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Look At Your Medical Bills Before Paying

This article was written by in Health. 15 comments.


My dentist’s office is changing billing procedure. I should note that my dentist is not part of an insurance network. It may be a cliché, but I have heard people who say that any dentist who aligns his office with insurance carriers is one you want to avoid. That doesn’t mean that I have to pay the full cost of my visits; my insurance (currently Aetna with COBRA through my former employer) still covers almost all of what my dentist charges for semi-annual maintenance. I haven’t had any problems come up, but the insurance company would cover most of that cost, as well.

As long as I have been a patient of my current dentist, the office calculates what it expects my insurance to cover before I leave the office. They submit the bill to my insurance company, and I pay the estimated remainder. It’s often not much. Occasionally, the estimate is off, and the dentist credits my account or bills me for their underestimation of the insurance company’s reimbursement. This system has worked well, at least for me. It’s less money out of my pocket than if I had to pay the full bill myself and submit the claim to my insurance company after the fact.

Starting with my next visit, approaching within the next few months, this will be the new procedure. The office has decided that rather dealing with the insurance companies directly for payment, this will be the patients’ responsibility. Before leaving the office, I will need to pay the full amount on the bill, and when I get home, I’ll need to submit a claim to my insurance company. I’m not particularly happy about the change.

I’ll need to pay more out of pocket. While the dentist office has claimed that insurance payments come within just a couple weeks, now that payments are going to a patient rather than the dentist, the claims could take longer to process. If there are any disputes, I may have less leverage than a dentist, though I have more motivation to pursue the case. I don’t like the idea that more paperwork will be my responsibility, but it’s always my responsibility to ensure I’m paying no more than I need to.

I was reminded of my dentist’s procedural change by Cameron Huddleston’s article in Kipligner. She received a bill from her doctor that was higher than she expected. She called the office to confirm that the doctor did not submit a claim to her insurance. I would imagine that some patients blindly pay any bill they receive from their doctor’s office, assuming the amount listed is what they owe after the insurance company has already covered part of the bill. It’s good to be aware of the costs of services and to review the bills.

Kiplinger

Published or updated July 10, 2011. If you enjoyed this article, subscribe to the RSS feed or receive daily emails. Follow @ConsumerismComm on Twitter and visit our Facebook page for more updates.

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About the author

Luke Landes, also known as Flexo, is the founder of Consumerism Commentary. He has been blogging and writing for the internet since 1995 and has been building online communities since 1991. Find out more about him and follow Luke Landes on Twitter. View all articles by .

{ 15 comments… read them below or add one }

avatar Bobka ♦13 (Newbie)

Unlike medical insurance which is designed to spread risk among many people and reduce the cost of a potential medical catastrophe, dental and vision care insurance are more like pre-paid preventative care plans. Some of the dental plans pay a dentist per head whether you use the services or not. Therefore some dentists feel that if you show up, you are only using valuable time that would otherwise be utilized by “paying” patients. Under such circumstances, do not be surprised if you are pressed to purchase additional services. One local dentist, for example, was routinely having hygienists recommend additional cost “deep cleaning”. Another was allowing only ten minutes for a dental hygiene appointment. For vision care, my optometrist was forced to use a substandard lab contracted to the insurance company. After five remakes, my doctor had to plead with the insurance company to allow him to use his normal reliable lab. When they finally agreed, I had perfect glasses made overnight.

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avatar wylerassociate ♦906 (Dime)

Bobka makes a good point because if a person does “deep cleaning” that is a much higher copay than a routine dental appointment which is either a $0 or 10 copay.

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avatar Pat S

Even if you have full coverage insurance, look at the bills. The cost of even a simple procedure will be eye opening, and prove why you need a good insurance company, regardless of your age.

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avatar Money Beagle

That’s kind of a bummer from a customer service perspective, but I’m guessing that they had quite a few no-pays that justified making that move. Too bad they couldn’t grandfather in long-time customers into the old way.

In either case, you’re right, it always helps to check and I was recently guilty of the ‘not paying close enough attention’ syndrome. My wife recently gave birth and her OB charges one lump sum for the delivery as well all the checkups along the way. A bill came in that had an office visit co-pay. I paid it without question. She saw it after the fact and didn’t think we should have been billed for it. Turns out that it was billable because of a maximum allowable number of visits during the pregnancy, but at least she checked to confirm.

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avatar Tom Murin

I switched dentists after getting a quote for 2 crowns. The current dentist would have cost a few hundred $$ more for each tooth. They also charged me for the full amount for service, but would submit the bill to my insurance carrier directly. I would get reimbursed in a few days – well before my credit card bill was due. I would also submit the out of pocket to my healthcare FSA. The new dentist (who was my prior dentist until I moved about 45 miles away) was not only less for the crowns, but they also accepted the insurance and had me pay only for the deductible and co-pay. I liked the old dental office, but their prices were just too high and I told them so when I cancelled my appointment.

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avatar SteveDH

I agree with you and with all the comments about always rechecking billing information but I think the leverage comment might be wrong. We’ve all heard of complaints by Doctors and about the way insurance companies, once the contract is signed, change into bullies. If they’ll talk to you, ask what really prompted the change – I doubt it’s a mere timing issue – they may feel they’re not getting what their due notwithstanding the “burden” of the process.

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avatar qixx ♦1,819 (Half-Dollar)

Always double check your insurance coverage as well. Sometime there is no mistake in the Dr office end, just in insurance that underpays. Luckily when this happened to me the Dr office was willing to work with me on payment (and wait for insurance to pay their whole amount).

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avatar Edwin Alexander

I just applied for Aetna health insurance as an individual and did not get how this dental insurance they offered work, therefore, chose not to purchase. It is a difficult product to understand, sounds even harder to deal with.

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avatar Ceecee ♦796 (Dime)

This is why my friends and I are tempted to make a medical/dental trip to Mexico or Costa Rico. Things here have gotten out of hand.

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avatar Juggler314

Flexo, if you have been going for a while, tell your dentist that you will be changing dentists due to this change in policy – offer to stay if they will let you have a credit account. That way you can file and then pay when you get your check. If they refuse…change dentists. I’ve had providers do this and it sucks. Insurance processing should just be considered part of your job as a medical provider (they do get paid a lot for their services…). Foisting it off to the customer is just lazy. And doing it because of some bad accounts…well that’s the cost of doing business – if the estimates being off resulted in patients owing…which was never recovered a simpler solution would be to charge a bit extra just in case and always be reimbursing customers for the difference.

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avatar shellye ♦107 (Cent)

One other thing to consider…my primary care doctor’s billing office will collect their co-pay up front (usually $20) then bill my insurance. They will send me a bill for the remaining balance. Which is fine, until I meet my yearly deductible. Then it’s covered at 100%. If the doctor’s office gets 100% of payment from the insurance company after they’ve billed me for my portion, the office KEEPS that money. They won’t issue a check, but rather credit me on a future visit. Since I’m relatively healthy and only go to the dr. if I’m really sick (plus routine visits once a year), the practice gets to use my money for months and years. I think they’re still working off a big credit they overbilled me for.

I love my doctor, but her billing staff leaves a lot to be desired.

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avatar Cameron Huddleston

Glad my recent column inspired you — Cameron

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avatar Medical claims denial

Rumor has it that up to 80% of medical bills have errors. Some procedures are denied incorrectly.

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avatar Cejay ♦1,521 (Half-Dollar)

I look at all my medical bills. I sometimes kid that I work all day with paperwork and then do it at night. But as everyone has mentioned it is my reponsibility to make sure that the charges are correct. I call the office if I have any questions. And I keep detailed notes and pursue the matter relentlessly. I do think they did away with it but at one time my insurance company had a program that if you found an error on a medical bill and pointed it out you got a prize. I don’t know how much it was because I never found an error. I will also say that my insurance EOBs have gotten more complicated recently.

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avatar skylog ♦368 (Nickel)

i totally agree with this. while i have only had one or two small issues with this, the bills are often so confusing and the charges/details somewhat obscure, the potential for a major problem is certainly real. when one starts talking about major procedures, a small error here and there can make a huge financial difference.

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