Tooth Talk: Insurance trouble? Inform yourself first

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Tooth Talk: Insurance trouble? Inform yourself first
July 28, 2008
By FRED ECK
marconews.com

Q: IĖm really mad. I just had a bunch of work done at my dentist. I paid my portion and now he sent me a bill because the insurance company didnĖt pay the rest. I donĖt think I should have to pay it. I think they made a mistake and was probably overcharged. Before I call the Better Business Bureau I thought I would ask you what you think. Can you help?

A: This is an all too common problem. I can help but you are probably not going to like my answer.

Since you have not told me what type of work you had performed, I can only offer assistance based upon my own experience with many, many, many similar situations.

Normally, when you are seen for dental work the fee is given to the patient. If dental insurance is involved, most offices will ÏestimateÓ the patients portion. The word estimate is key because there may be many factors unknown to your dentist that will affect the amount of money that the insurance company may or may not pay towards dental treatment.

To go further, each dental insurance plan is different and may include or exclude any number of procedures, waiting periods and time limits. When a claim is submitted, it is processed by a person who doesnĖt know you, doesnĖt know your needs, doesnĖt know your dentist and knows nothing about teeth or dentistry in general. They do know they have a claim to process which involves determining if you have benefits left for the year, if you have paid your deductible and what amount of money does the insurance company allow towards the treatment you had done.

In every circumstance that I have ever come across, the benefit paid will be less than your dentistĖs fee. See? I told you that you wouldnĖt like my answer.

This does not mean that you have been overcharged or a mistake has been made. Remember the person at the insurance company processing your claim? If they havenĖt lost it (which is a real possibility) they may have determined that your plan doesnĖt cover that service, your deductible wasnĖt paid, your plan has a waiting period or any number of things.

We always try to encourage our patients to familiarize themselves with their insurance plans. I understand they can be complicated but I would urge you to make a phone call so you can be better informed and prepared.

You may need to call your human resources person or the insurance company directly and ask them to explain exactly your deductible, what is included and what is not. Also, ask if there is a waiting period for certain procedure and what those procedures are.

Get the name, number and extension of the person with whom you spoke. This can be very important if you feel you may have been misinformed. If there has been a mistake made, both you and your dentist can work as a team to get the insurance company to rectify the error.