Estimate was off by 40%... what to do?

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ninotchka909@gmail.com - 24 Jul 2006 16:08 GMT

I'd be grateful for any insight that I can get into this stressful
situation.

Before my dental work was done, I was given a written estimate of what
my costs would be and what my insurance would cover. My insurance was
supposed to pay $1500 and I would pay $1781.

Fast forward; all the work is done. I have paid our portion of the bill
in full. Then I get a bill from my dentist for over $700. Their
explanation? The insurance company paid MORE than they expected for
some of the earlier claims; therefore, my insurance maxed out when only
2/3 of the way through the work, and I am responsible for the full tab
for the rest.

I always pay my bills promptly, and I don't want to rip anyone off. But
from my perspective, they have received the full amount they estimated
from me and from my insurance company. The costs of services did not
change; they performed (and billed me for) exactly the services they
had estimated.

Furthermore, if I'd gotten a more accurate estimate, I could have
chosen to
a) put off some of the work until the next calendar year (so it would
be covered) -- not all the work was urgent;
b) saved more money in my flexible spending account
c) gone with a different insurance company with a higher limit.

I understand that an estimate is only an estimate, but to be off by
almost 40%? Is this common? It doesn't seem right to me that they have
received all the money they expected to receive for the services, and
yet I'm being billed an extra $700+.

Excuse me while I bang my head on my desk for a while.

Any insight into this situation is much appreciated.

Regards,
Rachel

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Bill - 24 Jul 2006 20:17 GMT

> I'd be grateful for any insight that I can get into this stressful
> situation.
[quoted text clipped - 9 lines]
> 2/3 of the way through the work, and I am responsible for the full tab
> for the rest.

There is no question that when the dental insurance is maxed out, you
are responsible for all costs above that amount.

But if the insurance "paid MORE than they expected for some of the
earlier claims," that should mean that YOU paid LESS than expected for
those same claims.

The math is simple on those earlier claims. If the insurance paid MORE,
your share is obviously LESS than expected.

Use the money you saved when you paid LESS on the earlier claim, to pay
off the balance that you owe on the later claims.

And you don't have to take the dental office's word for it. The
insurance company sends you the original EOB's (statements of payment)
so you should be able to calculate it all by yourself down to the
penny.

> I always pay my bills promptly, and I don't want to rip anyone off. But
> from my perspective, they have received the full amount they estimated
[quoted text clipped - 8 lines]
> b) saved more money in my flexible spending account
> c) gone with a different insurance company with a higher limit.

These are all good strategies. Why didn't you add up all your old EOB's
so that you knew how much insurance money was available before maxing
out?

> I understand that an estimate is only an estimate, but to be off by
> almost 40%? Is this common?

Yes, whenever the total maximum limit is not carefully tracked.

It doesn't seem right to me that they have

> received all the money they expected to receive for the services, and
> yet I'm being billed an extra $700+.

If they have truly received all the money expected, they would not be
billing you for the missing $700, would they? It would be illegal to
bill you for more than the total cost of treatment. Were additional
treatments necessary, over and above the planned treatments on the
original estimate? Additional treatments mean additional costs.

> Excuse me while I bang my head on my desk for a while.
>
> Any insight into this situation is much appreciated.

Your own insight above, where you list the ways to deal with the
abysmally low annual limits imposed by dental insurance companies, are
already very good insights:
"> a) put off some of the work until the next calendar year (so it
would

> be covered) -- not all the work was urgent;
> b) saved more money in my flexible spending account
> c) gone with a different insurance company with a higher limit."

All you need to do is keep track of how much of the annual maximum has
been exhausted so you can put these strategies into operation. It
doesn't seem like that was done in this case, unless there is something
missing here.

Best regards,
- dentaldoc

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ninotchka909@gmail.com - 25 Jul 2006 03:13 GMT

> But if the insurance "paid MORE than they expected for some of the
> earlier claims," that should mean that YOU paid LESS than expected for
> those same claims.

Nope. I paid what they estimated. Their explanation -- they bill the
insurance company for more than they expect to receive and then write
off the difference.

> These are all good strategies. Why didn't you add up all your old EOB's
> so that you knew how much insurance money was available before maxing
> out?

All of this work happened in a fairly short time period. I had
carefully calculated (according to their estimates of what they
expected to be reimbursed) my maximum. By the time we got the bills
back and realized they'd paid too much, it was too late.

> If they have truly received all the money expected, they would not be
> billing you for the missing $700, would they? It would be illegal to

They have received MORE money for the earlier treatments than they
expected.

> bill you for more than the total cost of treatment. Were additional
> treatments necessary, over and above the planned treatments on the
> original estimate? Additional treatments mean additional costs.

No, no additional work was performed.

> All you need to do is keep track of how much of the annual maximum has
> been exhausted so you can put these strategies into operation. It

I did, according to THEIR estimate of what would be reimbursed. Now
since they received more money than they expected, I suddenly owe $700
more. That doesn't seem right to me.

Regards,
Rachel

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