Paying above and beyond dental insurance coverage

[TTQ B4U]

Question / Opinions from you wanted.

 

Family and I haven't had too much in the way of dental needs outside basic cleanings and the typical stuff where the Usual and Customary Fees are covered at 100%. However, the last time I went to the dentist he suggested I get fitted with a bite guard for when I sleep as it appears I am beginning to grind my teeth. I get that.

 

I get the EOB form and it shows for two simple mouth guards, he's being reimbursed $595 AND I'm expected to pay an additional $140 out of pocket as the insurance doesn't cover more than $595. This is not the deductible mind you, it's overage charges. I'm like WTF!

 

Needless to say, I feel I'm justified in being upset as I'm not about to pay $140 out of pocket. I've used the typical $20 heat and press ones from Kroger's before and they work just fine. My beef isn't about him making $595 either....it's in addition him charging me $140 out of pocket.

 

I work for an insurance co. and we call on eye care docs and they always outline what is not covered and will be additional to their patients. Even my MD will tell me if a procedure or appliance is going to cost me out of pocket. In this case, I love the dentist, he's cool and does good work, but no one ever even mentioned what the costs would be or that it would cost me out of pocket. Like every other visit and procedure, I went in believing it's covered under my plan in full. Some may say I should have asked, but I don't think so. I don't expect to have to asked on every single item. Even a server at AppleBee's will tell you upfront to substitute a salad for veggies is an additional $1.25. They know what is and isn't covered on insurance plans as they see thousands of patients and work with insurance co's daily. I do not.

 

I would never bill my photography clients for something unless I covered the fees with them. My wife as an attorney has a fee agreement and covers any additional fees. Even an airline gets your approval before they up-charge you on a seat. I honestly don't expect to have to ask nor do I expect to accept my dentist spending my money or suggesting something without covering all the details on how it will impact me. I also don't expect to just receive a bill telling me such either. How about a little common courtesy Mr. Dentist ?

 

/Rant.

 

What are your thoughts?

[Gergwheel1647545492]

you should have asked... and they should have told you without asking. Both parties are at fault i would say.

[nurkvinny]

Last year, during my second cleaning for the year, they told me I was due for x-rays. I said, "ok".

 

Found out later they took x-rays my first cleaning as well, and my insurance only covers one set of x-rays per year. I got a bill for the whole amount. We complained that we were never told and the dentist ate the cost.

[Furloaf]

That's an issue with your insurance, not your dentist, and I think more of your responsibility to be informed about than it is theirs.

[lawnman]

First thing I say when the dentist wants to do something besides a routine cleaning is . does my insurance cover this ??

I had a similiar experience to yours , and that is why I ask first.

[Mensan]

That's an issue with your insurance, not your dentist, and I think more of your responsibility to be informed about than it is theirs.

 

I don't agree. The dentist is familiar with the cost of fitment, and he should know that at almost $750, the cost will most likely not be covered at 100%.

 

Dentists also charge as much as possible for cleanings since they are reimbursed a high amount for those. He can eat some of this cost.

[iwashmycar]

I had the exact same experience. Not certain if it varies at different dentists, but I think I am going to try another one. I even have to pay some every time I get a cleaning. My insurance isnt THAT shitty.

 

Im referring to Martello in Picktown

 

Im probably due for another guard thing soon too. Hope I can get one per year from insurance, but ill have to check. Apparently I grind the shit out of them lol

[wnaplay1647545503]

I feel ya man. I am having similar issues with my attorney. The amount he is asking for is rediculous.

[Furloaf]

I don't agree. The dentist is familiar with the cost of fitment, and he should know that at almost $750, the cost will most likely not be covered at 100%.

 

Dentists also charge as much as possible for cleanings since they are reimbursed a high amount for those. He can eat some of this cost.

 

He stated it was an overage charge. Which means that he has reached the allotted amount provided by his insurance plan for this year. It is not the dentist's responsibility to keep track of how much their 100-1000s of patient's have spent in a year and also keep track of each of their separate insurance policies.

[TTQ B4U]

you should have asked... and they should have told you without asking. Both parties are at fault i would say.

 

I sorta see what you're saying about me asking. However, no one goes to the dentist with insurance and an open check book. It's 100% common practice that the basics are covered at 100%. I mean I knew going in that the enamel work was covered at 80%. So he bills say $100, insurance covers up to $100 and then pays $80 and I pay $20.

 

For my night guards they cover 100% up to $595. However, come Tuesday when I go see him, he's either going to have to reduce the bill by the $140 additional he wants or he's going to wear the bite guards as I'm not taking them nor paying for them.

 

One thing I do not expect is for my dentist to go spending my money without informing me of the difference. When I go in for an oil change which checks all filters, etc. even they ask if I would like to pay the additional $$$ for a new one. They never just say hey, we're going to replace your air filter and then do it. They always tell me up front what it's going to cost.

 

Again, none of my Eye Care Professionals/Customers do this with their patients. If you want Anti Reflective Coatings on your lenses, they always inform patients that category A&B are covered but C&D are an additional co-pay amount.

 

Thanks for the opinions.

[ImUrOBGYN]

I'm always very upfront about cost and what I specifically will be paying. Too often something like this happens or there's some kinda misunderstanding that leads to me bitching until it's fixed.

[Danielle]

My TMJ specialist fitted me for a night gard, and charged me $1300 for it, knowing I don't have dental insurance, and my medical doesn't pay shit when I go to him. People suck, insurance companies suck..

[ImUrOBGYN]

Wow, some of you have some greedy ass, overcharging dentist. I will tell you that most people don't think to "shop around" for their dentist but that's just what I did this last time I decided on a dentist. Holy shit, let me tell you there is a HUGE price range on same services between practices. I shopped around and also let the dentist know I was shopping around and that I had 0 insurance. Some places were as much as 3x+ for the same thing at another dentist. I mean 1000's in difference at times.

Anyway, I've found a dentist here in Delaware who's very affordable, very likable, and good at his job. Constant discounts and is always very upfront about prices, etc. He was also cheaper for what I needed done by thousands. Oh, stay the fuck away from the inside Sears dentist place... I forget offhand but I always see the commercial. If you do go anyway, bring your KY. They're so full of shit, it will be you getting fucked in the ass, not them.

[mrblunt]

I sorta see what you're saying about me asking. However, no one goes to the dentist with insurance and an open check book. It's 100% common practice that the basics are covered at 100%. I mean I knew going in that the enamel work was covered at 80%. So he bills say $100, insurance covers up to $100 and then pays $80 and I pay $20.

 

For my night guards they cover 100% up to $595. However, come Tuesday when I go see him, he's either going to have to reduce the bill by the $140 additional he wants or he's going to wear the bite guards as I'm not taking them nor paying for them.

 

One thing I do not expect is for my dentist to go spending my money without informing me of the difference. When I go in for an oil change which checks all filters, etc. even they ask if I would like to pay the additional $$$ for a new one. They never just say hey, we're going to replace your air filter and then do it. They always tell me up front what it's going to cost.

 

Again, none of my Eye Care Professionals/Customers do this with their patients. If you want Anti Reflective Coatings on your lenses, they always inform patients that category A&B are covered but C&D are an additional co-pay amount.

 

Thanks for the opinions.

 

I've had the same experience in recent months with my dentist. They bill my insurance for 'x' dollars, my insurance says that they will pay like 50% of the amount billed which is considered 'reasonable and customary' , then my dentist says your stuck with the rest and pay up.

 

All of my other health care providers accept the reasonable and customary charge except my GD dentist. For example when my wife went for blood work for her last pregnancy the amount billed to my insurance was 1300 dollars (which is just ridiculous), my insurance has a 98 dollar allowed amount. The lab didn't bill me 1200 bucks, they took their 98 and ran with it. Had the lab billed me 98 bucks I wouldn't have thought twice about it and just paid it. Instead I had to take the time to call my insurance company bc they originally denied the claim so i received the full 1300 dollar bill. I see the same thing on every single EOB. For our baby my insurance was billed 21K between the room and board and the delivery. Insurance paid 13k and they wrote off the other 8k. My copay was 250 bucks and that's all I'm responsible for.

 

Are you guys actually asking exactly what will be billed to your insurance and calling for coverage verification before hand?

[KennyFKINPowerz]

Dentists are Rapers!!!!!!!!!

[Skinner]

That's an issue with your insurance, not your dentist, and I think more of your responsibility to be informed about than it is theirs.

 

 

I disagree I just had a partial plate replaced (for a couple missing teeth) my dentist looked up my insurance info for found out what they will cover and what my out of pocket would be.They even took the extra step to call my insurance to verify the cost is the my missing teeth is congenital.

 

If you want there info I can PM you they are in Dublin.

[Nitrousbird]

Oh, stay the fuck away from the inside Sears dentist place... I forget offhand but I always see the commercial. If you do go anyway, bring your KY. They're so full of shit, it will be you getting fucked in the ass, not them.

Dentalworks. I go there, no issues. But I also have really good insurance. Just had a deep cleaning, and paid nothing but my co-pay (regular cleaning is covered 100%).