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  1. #1
    Join Date
    Jul 2006
    Posts
    12

    Default Deceived About Insurance Coverage

    My family has BC/BS medical and dental insurance through his employment. The insurance covers teeth cleaning twice a year at 100%. Our dentist office set us up for a cleaning and told us we wouldn't have to pay anything because it's covered by our insurance. They did a full mouth debribement on us which is a cleaning with an ultrasonic tool. The dentist told both of us after the cleaning that we would need to come back for the 2nd part of the cleaning. Our insurance company won't pay for the cleaning now. We also got a bill from our dentist for the 2 cleanings. I went to the dentist office and told them that our insurance won't pay for the cleanings. The receptionist told me that we are responsible for whatever our insurance company doesn't pay. I know this and understand this but I feel we were deceived by our dentist office. They should have told us what type of cleaning they wanted to do on us and inform us that our insurance would not pay for it BEFORE they performed the services. That way we would have asked what the cost was and decide from there if we wanted it done or not. Now we have a bill for $144 that we don't agree with. What should I do about this? Since we were lied to about this cleaning, are we obligated to pay this? Thanks in advance! Michelle

    PS. The receptionist also told us that we need to come back for our 2nd part of the cleaning and it wouldn't cost us anything because our insurance covers this cleaning at 100%. I told her that I was told our first cleaning was covered 100%. She said she will call our insurance company and see if they would put it under the free cleaning code and then we wouldn't have another cleaning for a year. I'm hoping BC/BS will do what the dentist office wants so this bill will disappear! My husband doesn't want to go to this dentist anymore and I do have to say, I agree.

  2. #2
    Join Date
    Jul 2006
    Location
    Northern California
    Posts
    252

    Default Re: I need advise

    Quote Quoting sixsenuf2002
    My family has BC/BS medical and dental insurance through his employment. The insurance covers teeth cleaning twice a year at 100%. Our dentist office set us up for a cleaning and told us we wouldn't have to pay anything because it's covered by our insurance. They did a full mouth debribement on us which is a cleaning with an ultrasonic tool. The dentist told both of us after the cleaning that we would need to come back for the 2nd part of the cleaning. Our insurance company won't pay for the cleaning now. We also got a bill from our dentist for the 2 cleanings. I went to the dentist office and told them that our insurance won't pay for the cleanings. The receptionist told me that we are responsible for whatever our insurance company doesn't pay. I know this and understand this but I feel we were deceived by our dentist office. They should have told us what type of cleaning they wanted to do on us and inform us that our insurance would not pay for it BEFORE they performed the services. That way we would have asked what the cost was and decide from there if we wanted it done or not. Now we have a bill for $144 that we don't agree with. What should I do about this? Since we were lied to about this cleaning, are we obligated to pay this? Thanks in advance! Michelle

    You are responsible to pay. Your dentist is in the dental business, not the insurance business. It is up to you to know, beforehand, what your insurance will pay, and for what type of procedures. It's your insurance and it's your insurance contract. Read the policy.

    Had you read the policy, and known the types of covered procedures, you could have said, "My insurance won't cover that type of procedure." Or, you could have said, "Before we start, could you please call my insurance company to confirm that your procedure is covered?"

    Pay the doctor.

  3. #3
    Join Date
    Sep 2005
    Location
    Behind a Desk
    Posts
    98,846

    Default Re: I need advise

    Is the bill for all services provided, or just for the second visit? I know my insurance would pay for a cleaning provided in a single visit - but not for a follow-up visit.

  4. #4
    Join Date
    Jul 2006
    Posts
    12

    Default Re: I need advise

    Quote Quoting Mr. Knowitall
    Is the bill for all services provided, or just for the second visit? I know my insurance would pay for a cleaning provided in a single visit - but not for a follow-up visit.
    The bill was just for full mouth debribement. I had no idea what the bill was for so this is why I went to the dentist office to inquire about it. The dental office never once mentioned the word debribement to either one of us, all they called it was a cleaning and our insurance company pays 100% for cleaning. They also did this to our son in law only he hasn't received his bill yet. The "follow-up" cleaning is covered 100% only we were not told about any follow up cleaning until after they had done the first one.

    And yes, I had read our policy and knew they covered teeth cleaning. Our dental office called it teeth cleaning, not debribement. Had they used the word "debribement", I would have asked them what "debribement" was and had them call our insurance company to see if it was a covered service or would have cancelled the appointments and called them on my own.

    If we're obligated to pay for their deceitfulness, we'll pay. But I will call BC/BS and my husband employer to let them know what this dentist office did since my husbands employer pays half of our insurance premiums.

  5. #5
    Join Date
    Nov 2006
    Posts
    3

    Default Re: Deceived About Insurance Coverage

    Generally I agree that it is up to the patient to know what their insuracne will cover, and you should not just rely on the doctor. However, what if the insurance originally indicated that it would cover a treatment, only to later say that they made a mistake. At that point, shouldn't the insurance company be obligated to pay for something that was incurred due to reliance on threir mistake? This is my particular situation. I have fought the company over this, but they are not budging.

  6. #6
    Join Date
    Mar 2005
    Location
    Michigan
    Posts
    28,906

    Default Re: Deceived About Insurance Coverage

    That's probably a subject best raised in a new thread.

  7. #7
    Join Date
    Jul 2006
    Location
    Ohio
    Posts
    1,094

    Default Re: Deceived About Insurance Coverage

    Quote Quoting sixsenuf2002
    View Post
    My family has BC/BS medical and dental insurance through his employment. The insurance covers teeth cleaning twice a year at 100%. Our dentist office set us up for a cleaning and told us we wouldn't have to pay anything because it's covered by our insurance. They did a full mouth debribement on us which is a cleaning with an ultrasonic tool. The dentist told both of us after the cleaning that we would need to come back for the 2nd part of the cleaning. Our insurance company won't pay for the cleaning now. We also got a bill from our dentist for the 2 cleanings. I went to the dentist office and told them that our insurance won't pay for the cleanings. The receptionist told me that we are responsible for whatever our insurance company doesn't pay. I know this and understand this but I feel we were deceived by our dentist office. They should have told us what type of cleaning they wanted to do on us and inform us that our insurance would not pay for it BEFORE they performed the services. That way we would have asked what the cost was and decide from there if we wanted it done or not. Now we have a bill for $144 that we don't agree with. What should I do about this? Since we were lied to about this cleaning, are we obligated to pay this? Thanks in advance! Michelle

    PS. The receptionist also told us that we need to come back for our 2nd part of the cleaning and it wouldn't cost us anything because our insurance covers this cleaning at 100%. I told her that I was told our first cleaning was covered 100%. She said she will call our insurance company and see if they would put it under the free cleaning code and then we wouldn't have another cleaning for a year. I'm hoping BC/BS will do what the dentist office wants so this bill will disappear! My husband doesn't want to go to this dentist anymore and I do have to say, I agree.
    Agreed with responses from both members but just want to add:

    Your insurance policy will state what action you can take to dispute their denial of payment for any covered benefit. Usually, it includes a statement of your understanding of the policy, what you anticipated and how the payment differed from the policy. The claims adjuster is frequently someone who has the ablility to make a reasonable change in the covered benefit.

    I know that you think the insurance company is responsible for paying your claim. But the insurance is a benefit for you because of someone's coverage. Consider including your appreciation of the benefit when you re-submit this claim for reconsideration and you might be surprised in a more receptive attitude.

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