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  1. #1

    Default Disputing a Dental Consultation Charge

    My question involves collection proceedings in the State of: New Jersey

    In December I had visited a dentist who after taking xrays on my mouth informed me I had a tooth abscess and needed the tooth removed plus possibly needing a bone graft depending how much bone was left. I made an appointment for a tooth extraction with an out of network (my insurance pays 65% out of network) oral surgeon that had been recommended to me. Over the phone I explained to them my tooth was infected, it was abscessed and I needed it removed asap. I made an appointment for the following week, the office explained to me that I would be responsible for 100% of the billings up front, they would then bill these back to the insurance and refund me anything received later. They quoted me the prices they charge for the extraction ($450 and bone graft $600)

    On the day prior to going to this oral surgeon for the extraction a colleague of mine told me that he didn't think I would get the tooth taken out because I hadn't been given antibiotics. So I went to the surgeon and before he was going to start the procedure I asked him if I needed to be on the antibiotics, he said that if I needed to get the bone graft he would prefer if I was on antibiotics so then he prescribed me some and postponed the extraction. I left the office during this first initial visit and was charged nothing.

    I took the anti biotics and came back a week later for the extraction. The extraction was done routinely, but the bone graft was not needed and I paid the $450 on the way out of the office with the agreement they would bill this $450 extraction charge back to the insurance and I would get the remaining balance sent back to me. A few weeks later I received a check for $115 instead of the $245 that I was expecting. I saw on the bill they deducted a $130 consultation fee. When I called and asked about this they said this was a consultation fee for the first visit I had with the dentist. I called my insurance company they said 'consultation' is not a covered benefit however other codes such as an 'exam' could be billed and would be covered.

    I tried to speak with the oral surgeon about this and the office manager refused to put him on the phone. They were unwilling to do anything about this charge and I repeatedly questioned why I was charged this fee without my knowledge and it was clearly against their policy of making me pay all the charges up front. I also asked them to appeal the charge to the insurance company with explanation this was because I was not on the antibiotics however all they did was rebill it as a consult and did not include any of this explanation.

    Do I have any case to bring this to the small claims court and get the $130 returned or do I have no chance of winning this?

  2. #2
    Join Date
    Sep 2005
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    Default Re: Disputing a Dental Consultation Charge

    It's not clear to me why you believed that a dental consultation would be free. If you chose to schedule and go through a dental consultation without asking about the cost, assuming that there would be no cost, that was obviously a mistake on your part.

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