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So I recently had some work done by my dentist and have some questions regarding verification responsibility, in order to 'arm' myself before I go in to dispute a bill I received from them tomorrow.
First some back story;
Fresh out of the military with no dental insurance I visited my new dentist to get some preliminary X-Rays done, just to see where I stood. I informed them I wouldn't be back for a while so my new dental insurance could mature to the point I could utilize it.
6 months later I called and scheduled my first cleaning (covered @ 6months) during that visit I was told I needed to schedule a "Deep Cleaning," and so scheduled that 5-6 months later, which was the next available 3hr slot, apparently that's how much time the procedure takes. It also happened to be 2 days prior to my 1yr insurance maturity level at which 'oral surgeries' are covered... that will be important later, for now, lets move on...
3 days prior to the appointment, their office called me to verify my dental insurance information and I spent 30min on the phone giving all needed info. 3 days later, I arrived for my appointment; while in the chair that afternoon they asked if I want to just do 1 quadrant or all 4, to which I responded, "So long as it's covered, we may as well get this out of the way." After the procedure I went to pay and schedule my next appointment, they told me I owed $950.00.
I immediately bulked, "Uh... shouldn't my insurance be covering a large chunk of that!?" The woman behind the counter said, "Oh we don't have anything on file for you, do you have your insurance card?" I gave it to her and informed her they took it 3 days prior over the phone, she said nothing and proceeded to input the information AGAIN.
(Red flags are going off like crazy at this point, and I visibly get nervous.)
"There we go, that's much better," she says as she hands me my card back with a smile, "They cover 50%, that'll be $475.00, sorry about that!" I breathe a sigh of relief and go back to my whimsical nature. Disaster averted!
At this point I should also note that on the back of that insurance card in bold letters it states, "Provider should verify eligibility before providing treatment." which is why I'm asking this question at all;
A month later, I received a "Not a Bill" notification from my insurance company of the "oral surgery" claim made and the amount paid, $0. That's right, despite the misleading name of 'Deep Cleaning' described to me, it's actually considered an oral surgery, because there were shots involved to numb the mouth. So I know what must now inevitably come from the dentist... and sure enough 2 weeks later, a bill from the dentist arrived in the amount of $475.00.
Misleading description aside, let's write that off as unintentional for now.
Why did they not verify all of my insurance information BEFORE the procedure!?
Why did I waste half an hour on the phone with them 3 days prior if it wasn't going to get put in the system!?
Is it not standard procedure to run insurance first in any medical case (exception being an emergency)!?
If I had known I was still 2 days to maturity on an oral surgery I thought was a cleaning I would never have agreed to drop $1000 out of pocket for a 4 quadrant 'cleaning' all at once... and certainly I feel I said as much when they asked me how many quadrants I wanted to do that day, it's the entire reason I waited for the dental plan to mature in the first place!?
Do I have a leg to stand on here or am I just pissed at myself and looking too hard for a reason to partially blame them? Is it not the responsibility of BOTH parties to check the eligibility of insurance coverage, especially since I was led to believe it was a cleaning procedure!? Not looking to escape paying, the work was done... but I feel I was mislead, and a reduced bill and payments over the course of a couple months would be nice. Is this an unreasonable request, given the circumstances?? I can't afford additional $500.00 administration errors like this.
First some back story;
Fresh out of the military with no dental insurance I visited my new dentist to get some preliminary X-Rays done, just to see where I stood. I informed them I wouldn't be back for a while so my new dental insurance could mature to the point I could utilize it.
6 months later I called and scheduled my first cleaning (covered @ 6months) during that visit I was told I needed to schedule a "Deep Cleaning," and so scheduled that 5-6 months later, which was the next available 3hr slot, apparently that's how much time the procedure takes. It also happened to be 2 days prior to my 1yr insurance maturity level at which 'oral surgeries' are covered... that will be important later, for now, lets move on...
3 days prior to the appointment, their office called me to verify my dental insurance information and I spent 30min on the phone giving all needed info. 3 days later, I arrived for my appointment; while in the chair that afternoon they asked if I want to just do 1 quadrant or all 4, to which I responded, "So long as it's covered, we may as well get this out of the way." After the procedure I went to pay and schedule my next appointment, they told me I owed $950.00.
I immediately bulked, "Uh... shouldn't my insurance be covering a large chunk of that!?" The woman behind the counter said, "Oh we don't have anything on file for you, do you have your insurance card?" I gave it to her and informed her they took it 3 days prior over the phone, she said nothing and proceeded to input the information AGAIN.
(Red flags are going off like crazy at this point, and I visibly get nervous.)
"There we go, that's much better," she says as she hands me my card back with a smile, "They cover 50%, that'll be $475.00, sorry about that!" I breathe a sigh of relief and go back to my whimsical nature. Disaster averted!
At this point I should also note that on the back of that insurance card in bold letters it states, "Provider should verify eligibility before providing treatment." which is why I'm asking this question at all;
A month later, I received a "Not a Bill" notification from my insurance company of the "oral surgery" claim made and the amount paid, $0. That's right, despite the misleading name of 'Deep Cleaning' described to me, it's actually considered an oral surgery, because there were shots involved to numb the mouth. So I know what must now inevitably come from the dentist... and sure enough 2 weeks later, a bill from the dentist arrived in the amount of $475.00.
Misleading description aside, let's write that off as unintentional for now.
Why did they not verify all of my insurance information BEFORE the procedure!?
Why did I waste half an hour on the phone with them 3 days prior if it wasn't going to get put in the system!?
Is it not standard procedure to run insurance first in any medical case (exception being an emergency)!?
If I had known I was still 2 days to maturity on an oral surgery I thought was a cleaning I would never have agreed to drop $1000 out of pocket for a 4 quadrant 'cleaning' all at once... and certainly I feel I said as much when they asked me how many quadrants I wanted to do that day, it's the entire reason I waited for the dental plan to mature in the first place!?
Do I have a leg to stand on here or am I just pissed at myself and looking too hard for a reason to partially blame them? Is it not the responsibility of BOTH parties to check the eligibility of insurance coverage, especially since I was led to believe it was a cleaning procedure!? Not looking to escape paying, the work was done... but I feel I was mislead, and a reduced bill and payments over the course of a couple months would be nice. Is this an unreasonable request, given the circumstances?? I can't afford additional $500.00 administration errors like this.
Who does the responsibility fall to when checking Dental insurance eligibility?
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