[Vikki and Audrey]

Let me start by saying that I am English and despite having been in NY for over three years, I still don't understand totally how medical insurance works. I would like to know if this is normal for here and something I need to get used to, or whether I am right to be upset.

Last week I went for my dental clean (included in insurance, no co-pay). They told me I had an embarrassing number of small cavities which needed to be filled now to stop them getting worse. We are about to buy a new condo and are a little tight on cash, so I asked how much it would cost.
She looked at the ex-rays and quoted me $800 of which 80% is paid by insurance, leaving me with a co-pay of $160.

Today I went in to have the teeth filled. The dentist said he found another cavity he hadn't seen before and did I want to have that one done also because that would complete everything. I said yes assuming that it would be another $200 and my total co-pay would end up as $200.

I went to pay and the total co-pay was $521!!! I couldn't believe it! Apparently my insurance maxed out, so I had to pay for one $200 filling myself. I am pissed off that I wasn't told first, but even if I am the stupid one who doesn't know what is going on with the insurance, $200 + the $160 originally quoted is still nowhere near $521.

The woman who quoted me is unapologetic, just said she couldn't help me.

I was so upset I cried the whole way home - it's not the money so much, it's the being taken by surprise like that.
I don't know what to do, in England this wouldn't fly but I am not sure if it is normal here? Do I just have to get over it or should I make more of a fuss?

Any advice much appreciated!

 

[Vikki and Audrey]

Oh forgot to mention that the dentist is the father of a good friend of mine which makes it much harder to deal with.

 

[nataliecmu]

Oh my gosh! I would be so mad! In fact, I am mad for you. That is BS that they didn't tell you... OR that they didn't say you could pay it off in payments. I have not come across a doctor yet who won't let yo make payments...

 

[LexiAndNikkisMom]

Most places would let you pay it off in payments.

That doesn't seem right. I would ask for an itemized receipt. That just doesn't seem to add up right. I think you can ask your insurance to look into it.

 

[Holliberry]

I dont like that either- I would call the insurance company first and find out how you can be "maxed" out. If you need fillings, thats what you pay for insurance for! Gee, how can they possibly say you are only allowed to get so many cavities per term?

The whole insurance thing in general is so screwed up, but I didnt think dental was that bad. What a bummer.

Good luck!

 

[LexiAndNikkisMom]

I don't have dental insurance so I don't know for sure but if it is like medical you have a max that you pay and then after that insurance pays it until you reach your max payout.

 

[dhodina]

They should bill your insurance first. Then you should receive a bill after they have paid with the remaining balance. That is how it works with our's at least.

 

[Vikki and Audrey]

It's not really the payment thing which upset me - we CAN pay it upfront (I hate debt), it's more the principle - who can afford to go to an appointment thinking it's going to be $160 and come out with a bill of over $500. It's not something we can do too often!

I am now scared to go to the dentist here again! Problem is that the quality of work is better here I think, just that the cost is prohibitive and that's with insurance!

I don't really understand how people manage it! I am lucky as I get my insurance through my husband's work, but colleagues of mine are paying upwards of $450 a mont for health insurance and then to have co-pays like this. How do people do it?

This is a tough country is get sick in - the care is great, you just have to move into a cardboard box to pay for it!!

 

[LexiAndNikkisMom]

I would ask around and find another dentist. Ask ahead of time how you pay. They should bill your insurance first and then in a couple of weeks send you a bill. If they don't do it that way then find another dentist. Otherwise they could be over billing you (you and the insurance are paying for the same thing).

 

[miko's mommy]

Originally posted by Vikki and Audrey@Apr 14 2005, 11:39 AM
It's not really the payment thing which upset me - we CAN pay it upfront (I hate debt), it's more the principle - who can afford to go to an appointment thinking it's going to be $160 and come out with a bill of over $500. It's not something we can do too often!

I am now scared to go to the dentist here again! Problem is that the quality of work is better here I think, just that the cost is prohibitive and that's with insurance!

I don't really understand how people manage it! I am lucky as I get my insurance through my husband's work, but colleagues of mine are paying upwards of $450 a mont for health insurance and then to have co-pays like this. How do people do it?

This is a tough country is get sick in - the care is great, you just have to move into a cardboard box to pay for it!! 

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What happened to you is awful. Unfortunately, dental insurance have yearly maximums of about $1000. So, if you get a lot of work done, it normally ends up running out. I think dental insurances are pretty worthless.

Better health insurances (such as ppo) tend to be expensive. They are more expensive if not provided (partly paid for) by employer. However, I think health care in US can be great. I was born and raised in Russia, where health care was free and the difference is amazing.

 

[ButterCloudandNoriko]

How convenient that whenever they misquote you that it's always LESS than the actual than MORE!

 

[Vikki and Audrey]

The problem is that the dentist is my friend's father, I don't know how it handle it with her either - should I say something or just find another dentist and not say anything? Tricky situation.

 

[mollyinmo]

Unfortunately, this is very normal. I have argued the point several times to no avail and end up writing the check. Depending on the plan that you have, the ins. company tells the dental office how much is covered...but they always point out that it is not a guarantee and you are responsible for all other charges and yes there is usually an annual maximum. A responsible person in the office should have checked and told you that you were reaching that amount and informed you that you would be responsible for the charges in full. I'm sure I'm talked about behind my back when I go or take my kids, but I always make them verify how much I will have to pay before anything is done and if they find additional problems have them check again.

Kind of off topic, but my ins only pays for the kids to have fluoride once a year, and its standard for the dentist to do it every 6 mos, so I get billed for the additional treatment...fine because its hopefully preventing problems but I make them tell me each and every time if its covered. (because I like to be a pain in the butt )

 

[Chelsey]

I'm sorry that you had to go throu this. I guess the bad part is a frien of a friend.
I live in canada, but the same thing apply's here. If your insurace runs out you end up paying out of your pocket. The thing that makes me mad is they should have told you that you were maxed out. Weather it be your dentist or the insurace company. You should have been giving a letter or some record stating this.
Your dentist should not have assumed it would be covered and still should have submitted the request for filling to your insurance company. They would have responded saying it is max and then you would know before hand.
Other issue. Your dentist could have offered you monthly plan to payafter seeing your sistuation friend or no friend that not how you treat your customers if you want them to come back.

 

[pico's parent]

When the dentist mentioned another cavity I believe you erred in not bringing up the cost at that moment. I'm sure the dentist has no clue about what your insurance pays or how much you have used up so I have a difficult time blaming him.

You made an assumption which was reasonable based on what you were quoted originally but which was erroneous when applied to the insurance. Personally, I find insurance a big question mark. I never feel like I have a handle on how much they are going to pay on any given treatment. It is sooo confusing.

Anytime I have to pay more than expected, I feel cheated somehow, even though it turns out to be legitimate I feel I didn't have control of the expenditure and that pisses me off.

If you like the work he did I would stick with him but be very clear to him and his staff that any work has to be firm quoted and checked out against your insurance to be sure the quote is firm.

 

[stini]

Originally posted by Pico's Parent@Apr 14 2005, 04:21 PM
Personally, I find insurance a big question mark.  I never feel like I have a handle on how much they are going to pay on any given treatment.  It is sooo confusing.
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Kind of along the same lines, I found some interesting stuff about credit card companies and how tricky they can be.

» Even if you make your credit card payments on time, the credit card bank can raise your interest rate automatically if you're late on payments elsewhere -- such as on another credit card or on a phone, car, or house payment -- or simply because the bank feels you have taken on too much debt.

» There is no limit on the amount a credit card company can charge a cardholder for being even an hour late with a payment.

» There is no federal limit on the interest rate a credit card company can charge.

SCARY!

Read more HERE.

Sources are from PBS "Secret History of the Credit Card." FRONTLINE® and The New York Times join forces to investigate an industry few Americans fully understand. In this one-hour report, correspondent Lowell Bergman uncovers the techniques used by the industry to earn record profits and get consumers to take on more debt. "The almost magical convenience of plastic money is critical to our famously compulsive consumer economy," Bergman says. "With more than 641 million credit cards in circulation and accounting for an estimated $1.5 trillion of consumer spending, the U.S. economy has clearly gone plastic."

 

[msmagnolia]

Vikki,
Your situation is not uncommon. It is really hard for dentists and physicians to find employees who are competent and knowledgable when dealing with insurance companies. Additionally, the office may be filing with 20 or more different plans, all of which have different rules. As difficult as it is, you should probably try to learn as much as possible about your particular plan so that you make sure that you get the benefits that are due you. I'm surprised that you were not offered a discount or the opportunity to make payments since this is a good friend's father. You would probably do your dentist a big favor by nicely expressing to him, not your friend, what happened. He may be unaware of this problem with his staff. Just because the employee was unsypathetic, do not assume that the dentist wants their patients treated this way. He needs your business.

These next remarks are not addressed to Vikki, nor do they apply to responsible, honest people....As to the suggestions that Vikki should have been billed later - this is a practice that, in dentistry at least, is dying. Why? Because people do not pay. Dental insurance does not pay nearly as well as hospitalization policies and patients do not understand this. Most plans do cover routine cleanings and Xrays, but other work has a pretty big co-pay. You would be amazed at the people that walk out of the office, pain free, and decide that the dentist will get whatever the insurance pays and that is all. After all, the dentist can't take the filling out, or undo the root canal, or replace the wisdom teeth. Dentists have had to get very creative about their financing and payment plans. Many have determined that if they aren't paid up front, then they'd rather the patient find another dentist. They are tired of working and then writing off 10 or 20% or more, because of dead beat patients. Even getting people to pay up front doesn't solve the problem. A check isn't even a guarantee - many bounce. Sadly, those who will not live up to their obligations have messed things up for honest, reliable people. It also drives health care costs up. Lets face it, we are all paying for those who won't pay. Lest you think that I am only referring to lower income people, think again! Some of the people who have owed my husband's practice significant amounts of money are some of the wealthiest people in our area. It is like pulling teeth, no pun intended, to get them to pay.

In general, there are reasons that money is expected up front, and it isn't all greed on the part of the health care professional.

 

[saltymalty]

Insurance companies are notorious for not paying full costs for dental procedures. You would do best to review your policy before you make any calls. Your policy documents will tell you exactly what the co-pay, deductible, and other charges will be for specific procedures. You should also request an itemized bill from the dentist, including insurance codes. You can then call the insurance company to see exactly what they are willing to cover. Don't be afraid to ask what a particular code means, or if there is a similar procedure that is covered. Sometimes doctors do write down the "wrong code" which ends up being your problem. I would not pay the bill until this is resolved. Instead, I would write the dentist a letter stating that you are sorting the insurance issue out and that you will not pay the bill until your insurance coverage is clear. If you don't get satisfaction, I would call the NY Attorney General, Elliot Spitzer. He has really been cracking down on insurance companies and their payout policies. It might also be that the insurance pays "reasonable and customary charges" that are significantly less than what the dentist charges. Depending on your coverage, the dentist may be able to collect the difference in these fees. However, if the dentist has a contract plan with your insurer, then he may be prohibited from collecting these charges under his contract. The thing is that often times, doctors still bill patients because billing is handled by a third party billing operation. Keep written records of everything, especially because you plan to apply for a mortgage. That way, you won't have any problems when your credit review is done. Good luck.

 

[FannyMay]

She already paid the bill so she can't tell them that she won't pay till she gets is straightened out with the insurance company.

My husband's dental insurance is really good. We don't have a "cap" that I know of. We have gone well over $1,000 this year alone. I have really, really bad teeth (congenital) so I have had alot of work done. I recently got a tooth pulled that had 3 previous root canals done on it and then they fitted me for the partial that I have now. I have to go back in a week or so to get it adjusted. We ended up paying only about $300 to get the tooth pulled and the partial made. All our cleanings are paid for (even deep cleanings if they ask the insurance company months in advance first). We also get free fillings (only the silver ones) and we pay extra for the white fillings (we only have silver fillings lol).
I also always ask how much everything will be. I even had them give me a print out of the price of the partial compared to a bridge and a permanent. The partial was $100 less than the bridge and with a partial I can upgrade to a permanent (about $2,000) years down the road without having to worry about ruining my teeth around the pulled tooth.

I also call my insurance company every time I don't think we should have been billed. They always go over it and realize they made a mistake and I never end up having to pay.
So if I were you I would read over my dental plan and then call your insurance company. If it was their mistake they will reimburse you for the money you paid extra since you already paid it.
I hope it works out for you.

 

[Vikki and Audrey]

Update:

I left a message for the actual dentist (not receptionist) to call me and he just did. First thing he said was that he apologized for the confusion.

We went over everything I have paid over the last year with him and he thinks I may have been overcharged about $100 in the past. He also offered to refund what I had paid and let me do a payment plan instead so I wouldn't have a big hit all at once. I said it was fine and he agreed to wait and see what the insurance company would pay for and he'll refund the rest.

I feel MUCH better - still a little shocked that it was so much more than expected, but at least he took the time to talk to me about it and is going to keep an eye out for the file himself until the insurance payment comes in.

Thanks for the support, I really needed to talk about it! Great group!