Question about dental billing - anyone know about estimates and actual payments?

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Posted 11/14/2012 by Shevy in NSBR Board
 

Shevy
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Posted: 11/14/2012 7:52:53 AM
I had to have a crown. My dentist presented me with an estimate $970. My portion was $791 as they checked my insurance and I had $178 remaining that they would pay. I signed off on the estimate.

Now, after the crown is done, they sent me a bill for the whole 970 and stated that my insruance had already been billed and no payment was received.

Does this mean that, even though my estimate was lower, I have to pay the larger amount? I thought that once an estimate was done, they couldn't charge you more?



*~*amanda*~*
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Posted: 11/14/2012 8:01:41 AM
An estimate is just an estimate, meaning that it SHOULD cost ABOUT the estimated amount.

Is it a situation where the insurance has been billed but hasn't paid their portion yet and that will be coming in the near future, thus making your amount due lower? That happens frequently with us and our dental bills. I'll pay the estimated amount and then the next month when the bill comes the insurance check has usually reached the dentist and its all good.



chelsea_bug
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Posted: 11/14/2012 8:04:22 AM
It may just mean that your insurance hasn't paid yet. I would get on the phone with your insurance company and find out what the deal is. I've had issues where the dentist coded things wrong or dated things wrong and had to be resubmitted before the insurance paid.

Now, I assume that the dentist checks with the insurance as a courtesy. If the insurance is really not going to pay, I would think you're on the hook for the entire $970, because you did sign off on that amount.


Chelsea_Bug

guzismom
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Posted: 11/14/2012 8:04:52 AM
Sounds like the problem was at the insurance; they informed the dental office you still had benefits to use for the year, which evidently you didn't.

An estimate is just that...you should expect to pay some amount NEAR that amount. I think =/- 10% is reasonable.



Marilyn (now in New Mexico!!)
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gritzi
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Posted: 11/14/2012 8:07:20 AM
I would check with the insurance company before paying the difference.

Yes, you can be billed for the difference since it was an estimated amount. This summer I had an unexpected dental procedure. The day of the procedure it was estimated that my amount would be $1200 while insurance would pay the additional $900.

About a month later we learned that insurance refused to pay anything except for $200 because the specialist wasn't in their network and no matter the network the procedure wasn't covered.

As a result, we were billed the additional $700.

Shevy
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Posted: 11/14/2012 8:20:19 AM
For some reason I had it in my head that the estimate was all they could charge. Oh well...



KatieBPea
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Posted: 11/14/2012 8:41:53 AM
I've only been on the patient side of this, but I think their checking your remaining benefit is just a courtesy, not a guarantee.

Could is just be that payment from the ins co hasn't come through yet? There has been more than once that I have received a bill from my dentist before payment came through.

Best of luck, and I hear you on the cost. I had to have a root canal, post and crown earlier this year. As a result, I was out of benefit for part of my second cleaning and checkup last month.



chelsea_bug
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Posted: 11/14/2012 8:50:12 AM

For some reason I had it in my head that the estimate was all they could charge. Oh well...
Technically, their estimate was $970...which is what they are charging.


Chelsea_Bug

BEF2008
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Posted: 11/14/2012 9:02:41 AM
Your dentist didn't change their estimate. They said $970 and $970 is all they'll get paid in the end. They don't care if they get it from you, your insurance or someone else, they just want their $970.

Your beef is with your insurance, who promised to cover some of it. It may be that you have to submit your bill (which you've paid in full) to your insurance and they will reimburse you the promised $178.

Is it possible that between the time that you submitted for the estimate and the time the crown was done that you or someone else used up that $178 for something else? You need to call your insurance company directly yourself.

gavinsmom
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Posted: 11/14/2012 10:31:53 AM
most likely the insurance company is dragging their feet in sending payment to the DDS so after 30 days, 60 days whatever the DDS decides you are on the hook for the entire amount. They want their money and they don't care whether it comes from you or the insurance company. Call your insurance company and find out what is going on on their end.


Nicole

eebud
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Posted: 11/14/2012 10:39:32 AM
I agree with the insurance company comments. Have you received an EOB from your insurance company? Do you have online access? Can you log in and see if there is a claim pending? It is possible that the dentist got the bill in the mail to you before the insurance company had a chance to pay........not necessarily that the insurance company is dragging its feet. For instance, my old dentist used to send out bills on a certain date of the month. If I had just been in a week earlier, I might have an outstanding balance that I really don't need to pay because I know insurance has been billed.

Also, the dentist filing your insurance is a courtesy to you. You still owe the bill. They are billing you exactly the amount they said it would cost so I am a bit confused about why the question about them charging more.





Hans on left, Bud in middle, Gretchen on right

MerryMom937
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Posted: 11/14/2012 12:56:18 PM
You are purchasing the service from the dentist. You have that relationship with the dentist.

You have the insurance, that is an arrangement between you and the insurance company.

The dentist does not have an arrangement with the insurance company, they bill as a courtesy to you, their patient.

If the insurance company doesn't pay, you are to pay the bill whilst you fight it out with your insurance carrier.

gmcwife1
SamFan

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Posted: 11/14/2012 1:02:59 PM

I had to have a crown. My dentist presented me with an estimate $970. My portion was $791 as they checked my insurance and I had $178 remaining that they would pay. I signed off on the estimate.

Now, after the crown is done, they sent me a bill for the whole 970 and stated that my insruance had already been billed and no payment was received.

Does this mean that, even though my estimate was lower, I have to pay the larger amount? I thought that once an estimate was done, they couldn't charge you more?


It sounds like there is confusion between estimate and remaining benefit

From your examples, your dentist did charge the estimated amount of $970.00. At the time they called/submitted the estimate to your insurance you still had $178.00 of your (yearly) benefit left available to you.

If a claim came in after the benefit quote was given that used up that $178.00 than you no longer have that left to pay part of your $970.00 bill

The bill for the services was always $970.00, who is responsible for that depends on how much you have left of your benefit.

Call your insurance carrier and check the status of your claim. See what you owe from them.


~ Dori ~

Shevy
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Posted: 11/14/2012 1:03:10 PM
I have every intention on paying. There's no question about that. I have a great relationship with the dentist and wouldn't dream of spoiling that. In fact, when I had the proceedure, I tried to pay in full and they told me to just wait it out for insurance. My insurance only pays a certain dollar amount per year for everything from reoutine cleanings to xrays to any emergencies. I must have used up my insurance for the year.

I know that I've had services involving my medical and when the estimate was lower than the actual amount owed, the office only charged me the estimate. However, it may have been the office policy of that specific office. That's why I was confused when I got this bill.

I have a call into my insruance company to ask about the payment and my coverage.


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