My dad had a root canal done recently. I sent him to an endodontic specialty office. They charged him $400 after the procedure and said they would file with the insurance company, and if the insurance company doesn't pay what is expected they will then charge the rest. If they pay more, they send a refund.
Few other things - price can vary based on which tooth it is. Root canals on back teeth sometimes cost more than ones on the front. Maybe this is where the discrepancy is? Also the office might be billing for a consultation which may not be covered by your insurance based on the limitations of your insurance. Like they only cover 2 exams or consults per year and you have already used them all up.
ETA - some offices ask for deposits for longer procedures like root canals.
Or it could just be a shady office.
I guess the part that is throwing me is that the insurance said my portion is $180, and even when I asked about a discrepancy in charges, they said there should be no instance where I pay over the $180 unless they are charging for the crown as well.
I just had a crown done, and the admin at the office went over the financial numbers with me before the dentist started the procedure. She had the costs printed out on paper, and had me sign at the bottom of the page. I paid after the dentist did the majority of the work.
TL;DR - I vote it's odd you got a verbal estimate with a request for prepayment before the procedure.
This is how all of my other dental procedures were done, but it's been a couple years.
Post by Stingyshark on Dec 19, 2014 7:28:04 GMT -5
I didn't read all the responses, so I apologize if this has all been covered.
Every insurance company you ever call will say something like..... "this is not a guarantee of payment and it's an estimate of benefits.. blah blah blah.. we don't know how much we will pay until we get the exact claim."
Like they told you, they are covering their ass in case your insurance doesn't pay. Which, from a billing standpoint I can see.. but, from a patients stand point, that's not your problem.
Unless they bill the exact amount that is allowed within their contract from your insurance they can't expect to get paid "the total amount requested." If that was the case then we'd be making a helluva a lot more money than we are.
So, they do, in fact know how much they are going to get paid. They should be able to call the insurance and find out the allowed amount for a specific code. (i don't know dental billing, but this is how it works for regular medical billing).
You can call your insurance again and let them know what the dental practice is requesting - they may be willing to 3 way call w/ the practice and let them know what your benefits are for the exact codes. Although in some instances they may not know the exact codes bc who knows what the Dr. will find once he's in there. There could be a variety of codes based on the severity of whatever he finds. (maybe.) (Again, i do medical billing, not dental).
I guess this is the way medical practices are going now (except me, i'm still laaa laaa laaa, pay me later). I had a patient call yesterday upset that she was asked to pay $600 over the phone for a CT scan that she isn't scheduled to have until Monday.
Also. You should be able to pull up your EOBs from your dental insurance website.
I didn't read all the responses, so I apologize if this has all been covered.
Every insurance company you ever call will say something like..... "this is not a guarantee of payment and it's an estimate of benefits.. blah blah blah.. we don't know how much we will pay until we get the exact claim."
Like they told you, they are covering their ass in case your insurance doesn't pay. Which, from a billing standpoint I can see.. but, from a patients stand point, that's not your problem.
Unless they bill the exact amount that is allowed within their contract from your insurance they can't expect to get paid "the total amount requested." If that was the case then we'd be making a helluva a lot more money than we are.
So, they do, in fact know how much they are going to get paid. They should be able to call the insurance and find out the allowed amount for a specific code. (i don't know dental billing, but this is how it works for regular medical billing).
You can call your insurance again and let them know what the dental practice is requesting - they may be willing to 3 way call w/ the practice and let them know what your benefits are for the exact codes. Although in some instances they may not know the exact codes bc who knows what the Dr. will find once he's in there. There could be a variety of codes based on the severity of whatever he finds. (maybe.) (Again, i do medical billing, not dental).
I guess this is the way medical practices are going now (except me, i'm still laaa laaa laaa, pay me later). I had a patient call yesterday upset that she was asked to pay $600 over the phone for a CT scan that she isn't scheduled to have until Monday.
Also. You should be able to pull up your EOBs from your dental insurance website.
Thanks, this is helpful. I can't imagine that medical billing is all that different.
I may try this, although I'm sort of turned off at the whole practice, because the receptionist was very unpleasant when I called back to get some clarification.
I didn't read all the responses, so I apologize if this has all been covered.
Every insurance company you ever call will say something like..... "this is not a guarantee of payment and it's an estimate of benefits.. blah blah blah.. we don't know how much we will pay until we get the exact claim."
Like they told you, they are covering their ass in case your insurance doesn't pay. Which, from a billing standpoint I can see.. but, from a patients stand point, that's not your problem.
Unless they bill the exact amount that is allowed within their contract from your insurance they can't expect to get paid "the total amount requested." If that was the case then we'd be making a helluva a lot more money than we are.
So, they do, in fact know how much they are going to get paid. They should be able to call the insurance and find out the allowed amount for a specific code. (i don't know dental billing, but this is how it works for regular medical billing).
You can call your insurance again and let them know what the dental practice is requesting - they may be willing to 3 way call w/ the practice and let them know what your benefits are for the exact codes. Although in some instances they may not know the exact codes bc who knows what the Dr. will find once he's in there. There could be a variety of codes based on the severity of whatever he finds. (maybe.) (Again, i do medical billing, not dental).
I guess this is the way medical practices are going now (except me, i'm still laaa laaa laaa, pay me later). I had a patient call yesterday upset that she was asked to pay $600 over the phone for a CT scan that she isn't scheduled to have until Monday.
Also. You should be able to pull up your EOBs from your dental insurance website.
Thanks, this is helpful. I can't imagine that medical billing is all that different.
I may try this, although I'm sort of turned off at the whole practice, because the receptionist was very unpleasant when I called back to get some clarification.
Not exactly the same, but this happened with our insurance when LO had tubes put in her ear. They said we had to pay $480, but we thought it should have only been around $250. We ended up getting $ back, but not $200 worth, we had like 17 copays to pay - the anesthesiologist, doctor, and then extra stuff we were required to pay out of pocket. And they refunded us some $ and then sent a bill for something else, it was really annoying.
I guess the part that is throwing me is that the insurance said my portion is $180, and even when I asked about a discrepancy in charges, they said there should be no instance where I pay over the $180 unless they are charging for the crown as well.
I was suggesting that maybe the discrepancy is because you are having a root canal on a back tooth which is usually more expensive, while the insurance company is telling you the out of pocket for a root canal on a front tooth?
What stingy posted is usually true except this - offices don't know exactly how much they will get paid. Dental insurance companies won't always say this over the phone, especially if the office is out of network. Even if the office is in-network, some won't provide a fee schedule, Delta Dental is notorious for this. They just won't tell the office anything and will say "submit the claim and see what happens." So the office has no way to tell you exactly what your copay is and generally overestimates and provides refunds.
I experienced this yesterday. Called an insurance company to find out out-of-network coverage for some codes and the woman was all "80% of reasonable and customary" but when I asked what is "reasonable and customary" they won't say. Or they will tell you coverage for one thing over the phone, but when the claim is actually processed, they will downgrade it and pay lesser than expected.
I guess the part that is throwing me is that the insurance said my portion is $180, and even when I asked about a discrepancy in charges, they said there should be no instance where I pay over the $180 unless they are charging for the crown as well.
I was suggesting that maybe the discrepancy is because you are having a root canal on a back tooth which is usually more expensive, while the insurance company is telling you the out of pocket for a root canal on a front tooth?
What stingy posted is usually true except this - offices don't know exactly how much they will get paid. Dental insurance companies won't always say this over the phone, especially if the office is out of network. Even if the office is in-network, some won't provide a fee schedule, Delta Dental is notorious for this. They just won't tell the office anything and will say "submit the claim and see what happens." So the office has no way to tell you exactly what your copay is and generally overestimates and provides refunds.
I experienced this yesterday. Called an insurance company to find out out-of-network coverage for some codes and the woman was all "80% of reasonable and customary" but when I asked what is "reasonable and customary" they won't say. Or they will tell you coverage for one thing over the phone, but when the claim is actually processed, they will downgrade it and pay lesser than expected.
True; Some insurance will not provide fee schedules, which is just assinine. A lot of our fee schedules are 80% of the 1999 Medicare fee schedule.. LOLZ .. right. But some insurances do provide fee schedules, and/or someone in the office has made one based on how claims have paid in the past (this requires a lot of work).
This sends me into a rage when I get told this.. Before we were credentialed w/ all the insurances this was the standard response.. The fuck am I supposed to do with that information? and when you ask what that means..... oh brother. It's an average of what they pay similar providers in the area for the same and/or similar services.. Oh, well that's helpful.
Post by Stingyshark on Dec 19, 2014 9:47:13 GMT -5
Also, if it's truly a "co-pay" then that's all you should be responsible for. That is a weird number, but whatever. If it's "co-insurance" then they really can't collect anything until the claim is processed, especially since they are saying they don't know how much the insurance is going to reimburse.
My endodontist also charged me $400 for a root canal, but my insurance company paid the claim, and the office did send me a check back (onjly after I looked into it and called them though).
Then, I needed to have that same tooth pulled because the crown fell out and my dentist said the tooth couldn't be saved, so I went to an oral surgeon. My husband had just been to the same oral surgeon like 2 months before for a molar pulling as well. Their office tried to tell me the same thing (they weren't sure how much my insurance would pay), and when I pointed out that (1) they only only charged my husband $50 when they were trying to charge me $300 for the same thing and (2) our insurance company paid with no problem, they begrudgingly only made me pay the $50. Shady fucks. All of them.
Now we have different dental insurance where we get the checks directly, which I thought was going to be a pain in the ass, but hasn't been because of this issue.
True; Some insurance will not provide fee schedules, which is just assinine. A lot of our fee schedules are 80% of the 1999 Medicare fee schedule.. LOLZ .. right. But some insurances do provide fee schedules, and/or someone in the office has made one based on how claims have paid in the past (this requires a lot of work).
This sends me into a blind freaking rage when I get told this.. Before we were credentialed w/ all the insurances this was the standard response.. The fuck am I supposed to do with that information? and when you ask what that means..... oh brother. It's an average of what they pay similar providers in the area for the same and/or similar services.. Oh, well that's helpful.
I am keeping detailed track of how claims are being paid to have more info to be able to help our patients as much as possible. But it takes time, and as a new office we don't have years of claim history to go by.
The frustrating part (happened yesterday) is having the parent question me when I actually do know the answers. Somehow I am the one trying to rip them off, the tiny office that needs a new paint job. The insurance company with its name plastered across the freakin' Superbowl football stadium down the street has to be the honest one. Because generously paying claims is how you collect money to sponsor football stadiums. No.
This doesn't provide any excuse for shady offices which unfortunately, there are those out there too.
True; Some insurance will not provide fee schedules, which is just assinine. A lot of our fee schedules are 80% of the 1999 Medicare fee schedule.. LOLZ .. right. But some insurances do provide fee schedules, and/or someone in the office has made one based on how claims have paid in the past (this requires a lot of work).
This sends me into a blind freaking rage when I get told this.. Before we were credentialed w/ all the insurances this was the standard response.. The fuck am I supposed to do with that information? and when you ask what that means..... oh brother. It's an average of what they pay similar providers in the area for the same and/or similar services.. Oh, well that's helpful.
I am keeping detailed track of how claims are being paid to have more info to be able to help our patients as much as possible. But it takes time, and as a new office we don't have years of claim history to go by.
The frustrating part (happened yesterday) is having the parent question me when I actually do know the answers. Somehow I am the one trying to rip them off, the tiny office that needs a new paint job. The insurance company with its name plastered across the freakin' Superbowl football stadium down the street has to be the honest one. Because honesty is how you collect money to sponsor football stadiums.
This doesn't provide any excuse for shady offices which unfortunately, there are those out there too.
Sorry to hijack your thread, Mel.
I have attempted to keep track, but it's impossible. BCBS for example, has at least 5 different options.. and they all pay differently. It's absurd.
Paying before the treatment the DAY OF the treatment isn't odd. But prior to that is!
Also not odd that they don't want to wait for the insurance reimbursement first before seeing what you owe. Your payment is their paycheck. How long do you want to wait for YOUR paycheck?
Paying before the treatment the DAY OF the treatment isn't odd. But prior to that is!
Also not odd that they don't want to wait for the insurance reimbursement first before seeing what you owe. Your payment is their paycheck. How long do you want to wait for YOUR paycheck?