. to re-evaluate the claim (which could take 30 days) and that you are in this position because you were misinformed by his staff. I wouldn't get into tons of your personal business. Just keep it "I am not in a position to cut you a $95 dollar check. I'm working with the ins. What kind of payment plan can we work out if they deny it again?"
You need to see this as business. If the common friends thing gets in the way or this goes badly on a personal level, I'd get a new dentist.
Edit: The billing manager is probably a better place to start, but it depends on the practice how that's run.
I'm an insurance agent and don't believe insurance either pays or doesn't depending on what ORDER you do things. They pay if its covered, or don't pay if it isn't. So if they pay for xrays, and you had xrays, then it would be covered. It wouldn't matter at what appointment you had them done or if they were done before or after a cleaning, it would only matter that you actually HAD them done...if that makes sense. I think your dentist office is a little confused and they need a new billing person. Call your insurance company and get it cleared up. Good luck.
Have not read the other posts but I would call the dentist office and explain the issue and tell them they need to resubmit the claim in the proper order.
Call the office. Talk to the office/billing manager. Tell them the office scheduled your appointment wrong and your insurance is rejecting the billings and ask what they can do to help. I think they can correct it internally.
Get the billing manager to help you, the insurance can't change anything. Ultimately though, patients are supposed to know how their insurance works, rather than relying on someone to know how every different dental plan works for hundreds of different patients. Hope they can fix it for you, they should!!
Is the dentist in the network of the insurance company? If so they may have a contract requiring things be done a certain way. BUT - it also protects you in that the dentist is required to follow the contractual agreement and if they don't they cannot charge you for their error (this applies only when they're in network).
I would call the insurance company and ask for their explanation. I've worked in employee benefits - including dental for more than 30 years now and I've never heard of this specifically. What the dentist office is not saying is that they get paid more when they do things at separate visits. See the process of having clean sterile equipement, the process of getting you in and out of the chair, the office staff's time, etc is all taken into account when reimbursement is determined for proceudres performed at any medical or dental provider. If you've already been cleared through the office staff, got your little clipped on bib, water cup, sterile tray of equipment then additional procedures done while you're in that chair are "discounted" since they don't need another sterile tray of equipment, you don't need to go through reception again, etc. If the charge for a filling is $100 - but they're performing it while you're already in the chair for a different procedure such as cleaning - then the filling might be considered at $75 instead of $100.
There are standard codes and practices that are applied to all medical & dental reimbursements. Every time the insurance companies make a new procedure, the providers attempt to work around it to maximize their income. Neither party is bad - they're just working around what they are given.
Further - most dentist want to minimize your time spent in the chair at any one sitting. People are known to become restless and you'll have a better experience if you're in the chair for 20 minutes as compared to 60 minutes. But, as a busy mom I'm sure you'd rather jsut get it all over in whatever time it will take even if it's 2 hours!
In any event - talk to the insurance compnay. Find out what the real story is and then don't be afraid to negotiate with the dentist. Others do so you might as well.
