Re: Dentist/Insurance Billing Malpractice
[QUOTEseem silly and "who cares" to a lot of you but it's a simi-big deal to me in my current situation.
My husband and I went to a new dentist last month. We're young and poor so I asked the receptionist how much the cleanings would cost us before making the appointment. She told me that since it's a preventive action, it is paid fullly by our insurance. After the appointment, again I asked if we needed to pay anything. The lady said again that it is paid for by insurance.
We now have bills from Regence that reads:
Medical Care 3/14/09 (our cleanings)
Billed Charges: $128
Eligible Charges: $111.40
Amount Payable to Provider: $91.40
Your responsibility: $20
I had to go in for a follow up appointment to recieve two fillings. I recieved a bill from Humana that shows:
Est. Memeber responsibilty: $117.60
Amount paid by humana: $113.40
Today I recieved a bill from my dentist for $280. It shows:
actually, this is not just the cleanings. Actually, the only part that is actually the cleaning is the item titled prophylaxis. The others are an x-ray (intraoral complete series and the bitewings), a flouride application (topical flouride varnish) and the basically an administrative fee for the first visit and evaluation. Now, if they insurance includes all of that within a "cleaning" I cannot say. That is something you would need to address with the insurance company.
DMD3:Comp oral eval-new/estab pat: Laura $40.00
HYGN:Bitewings-four films: Laura $43.00
HGYN:Prophylaxis-adult: Laura $60
HGYN:Topical Fluoride Varnish: Laura $20
DMD3:Comp oral eval-new/estab pat: Gary $40.00
HYGN:Intaoral-comlete series: Gary $90.00
HGYN:Prophylaxis-adult: Gary $60
HGYN:Topical Fluoride Varnish: Gary $20
Amount due: $74.00 (that is just for the cleanings!)
and this is obviously the fillings, from the second appointment.
(following is showing charges for fillings)
DMD3: REs.4 Sur. Post. Prim. or Perm. Laura $165.00
DMD3: REs.3 Sur. Post. Prim. or Perm. Laura $150.00
Amount due: $84.00
you only pay the dentist. The insurance company is simply stating what is your responsibility to the dentist based on your policy.
I'm not understanding why I'm paying all three parties for my "responsible amounts". I might just be overlooking something... but it seems like I'm paying more than I was supposed to
I only saw one cleaning each for you and your husband. Did I miss something?
And why am I being billed for cleanings TWICE when I was told it was paid for by insurance??
what I believe you are seeing is where a doctor bills whatever they typically bill. Then, if they are contracted with the insurance company, the insurance company actually determines what the doctor can charge the patient and then the insurance company pays whatever they are contract to from that.
I'm also noticing that it appears that the dentist is showing that the cleanings cost $210 but from Regence its showing that the cleanings toal cost was $128...
the part I question is the fact your bill is for $280 yet the total shown on the breakdown is only $158 but I did notice it did not show a payment on your cleaning or a total.
Give me a minute to re-read this and what I posted. I missed something in there and need to reassess.
ok, if you add the items for the cleaning visit minus the prophylaxis and add the $117 from the Humana EOB, and the $20 (co-pay maybe?), you come up with just about the $280. The charges get altered, as I tried to explain previously so I would think that is where the discrepancy between the $280 and the total using the figures I listed comes from.
I am not an attorney and any advice is not to be construed as legal advice. You might even want to ignore my advice. Actually, there are plenty of real attorneys that you might want to ignore as well.