>> Please tell me what you think about this. Below is what my son's dentist
>> charged us and the resulting fees and insurance payments. Am I crazy or am I
[quoted text clipped - 8 lines]
>
>Steve
> I understand about the ins. not paying for the nitrous,
>but is the dentist allowed to submit a seperate charge (to me) for the
>deductable? On the second bill they sent me they changed the unspecified
>code to "Deductable".
I don't think you, "3boyzmom" understand *anything*
about the practice and cost/billing for dental treatment.
In my office you would pay "up front" before treatment.
That way I don't have to send you a *bill*.
You can collect from your InsCo, by yourself.
Guess you are so used to someone else paying your way
that you don't think you owe anything to anybody that
provides a service.
Sad that.
> Steve B.,
> This dentist is a participating dentist. I think my own dentist rolls the
[quoted text clipped - 7 lines]
> Thanks for your reply!
> 3boyzmom
This is confusing. The services are submitted to the insurance
company. Typically deductibles don't apply to "preventive" and
"diagnostic" services such as exams and x-rays. But restorative
procedures generally incur a deductible. Before managed care this
usually meant the first dollars charged for a procedure. Now it
generally means it comes out of an allowable fee rather than the fee
charged. For example, say there is a $50. deductible, and the dentist
charges you $100, and the service is covered at 50%. Under an old-style
plan, the first $50. charge would be the deductible, payable by you.
The remaining fee of $50 would be covered at 50% (as per our example),
so they would pay $25, you would pay the other $25. IOW, in this
example you pay $75, the insurance company benefit is $25.
Now, with managed care, the allowable fee may be only $50. A
non-participating dentist would submit a claim for $100, but the
insurance company would only consider the first $50 for payment. Many
insurance companies don't even use their own charges against the
deductible, but figure the benefit at 50%, so they would only apply $25
against your deductible. Not only would you get no benefit, but you
would have to incur enough further covered charges to eliminate the
deductible for the year.
You are charged a deductible by dentist. The dentist does NOT bill a
deductible to the insurance company. The insurance company deductible
is a means of decreasing their payable benefits.
If your dentist is participating in your plan and your plan is a
PPO-type plan, he should not be billing you for higher than the
allowable fee for that service. However, please note that there are any
number of ways of writing an insurance policy--as well as any number of
ways to bill the insurance company. If the procedure is a covered
procedure, a participating dentist should not be charging YOU based on a
fee higher than allowable. If it's a non-covered service, he is free to
charge whatever he wishes.
You should clear up just what services were performed, and if they were
billed appropriately.
Steve
>>> Please tell me what you think about this. Below is what my son's dentist
>>> charged us and the resulting fees and insurance payments. Am I crazy or am I
[quoted text clipped - 6 lines]
>>
>> Steve