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Medical Forum / General / Dentistry / February 2008

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Dentist billing practices

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3boyzmom - 23 Feb 2008 18:44 GMT
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
being charged twice for the $50 deductible?

Dentist charged $205 for a filling in my son's front tooth.  The ins. co.
negotiated amount was $128, they deducted $50 for the deductible.  So, $78
was the covered amount of which they paid $62.40 (80%) and we are responsible
for $15.60 (20%).   There was also a seperate charge on the bill for $50
which they later rebilled (to me) as deductable. (When they billed the
insurance company they coded it as an Unspecified Diagnostic Procedure)   And
the last charge on the bill was $45 for Nitrous Oxide.  The insurance company
denied benefits for the $50 and $45 charges.  

So, as I see it we should pay $50 ded. + $15.60 + $45=$110.60, do you agree?

Are they allowed to submit a seperate charge for the deductable?
Steven Bornfeld - 24 Feb 2008 04:09 GMT
> 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 - 12 lines]
>
> Are they allowed to submit a seperate charge for the deductable?

    I don't know of any dental insurance that pays for nitrous.  You do not
say whether the dentist is a participating dentist in your plan.  I
don't know what the "unspecified diagnostic procedure" was, but there is
no harm in asking that the bill be explained to you.

Steve
3boyzmom - 24 Feb 2008 18:13 GMT
Steve B.,
This dentist is a participating dentist.  I think my own dentist rolls the
nitrous charge into the procedure because I never see a charge for it but I
know that I get it.  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'm pretty sure they know that if they send it to the
insco with "Deductable" on there that the insco will not pay it.

Thanks for your reply!
3boyzmom

>> 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
Newbie@bix.nex - 24 Feb 2008 18:32 GMT
> 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.
Steven Bornfeld - 24 Feb 2008 21:17 GMT
> 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
Steven Fawks - 24 Feb 2008 12:15 GMT
Sounds like a typical 'insurance game'.

Dentist signs up for a 'plan' to get patients.  Plan fees are
ridiculously low.  Dentists scams a few fees in there to up
the total to make up for the discounts. Shady business practice, but
the insurance company is engaged in this as well.  The insco
claims they are just looking out for the patient, but that is
a load of BS.  They are just looking for a profit themselves.

Decent dental care simply is not cheap.  Shop for big discounts,
and you will either get crappy dentistry, or imaginary savings.

BTW, I charge for nitrous too.  I see no reason to raise all
of my fees to cover it.  Those that 'need' it should bear the
cost.

JMO,
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 - 12 lines]
>
> Are they allowed to submit a seperate charge for the deductable?
Jeffrey Krantz - 25 Feb 2008 01:51 GMT
the deductable is always YOURS TO BE paid, then you do owe the copayment and
the nitrous charge. it is legal and appropriate.
> 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
[quoted text clipped - 17 lines]
>
> Are they allowed to submit a seperate charge for the deductable?

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