Medical/Dental insurance underpayment?

MarkVIII93

MarkVIII93

Forum Member
Earlier in the year, I had some dental work done. Had a small out of pocket cost as expected. Fast forward a few months later, I get a bill and breakdown of cost in the mail from my dentist stating that I owe them over $500 due to "insurance paid less than expected"... I was told that the out of pocket cost was going to be under $100 originally. What are my options? Aside from pay them back. I feel like they may have under-quoted me and now trying to cover their own ass. Any opinions or has anybody else dealt with this in the past?
 
MarkVIII93 said:
Earlier in the year, I had some dental work done. Had a small out of pocket cost as expected. Fast forward a few months later, I get a bill and breakdown of cost in the mail from my dentist stating that I owe them over $500 due to "insurance paid less than expected"... I was told that the out of pocket cost was going to be under $100 originally. What are my options? Aside from pay them back. I feel like they may have under-quoted me and now trying to cover their own ass. Any opinions or has anybody else dealt with this in the past?
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Technically by law it's their fuckup and they should be eating that...
 
do you have the bill showing the amount you paid earlier as the due balance? if so and now they have a different balance tell them to pound sand, like reiko said they fucked up and hope you are crazy enough to pay it. As long as they had your insurance info prior to the appt they are up shits creek.

I deal with this all the time, therapists will tell us things are covered by insurance and then bill us 6 months later,


always get things in writing and receipts, then again you should anyways as all medical payments are tax deductable
 
moneypit said:
do you have the bill showing the amount you paid earlier as the due balance? if so and now they have a different balance tell them to pound sand, like reiko said they fucked up and hope you are crazy enough to pay it. As long as they had your insurance info prior to the appt they are up shits creek.

I deal with this all the time, therapists will tell us things are covered by insurance and then bill us 6 months later,


always get things in writing and receipts, then again you should anyways as all medical payments are tax deductable
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I'd love to get some insight from a lawyer. After the procedure, they tried to charge me over 900. I questioned that heavily and they found some write off or some BS in which reduced my out of pocket to $89. Big difference.. I specifically asked if I was all set and that's all I had to pay including the follow up appointment. They replied yes. Mind you this is a procedure I got done back in the beginning of March. I just received this bill beginning of June.
 
MarkVIII93 said:
I'd love to get some insight from a lawyer. After the procedure, they tried to charge me over 900. I questioned that heavily and they found some write off or some BS in which reduced my out of pocket to $89. Big difference.. I specifically asked if I was all set and that's all I had to pay including the follow up appointment. They replied yes. Mind you this is a procedure I got done back in the beginning of March. I just received this bill beginning of June.
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Not your problem... Show them the paid invoice and tell them to pound sand...
 
I think this whole thing could go either way. It depends on what the paperwork said and what you signed. When I had my wisdom teeth out, the dentist got a pre-approval from the insurance company, but he told me up front I would have to pay the difference between what they paid and what he normally charged. Because I wanted that guy, I paid the difference. If you go to a place that is "In Plan" for Delta or one of the dental plans, then they should take whatever delta (or your plan) pays. If they are not in plan, then technically you might owe it, although they will have to justify why the original number changed.

I am shocked that your dentists did not do a pre-approval. I don;t let a dentist touch my mouth for anything other than a cleaning without one. I would look at your paperwork in detail and compare the procedure codes (not sure what the technical term is) for the pre-approval compared to what the dentist is charging you for. Your own insurance should have been sending you "Explanation of Benefits" statements too. Those should have some clues as to what the dentist is asking them for and what they actually paid for. Compare the EOB's to the dentist bills and see if they Jive in terms of costs and codes.

Also, I had a dentist recently screw up a pre-approval. They got a crown approved, but then the insurance wouldn't cover the enamel coating because it was on one of my back molars. I told them to pound sand and they ate it, because they screwed up the pre-approval. It was only $100, but I told them it was their mistake not mine and I wasn't paying.

Good luck!

-Geoff
 
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I did find the original paperwork regarding the procedure estimate. Of course they include a disclaimer that states the out of pocket costs may not reflect the exact amount expressed in the estimate.
 
1. get your EOB from your insurance
2. compare amounts.
3. if they accept your insurance, then they are contractually agreed to accept that amount as payment in full
4. tell your insurance company what they are trying to pull

This is called "Balance billing" and it is illegal
 
wikdsvt said:
1. get your EOB from your insurance
2. compare amounts.
3. if they accept your insurance, then they are contractually agreed to accept that amount as payment in full
4. tell your insurance company what they are trying to pull

This is called "Balance billing" and it is illegal
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Depending on if the amounts match. What does that determine?


Sent from my iPhone using Tapatalk
 
Right now it's the dentist office. They improperly coded their billing when they sent the pre approval to the insurance company and gave my "X" dollar amount to pay. Four months after I paid my balance due for the procedure, the office attempted to bill me extra due to their mistake. I asked the office multiple times immediately following the procedure if the amount due was correct. I was told yes. I assume they wait 2 years to send this to collections in Hope's I'd lose my paperwork
.. I'll be submitting it to the collections agency
Hopefully they kick it back to the dentist office.

Sent from my SM-G950U using Tapatalk
 
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