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  1. #1
    Join Date
    Jul 2014
    Posts
    26

    Default Can You Be Billed by a Healthcare Provider if the EOB Shows No Balance Due

    My question involves collection proceedings in the State of: Colorado
    My wife had dental work done and we provided the insurance and paid the expected copay upfront. My EOB from the dental insurance shows no balance owing. The dental place is harassing us for the amount disallowed by the insurance. My thought is that they can't try to collect this. I think the harassment is their MO to extract as much as possible from clients. Please advise.

  2. #2
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,495

    Default Re: Dental Place Trying to Charge for Disallowed Charges

    Is your dental plan a managed care plan and if so, is the dental provider part of the approved network?

  3. #3
    Join Date
    Sep 2012
    Posts
    1,988

    Default Re: Dental Place Trying to Charge for Disallowed Charges

    are they in network?

    if yes: report them to your insurance company.

    if no: pay the bill before it goes to collections.

  4. #4
    Join Date
    Jul 2014
    Posts
    26

    Default Re: Dental Place Trying to Charge for Disallowed Charges

    If they participate in my Dental Plan, does that mean they're in network? When we went there they said they accept our insurance.

  5. #5
    Join Date
    Apr 2009
    Location
    Somewhere near Canada
    Posts
    35,894

    Default Re: Dental Place Trying to Charge for Disallowed Charges

    I can only comment on the "accept our insurance" part.

    It's true that (for example) my surgeon and his office accept our health insurance.

    BUT...that does not mean that he's specifically checked our individual plan...just that they've worked with the carriers before.

  6. #6
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,495

    Default Re: Dental Place Trying to Charge for Disallowed Charges

    "We accept XYZ Insurance" = If XYZ Insurance sends us a check we'll cash it.

    "We are a participating provider on XYZ Insurance's PPO (or HMO, or POS) plan" = We have signed a contract with XYZ Insurance which states that for individuals who have XYZ Insurance's PPO (or HMO, or POS) plan, we will accept as full payment the amounts agreed to by XYZ Insurance and will not charge the individual more than XYZ states is the patient-owed balance.

    The problem arises when people mistake the first statement for the second.

    What I would recommend is that you contact your insurance carrier and notify them of the issue. You want to be speaking to their Provider Relations department, or whatever they call the division that works with the dentists and their contracts. If the provider is in network, they will contact the provider on your behalf and let them know that their contract prohibits balance billing. If the provider is not in network, they'll tell you that too.

    If the doctor is not in network, then he is not bound by the insurance's decision that you owe nothing and you will have to work it out with him.

  7. #7
    Join Date
    Jul 2014
    Posts
    26

    Default Re: Dental Place Trying to Charge for Disallowed Charges

    I signed into my insurance webpage and it says this dentist participates in my insurance. So that means we don't anything, right?

  8. #8
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,495

    Default Re: Dental Place Trying to Charge for Disallowed Charges

    Ideally, yes. Since I can't see your bills or your provider information I hesitate to give a flat out, yes, but the likelihood is good.

    Contact the provider relations department of your dental insurance carrier and inform them that you are being balance billed. They will assist you.

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