Dental office is in network.
Chronology:
Dental visit in July 2021 for an exam; a scale and plane (D4341) was scheduled for two days the following week (right and left sides of mouth). This claim (for the exam) processed and paid as in network
Visit August on two consecutive days for procedure upper and lower left first day and upper and lower right the following day. Paid my 20% copay. The question is about this claim and will be explained below.
Visit first week of March for periodontal maintenance cleaning. Paid 2022 deductible and 20% copay; claim processed and paid as in network (I just checked the insurer website today).
When I got home from the periodontal maintenance I looked at the bill before filing it and noticed it showed an outstanding balance from the two August 2021 visits. I checked my insurance website and noticed no claim had ever been filed for the August visits. I called the dental office and the receptionist said, “Oh yeah, I noticed that. Don’t worry about it, we’ll file it now.”
Today I get an envelope in the mail from the insurance company. Inside is a check payable to myself. Explanation states it is in payment for the August procedures and and the breakdown says “Network: Nonparticipating dentist.” (Note that the Business/Dentist listed on all the claims is the same. Some just say “XXX Network.”)
Now it gets weirder: The amount they are paying for procedure D4341 is a little over twice the amount the dentist stated the procedure would cost. I still have the bills from August.
The dental office billed the new higher amount even though I have paperwork showing they were going to bill an amount ~50% as high. They also state that I paid more (my 20%) than I actually did.
I haven’t called the dentist yet (got the mail too late) but I’m sure they will want me to pay them the entire amount of the check, which seems right except that they billed the procedure last August at a lower price.
The whole thing seems fishy. The fact that they were so nonchalant that they were never paid for the August visit (because they never filed a claim originally) seems fishy. Before I call them and/or the insurance company can anyone enlighten me on what may be going on?
submitted by /u/Culican
[link] [comments]Dental office is in network. Chronology: Dental visit in July 2021 for an exam; a scale and plane (D4341) was scheduled for two days the following week (right and left sides of mouth). This claim (for the exam) processed and paid as in network Visit August on two consecutive days for procedure upper and lower left first day and upper and lower right the following day. Paid my 20% copay. The question is about this claim and will be explained below. Visit first week of March for periodontal maintenance cleaning. Paid 2022 deductible and 20% copay; claim processed and paid as in network (I just checked the insurer website today). When I got home from the periodontal maintenance I looked at the bill before filing it and noticed it showed an outstanding balance from the two August 2021 visits. I checked my insurance website and noticed no claim had ever been filed for the August visits. I called the dental office and the receptionist said, “Oh yeah, I noticed that. Don’t worry about it, we’ll file it now.” Today I get an envelope in the mail from the insurance company. Inside is a check payable to myself. Explanation states it is in payment for the August procedures and and the breakdown says “Network: Nonparticipating dentist.” (Note that the Business/Dentist listed on all the claims is the same. Some just say “XXX Network.”) Now it gets weirder: The amount they are paying for procedure D4341 is a little over twice the amount the dentist stated the procedure would cost. I still have the bills from August. The dental office billed the new higher amount even though I have paperwork showing they were going to bill an amount ~50% as high. They also state that I paid more (my 20%) than I actually did. I haven’t called the dentist yet (got the mail too late) but I’m sure they will want me to pay them the entire amount of the check, which seems right except that they billed the procedure last August at a lower price. The whole thing seems fishy. The fact that they were so nonchalant that they were never paid for the August visit (because they never filed a claim originally) seems fishy. Before I call them and/or the insurance company can anyone enlighten me on what may be going on? submitted by /u/Culican [link] [comments]Read Morer/HealthInsurance