Medical (incl. dental) billing should be straightforward to look up the codes/contracted rates and see what the patient/insurance payment/insurance discount should be and collect appropriately. Yet time and time again office staff can’t figure this out.
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It works like this: they replace a filling on cavity for $250. If I pay in full on the day they do the work, they’ll charge me $237.50 instead which I’ll put on credit card to get 5% cashback (about $12 cashback); then they send it to my insurer (MetLife) which covers 90% on fillings (90% of $250 = $225); then insurer sends me a check for $225 (along with the EOB, takes about a week usually) and insurer assumes I pay the balance somehow. Ends up being nearly $0 out of pocket this way.
If instead, I could let my dentist send the $250 bill to the insurer, insurer would pay the dentist $225, and then dentist would bill me for the $25 balance ($24 after cashback). But that method almost costs me 10% extra and since I always get the check for the covered amount before my credit card bill is due, it doesn’t hurt my float too much.
And the part where I kinda make money is on routine dental cleanings which are covered 100% or procedures covered 90% which I know in advance and can plan to use a limited FSA for.
I was understanding the mechanics. But isn’t it unusual for the dentist to bill the insurance, then the insurance send you a check that they just hope you’ll use to pay the dentist? I’m surprised the dentist allows your upfront payment to be optional, since they’re only going to see the insurance payment if you choose to give it to them.
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They used to call in to check what your coverage was, then bill you for the difference after the insurer paid them. But they had issues with people not paying the balance, claiming to be insured and not actually being, and/or having to resolve issues with insurer. It must be worth their time to not bother about this and let you deal with the insurer to get you the amount covered.
Either way, they’ve been operating this way for about 5 years now and I don’t mind at all.
Which card might that be?
Either of us frequently have a quarterly offer from either Citi Dividends, Citi ThankYou or others giving us 5% on all purchases up to a relatively low limit ($500-1000 usually) to make us use semi-inactive cards. That won’t cover an implant but you get what you can when you can.
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I go to a husband and wife owned dental practice. The wife is the dentist I see, but it has the husband’s name on the EOBs. Sometimes the network search tools only shows one of them in network. As long as I get the in network discount, I can’t say I care.
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It’s ok for the network/billing dentist and the rendering dentist to be different. They should have that info with the payor though and be credentialled