I just started going to a new dentist. They’re part of a large practice. The specific dentist I see is listed on my dental insurance website as in network (Metlife). The EOB lists another dentist’s name, also part of the same practice, seemingly one of the initial dentists and/or owner(s).
Does anyone know if this indicates anything wrong? Should I ask questions about this, or is this completely normal/acceptable.
The office still may owe some refunds to me, and they haven’t contacted me about them yet (been about 45 days since the insurance company paid them) and I’ve been back in a couple times and they continue to just charge me the full amount of that day’s service. So normally I wouldn’t ask questions about the dentist’s name, but it’s just starting to seem a bit weird.
This is not usual but I also wouldn’t worry about it. Normally the actual provider’s name shows up. But if it’s the same practice and both are in network, it probably doesn’t make a difference. But, do follow-up on your balance. In my experience, dentist offices aren’t as good as other medical providers at updating your account with insurance discounts and payments.
Yeah, I’m with @scripta on this. Prior to the dentist I have now, I never paid a dentist at the time of service. They verified that I had dental insurance, and billed me after insurance paid their portion.
My current dentist can see my coverage and requires that I pay the patient portion that they estimate I will owe. They are sometimes wrong, and I then have to chase them for the money.
My dentist offers a 5% discount for paying in full up front (I guess it saves them some hunting down customers who may or may not pay), then I get reimbursed by my insurer. I could wait until the insurer pays their portion too but it’s usually not worth it. Between cashback on the full amount of the bill, not just my copay, and that 5% discount which does not appear on what they bill the insurer, some minor procedures covered at 90+% end up making me money so it’s an acceptable setup.
you MUST contact your dentist’s office. If its anything like the medical profession, even tho insurance covers the procedures, some docs do not accept the payment. Had this problem years ago with a minor surgery. Anesthesiologist group was listed on my GHI plan, but I got a bill months later for like 850.00. Found out this particular doc in the plan did not accept the payment but the others did. made a big stink and GHI did pay him. Now any procedures (medical/dental) I specifically ask if this doc takes the insurance even if his group is listed.
I’m pretty certain most dentists are employed by the practice, and it’s the practice that does the billing. If the practice was originally a one-person office, the billing may still be done under that legacy name.
I doubt it’s anything to worry about, but it definitely is something to ask about (you never know what you might learn).
They collect from you, then still bill the insurance, and the insurance reimburses you? I thought that when you pay the provider, it’s typically up to you to submit the receipts to insurance for reimbursement? When they bill the insurance, doesnt the insurance company send them the payment?
Dentists are often out-of-network. That means in many cases balance-billing applies. Dental insurance is more like a “service plan”, it’s pretty common to not have things covered fully.
Some of the in-network reimbursement rates are absurdly low. For people who aren’t completely bankrupt, it often makes sense to pay for an out-of-network dentist. Just being out of network doesn’t automatically mean they’re trustworthy, but there’s more chance if they’re not paid just $5 for a filling that they won’t do 10 unnecessary fillings at once.
My current dentist has always had a form you sign that says they only do dental insurance billing as a “courtesy” and that ultimately payment is fully the patient’s responsibility.
Thanks, was planning on giving them until next month since I had the final of my scheduled appointments for the near future recently, so want to give them time to get correct reimbursements for all of them so I can just ask for one refund (if it comes down to that). I’m not worried about the refund. I can just dispute with my credit card if necessary, and if it gets to that point, obviously not going back to the same dentist so don’t care if they’re upset about it.
Not sure I follow the question exactly, but insurance only pays 95% of what’s covered. Also, there are some procedures that aren’t covered. I pay what the dentist thinks my responsibility will be. As I’m learning from this thread, that’s not common. With my last dentist, who was awesome, I don’t even recall how he did it. But I do remember the amounts that my HRA paid me (based in info the administrator gets directly from the insurance company) were identical to the charges from my dentist on my credit card.
I stupidly didn’t even bother checking the charges from the dentist until I saw the reimbursement from the HRA and was searching my credit card transactions for that amount, and nothing was coming up. I think it’s just a less financially competent office (even though it’s a large practice compared to my other dentist that was just two dentists in the practice).
This is my current situation it appears. They hopefully, I won’t have to chase them for the money.
Your insurer pays you personally? How do you set this up? Is this common or something specific to your insurer and/or plan?
Yeah, I was nervous about that initially, but I confirmed that my dentist is listed as in plan per Metlife’s website.
I’m not sure what that has to do with my question?
Shandril said she pays the dentist the full amount, the dentist bills the insurance, and the insurance reimburses her for what was covered. That seems pretty unusual. Generally, I thought that if the dentist bills the insurance, the insurance pays the dentists. Or If you pay the dentist, you need then to pursue reimbursement from the insurance yourself.
I like your dentist, as long as his name isn’t Zell, and he doesn’t repeatedly ask if it is safe.
One question, though. Does he know that you have insurance? If not, how does he know to discount his fool blown rate? Okay, that was two questions.
So how did you end up in a situation where the dentist owes you money? Did they underestimate how much insurance would pay them and charged you more in the past?
The reason I asked is because at least my dental insurance works as follows: it fully covers some of the most basic things, like 2 cleanings per year, composite fillings in the front / amalgam in the back, and for all other procedures (or filling upgrades) the dentist agrees to charge the rates approved by the insurance (and there’s a schedule I can download). An in-network dentist can’t just add 5% to everything.
I agree that the short descriptions are not written to be understood by anyone outside of that profession. I usually just look at the billing codes, that’s how the rate schedule is organized. And those codes are standard, so you can google their actual meaning.
That’s not an “or”, that’s the result of the dentist being paid by the insurance. Which I would’ve assumed was the case, except that she said “then I get reimbursed by my insurer” which implies a direct payment to her - which generally doesnt happen when the dentist bills the insurer.