Medical Bills and Insurance

[Matt]

Today I had to resolve an issue with a Dentist the wife visited. When she went there originally and asked if her insurance was good they said yes.

She has a routine cleaning, and a bill comes in for $1600.

The insurance company that covers this (Delta) decided to pay up $246 of this, and the Dentist attempted to get us to pay the balance.

I know this is BS, and I went there today to sort it out, they again asked for the money, were really aggressive and rude and refused to sign a paper I had with me that stated they wouldn't come after us for more money.

They said that they wouldn't 'help us out like this' by signing, that we would have to 'take their word that it was done'.

I dealt with them personally and simply couldn't get a signature out of them, and and trust them about as far as I can throw them.

For those who work in the industry, what can be done to protect people against this? I know that they must be successful in effectively scamming people by fear and threats. My thoughts were to from now on get a note in writing from the doctor/dentist that they will not seek any payment from us in addition to what they can get insurance to pay.

Love to hear your thoughts.

 

[ushdadude]

First off, I've never heard of a routine cleaning that costs $1600. Maybe they did scaling and root planing ie "deep cleaning"?
Second, there is a big difference between accepting someone's insurance and participating in the insurance. Accepting means that they the dentist sets the fee and bills out to the insurance. whatever they don't cover, the patient is responsible for. Participating in the insurance means that the dentist signed a contract with the insurance company and CANNOT bill the patient for anymore than the fee schedule determined by the insurance company.
I don't know of any dentist who would signs this type of note because the fees are usually discussed beforehand. The patient should know what they are are responsible for before the treatment is started. If it is extensive treatment the dentist will usually send in pre-authorization to the insurance company.
As for the dental staff personalities, I have no answer.
Hope this helps.

 

[Matt]

First off, I've never heard of a routine cleaning that costs $1600. Maybe they did scaling and root planing ie "deep cleaning"?
Second, there is a big difference between accepting someone's insurance and participating in the insurance. Accepting means that they the dentist sets the fee and bills out to the insurance. whatever they don't cover, the patient is responsible for. Participating in the insurance means that the dentist signed a contract with the insurance company and CANNOT bill the patient for anymore than the fee schedule determined by the insurance company.
I don't know of any dentist who would signs this type of note because the fees are usually discussed beforehand. The patient should know what they are are responsible for before the treatment is started. If it is extensive treatment the dentist will usually send in pre-authorization to the insurance company.
As for the dental staff personalities, I have no answer.
Hope this helps.

It does help, thanks!

Yes, I think they did the 'we accept the insurance' line, but didn't explain what that meant, meaning that they were going to charge her but didn't tell her this.

And yes, you are correct about the scaling and root planing. But this wasn't asked for.

She went in, asked if they took her insurance and asked for a cleaning... they said yes.

Am I wrong in thinking that the behavior here is unusual? It strikes me as deceptive. As does their refusal to sign a receipt of my check today, and that instead we must 'trust them'.

 

[tkky]

Most dental insurance is crap. That's the foundation you have to start with. Most of it is unlike medical insurance and you almost always have a balance to pay.

And I agree with your disappointment in the bait and switch (or non-consent for the treatment).

 

[ushdadude]

It does help, thanks!

Yes, I think they did the 'we accept the insurance' line, but didn't explain what that meant, meaning that they were going to charge her but didn't tell her this.

And yes, you are correct about the scaling and root planing. But this wasn't asked for.

She went in, asked if they took her insurance and asked for a cleaning... they said yes.

Am I wrong in thinking that the behavior here is unusual? It strikes me as deceptive. As does their refusal to sign a receipt of my check today, and that instead we must 'trust them'.

An office should be straight up with a patient and clearly tell them who is responsible to pay what. You don't really ask for a s r/p. If the dentist thinks it's necessary they'll recommend it. Again, it should be spelled out before the treatment is done. I find that it is better to be forthright with patients from the beginning and avoid these types of situations. Some still aren't happy when they get the bill but at least there was complete transparency.

 

[cocobird]

My thoughts were to from now on get a note in writing from the doctor/dentist that they will not seek any payment from us in addition to what they can get insurance to pay.

Love to hear your thoughts.

Regarding your last thought, I would add that dental insurance may fully cover certain preventative care such as an examination, x-rays, and teeth cleaning; however, other things such as fillings, crowns, and other dental work are not fully covered and often require a significant payment by the patient. I'd suggest a review of your policy to see what may or may not be fully covered before trying.

In this particular situation, that dentist sounds unethical and I'd probably file complaints with the BBB and the insurance company. Probably won't help solve your issue, but at least you could warn others.

If you have a local consumer assistance group (example - one of our tv stations will try to resolve issues and then airs it, which often scares the business into resolving the problem), you might try them.

For what it's worth, although the dentist may try to impact your credit report, most lenders ignore "medical" claims because of the notoriously poor and delayed payment system. Also, you can always explain it if asked about it.

 

[Jason Annan]

Couple of questions:
1. Were you are a private office or a doc-in-the-box (like Aspen Dental or DentalWorks?). Makes a huge difference in quality of care.
2. Let us know the full description of procedures. No way in the world any dentist charges $1600 for a "routine cleaning", and if your wife had scaling/root planning, that still a steep charge. Unless you have a crap insurance policy, a lot of s/rp is paid for at 80%, 50% at a minimum. So the $246 insurance payment isn't adding up. A full breakdown would be helpful for me to give you sound advice.
3. As echoed above, dental insurance is NOT medical insurance. Think of dental insurance as a really, really bad savings plan. You (or your company) are essentially paying in premiums about the maximum amount you get in benefits, less insurance profits. It's tough love to say, but I tell all of my patients: you are better off setting aside $100 a month into a rainy day fund, or better a HSA. Use this for dental work. Keep Delta, or MetLife, etc., out of the mix.
4. Sorry to say it, but ultimately YOU are the policy holder. Not the dentist. So it is up to YOU to know YOUR insurance. Please, I don't mean this to be smug, but you are a much better advocate for yourself if you know the policy you own. Example: do you know you yearly max, deductible, co-pays by service type (basic, preventative, major)? Yes, all of this is in the manual you get from the insurance company.

 

[Matt]

Couple of questions:
1. Were you are a private office or a doc-in-the-box (like Aspen Dental or DentalWorks?). Makes a huge difference in quality of care.
2. Let us know the full description of procedures. No way in the world any dentist charges $1600 for a "routine cleaning", and if your wife had scaling/root planning, that still a steep charge. Unless you have a crap insurance policy, a lot of s/rp is paid for at 80%, 50% at a minimum. So the $246 insurance payment isn't adding up. A full breakdown would be helpful for me to give you sound advice.
3. As echoed above, dental insurance is NOT medical insurance. Think of dental insurance as a really, really bad savings plan. You (or your company) are essentially paying in premiums about the maximum amount you get in benefits, less insurance profits. It's tough love to say, but I tell all of my patients: you are better off setting aside $100 a month into a rainy day fund, or better a HSA. Use this for dental work. Keep Delta, or MetLife, etc., out of the mix.
4. Sorry to say it, but ultimately YOU are the policy holder. Not the dentist. So it is up to YOU to know YOUR insurance. Please, I don't mean this to be smug, but you are a much better advocate for yourself if you know the policy you own. Example: do you know you yearly max, deductible, co-pays by service type (basic, preventative, major)? Yes, all of this is in the manual you get from the insurance company.

This is why I disagree. We have a crappy dental plan, but it does cover a cleaning a year.

So when we go to a dentist and say:

"My plan covers a cleaning, do you take my plan"

and they say

"yes"

We shouldn't be getting anything more, so I think that they screwed us by 'upgrading' the cleaning to the scaling/planning, which isn't something a consumer would know about, and then said oh yeah you are covered, but you have to now pay $1300 more...

It's clear deception.

 

[Jason Annan]

Yep, agree with you there. No way in hell I'd do anything but look without a signed financial agreement from the patient. Your wife didn't sign any consent? S/RP involves numbing and a lot of scraping--it's a big procedure. In my office we schedule for 2 hours for the entire mouth. It's a procedure code that's heavily abused, especially in the doc-in-a-box outfits like Aspen.

Since this is a site about Personal Finance, I think it would be a useful endeavor to lay out your insurance premium payments versus the returns you see. Eye opening.

 

[Matt]

Yep, agree with you there. No way in hell I'd do anything but look without a signed financial agreement from the patient. Your wife didn't sign any consent? S/RP involves numbing and a lot of scraping--it's a big procedure. In my office we schedule for 2 hours for the entire mouth. It's a procedure code that's heavily abused, especially in the doc-in-a-box outfits like Aspen.

Since this is a site about Personal Finance, I think it would be a useful endeavor to lay out your insurance premium payments versus the returns you see. Eye opening.

Yeah, from a personal finance perspective I would rather look into what medical companies are charging insurance companies and work that direction - but a lot to tackle! I found this article quite shocking http://www.bloomberg.com/news/2014-04-09/top-medicare-doctor-paid-21-million-in-2012-data-shows.html but that is only part of the puzzle.

I personally don't visit doctors very much, I don't trust insurance and billing in the US and I think many docs aren't good anyway. I do remember going to a Chiropractor and having him put a stim machine on me for 30 mins. When I asked about cost (concerned it wasn't covered) his answer was - don't worry, if they don't pay us we don't charge you.

I saw the bill... $2500

Seems to me that a lot of medical practitioners are billing very large amounts in the hope they can 'get what they can get' from insurance.

I know there are good people out there too, but they are so hard to find with all the dodgy folk.

 

[cocobird]

I would urge you to find a physician you are comfortable with. Finding a good reliable doctor is going to be very important once you have a baby. It is not a project you want to put off. I would guess that your wife will be meeting many other new mothers and perhaps can get some reference. She can also talk to her doctor or midwife if that is what she is using.

Although you do not trust doctors, you don't want to be in the position of having to find one on an emergency basis either No matter how carefully you plan, the unexpected can happen (tripping and breaking a bone, car accident, etc). Plus, good doctors often do not take new patients because they have all the work they can handle. Best to become a patient first so you have the option.

 

[Matt]

I would urge you to find a physician you are comfortable with. Finding a good reliable doctor is going to be very important once you have a baby. It is not a project you want to put off. I would guess that your wife will be meeting many other new mothers and perhaps can get some reference. She can also talk to her doctor or midwife if that is what she is using.

Although you do not trust doctors, you don't want to be in the position of having to find one on an emergency basis either No matter how carefully you plan, the unexpected can happen (tripping and breaking a bone, car accident, etc). Plus, good doctors often do not take new patients because they have all the work they can handle. Best to become a patient first so you have the option.

Sound advice - however we are moving in 5 days And then moving again

After that, I think it's a high priority.

 

[ushdadude]

I would urge you to find a physician you are comfortable with. Finding a good reliable doctor is going to be very important once you have a baby. It is not a project you want to put off. I would guess that your wife will be meeting many other new mothers and perhaps can get some reference. She can also talk to her doctor or midwife if that is what she is using.

Although you do not trust doctors, you don't want to be in the position of having to find one on an emergency basis either No matter how carefully you plan, the unexpected can happen (tripping and breaking a bone, car accident, etc). Plus, good doctors often do not take new patients because they have all the work they can handle. Best to become a patient first so you have the option.

i second that for dentistry

 

[TinyElvis]

A better question than 'do you take the plan?' is 'are you in network?'. If the answer is no then you'd better ask for rates ahead of time.

I have learned to value the pre-negotiated rates that medical/dental insurance gives you. It irritates me to no end to see a statement from my medial insurance company where some item was marked down from something like $970 to $12 (and no I'm not exaggerating) due to negotiated rates. It must be brutal to be sick and uninsured.

 

[Annie H.]

The problem with Delta is that they have several levels of participation/insurance/dentists-- PPO, Premier, USA, Direct. In the PPO network the dentist must accept Delta payment as payment in full. At other levels--such as Premier--the dentist does NOT have to accept your payment as PIF and can upcharge you. Take this as a lesson to ask: 1) what's the charge for this procedure 2) does my insurance cover 100% 3)check out the website or call your insurance http://www.deltadental.com/DentistSearch/DentistSearchController.ccl to verify the coverage prior to treatment. Once you're settled into a health or dental plan, you'll become familiar with what is covered.

This is one of the biggest problems in US healthcare--the huge difference providers charge--for MRI, surgery, consultations, etc.--and the difficulty of getting a doc/provider to give an upfront quote. There are stories on Bogleheads and other places detailing successful negotiations--as mentioned above. Another tactic is if you have to go to a provider not in your network ask for a "courtesy reduction"in the billing to the lowest managed care reimbursement rate. This can result in 25% savings

. Finally, if your finances or I should say, lack thereof, warrant it you can submit a "letter of hardship" asking for a lower rate:
http://www.cbsnews.com/news/slash-your-medical-bills-7-ways-to-haggle/

 

[Matt]

The problem with Delta is that they have several levels of participation/insurance/dentists-- PPO, Premier, USA, Direct. In the PPO network the dentist must accept Delta payment as payment in full. At other levels--such as Premier--the dentist does NOT have to accept your payment as PIF and can upcharge you. Take this as a lesson to ask: 1) what's the charge for this procedure 2) does my insurance cover 100% 3)check out the website or call your insurance http://www.deltadental.com/DentistSearch/DentistSearchController.ccl to verify the coverage prior to treatment. Once you're settled into a health or dental plan, you'll become familiar with what is covered.

This is one of the biggest problems in US healthcare--the huge difference providers charge--for MRI, surgery, consultations, etc.--and the difficulty of getting a doc/provider to give an upfront quote. There are stories on Bogleheads and other places detailing successful negotiations--as mentioned above. Another tactic is if you have to go to a provider not in your network ask for a "courtesy reduction"in the billing to the lowest managed care reimbursement rate. This can result in 25% savings

. Finally, if your finances or I should say, lack thereof, warrant it you can submit a "letter of hardship" asking for a lower rate:
http://www.cbsnews.com/news/slash-your-medical-bills-7-ways-to-haggle/

Hi Annie, that's great advice. However I want to go on and say the problem isn't with Delta. The problem is with a system that uses industry specific terminology that is confusing and deceptive to the consumer. I know for an absolute fact that these guys bully their patients, and that many of them must crumble in fear of them.

And none of that happens prior to billing.

 

[Annie H.]

The problem is with a system that uses industry specific terminology that is confusing and deceptive to the consumer. I know for an absolute fact that these guys bully their patients, and that many of them must crumble in fear of them.

And none of that happens prior to billing.

Welcome to Healthcare in the US-- run by Big Pharma and Big Insurance. Americans pay some of the highest prices in the world for medical care & prescription drugs, in many cases more than twice as high. Take a look at some comparisons here:
http://www.scribd.com/doc/218696892/International-Federation-of-Health-Plans-2013-Comparative-Price-Report

Even more astounding, WHO ranks us 37th in the world in QUALITY of care, despite being the #1 most expensive.

http://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems_in_2000

Down off my soapbox now...

 

[Matt]

Welcome to Healthcare in the US-- run by Big Pharma and Big Insurance. Americans pay some of the highest prices in the world for medical care & prescription drugs, in many cases more than twice as high. Take a look at some comparisons here:
http://www.scribd.com/doc/218696892/International-Federation-of-Health-Plans-2013-Comparative-Price-Report

Even more astounding, WHO ranks us 37th in the world, despite being the #1 most expensive.

http://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems_in_2000

Down off my soapbox now...

Indeed. It certainly smarts more as a foreigner coming from a place with 'free' healthcare.

 

[MoneyMateKate]

You know that form they make you sign, basically saying you promise to pay no matter what? After getting the same runaround you describe with "accepting my insurance" v. "in-network" (needed a tooth pulled), I have fantasized about handing THEM a form to sign saying they will inform you of the cost before doing anything. Yes, I know that they never know how much they're going to get from specific insurance companies and specific plans, but I think that's a crappy excuse.