Dental Insurance Question

[Luv Bunnies]

I need to rant for a second, but I'm also wondering if anyone knows how my dentist should be handling this insurance issue. My family has been with the same dentist for over 20 years. DH and I saw the dentist who previously owned the practice and stayed when he retired and she took it over. Both of our adult boys started seeing her when they turned 18 and it was time to leave their pediatric dentist. We have always had the same type of insurance and never had a problem. We would go in for cleanings or procedures, her office would bill the insurance, they would pay and we would pay the balance. A cleaning with fluoride would cost us anywhere from $25 - $40 (if x-rays were done). A filling, crown, etc. would be covered at 80-90% and we would pay the rest. Never had an issue with billing or payment.

This past August, my DH needed a gum graft. It cost close to $1000. We paid about 10% of that. Easy enough. This past February, my DS26 (still covered under my insurance due to a disability) needed the same procedure. I knew it would cost more than DH's since DS needed anesthesia. He has massive anxiety about dental and medical procedures. I figured we would pay about the same percentage as we did for DH. The dental office never gave me an estimate of benefits/out-of-pocket costs, and I had no reason to believe it would be any different.

So last month, we received a check from our dental insurance company. I had never received any kind of check from them before as they had always paid the dentist directly. I called the dentist's office to ask about it. The dentist, herself, returned my call and explained that as of January 1, 2022, she is no longer on contract with our insurance company. I asked her why we were never told. She said the insurance company "forbid" her from informing any of her patients who use their plan. They would inform us themselves. I never received a letter or email stating that our dentist would no longer be accepting our coverage. I told her that since we are such long-time patients, I would expect her office to have told us as a courtesy. When we booked DS's gum graft, she still never told us she was off-contract with our insurance nor gave us an estimate of the charges, which totaled over $2300. For that procedure, the insurance company sent us a whopping $164. Since then DH, DS and I have been in for cleanings. We are now being billed at full cost for those. I assume the insurance company will send us checks for some portion of those charges, but I don't expect it to be much. Our total bill right now is over $2800! And we have dental insurance! There's absolutely no reason for us to be spending so much on dental care. What really bothers me is that neither she nor the insurance company told us that she was going off-contract with them.

So my question is: Who should have told us so we could make an informed choice? The insurance company? The dentist? Or was it up to me to ensure she hadn't dropped our insurance before booking the procedure (keeping in mind that she's taken our insurance for the 20+ years we've been seeing her). My other issue right now is that she made a night guard for my son using an old impression. She never had my son come in to get it fitted, just sent it home with my DH after his appointment. It doesn't fit. DS can't even get it to snap down onto his teeth. No way I'm paying for it. I realize it's time to get a new dentist, but I'm trying to navigate the current charges from this one.

 

[GreatLakes]

I need to rant for a second, but I'm also wondering if anyone knows how my dentist should be handling this insurance issue. My family has been with the same dentist for over 20 years. DH and I saw the dentist who previously owned the practice and stayed when he retired and she took it over. Both of our adult boys started seeing her when they turned 18 and it was time to leave their pediatric dentist. We have always had the same type of insurance and never had a problem. We would go in for cleanings or procedures, her office would bill the insurance, they would pay and we would pay the balance. A cleaning with fluoride would cost us anywhere from $25 - $40 (if x-rays were done). A filling, crown, etc. would be covered at 80-90% and we would pay the rest. Never had an issue with billing or payment.

This past August, my DH needed a gum graft. It cost close to $1000. We paid about 10% of that. Easy enough. This past February, my DS26 (still covered under my insurance due to a disability) needed the same procedure. I knew it would cost more than DH's since DS needed anesthesia. He has massive anxiety about dental and medical procedures. I figured we would pay about the same percentage as we did for DH. The dental office never gave me an estimate of benefits/out-of-pocket costs, and I had no reason to believe it would be any different.

So last month, we received a check from our dental insurance company. I had never received any kind of check from them before as they had always paid the dentist directly. I called the dentist's office to ask about it. The dentist, herself, returned my call and explained that as of January 1, 2022, she is no longer on contract with our insurance company. I asked her why we were never told. She said the insurance company "forbid" her from informing any of her patients who use their plan. They would inform us themselves. I never received a letter or email stating that our dentist would no longer be accepting our coverage. I told her that since we are such long-time patients, I would expect her office to have told us as a courtesy. When we booked DS's gum graft, she still never told us she was off-contract with our insurance nor gave us an estimate of the charges, which totaled over $2300. For that procedure, the insurance company sent us a whopping $164. Since then DH, DS and I have been in for cleanings. We are now being billed at full cost for those. I assume the insurance company will send us checks for some portion of those charges, but I don't expect it to be much. Our total bill right now is over $2800! And we have dental insurance! There's absolutely no reason for us to be spending so much on dental care. What really bothers me is that neither she nor the insurance company told us that she was going off-contract with them.

So my question is: Who should have told us so we could make an informed choice? The insurance company? The dentist? Or was it up to me to ensure she hadn't dropped our insurance before booking the procedure (keeping in mind that she's taken our insurance for the 20+ years we've been seeing her). My other issue right now is that she made a night guard for my son using an old impression. She never had my son come in to get it fitted, just sent it home with my DH after his appointment. It doesn't fit. DS can't even get it to snap down onto his teeth. No way I'm paying for it. I realize it's time to get a new dentist, but I'm trying to navigate the current charges from this one.

Ultimately it is up to you to confirm your providers are still in network but it is really bad of your dentist not to inform you. Mine re-confirms insurance every time. My experience with dental insurance is they are moved in and out of network much more often than other doctors. I've had my same insurance for about 7 years now but am on my 4th dentist because they keep moving around.

I'm also not sure what exactly the insurance company can do to "forbid" any medical provider from disclosing that they left a network. If they are out of the network now what are they going to do? Leave a bad Yelp review?

 

[sam_gordon]

I need to rant for a second, but I'm also wondering if anyone knows how my dentist should be handling this insurance issue. My family has been with the same dentist for over 20 years. DH and I saw the dentist who previously owned the practice and stayed when he retired and she took it over. Both of our adult boys started seeing her when they turned 18 and it was time to leave their pediatric dentist. We have always had the same type of insurance and never had a problem. We would go in for cleanings or procedures, her office would bill the insurance, they would pay and we would pay the balance. A cleaning with fluoride would cost us anywhere from $25 - $40 (if x-rays were done). A filling, crown, etc. would be covered at 80-90% and we would pay the rest. Never had an issue with billing or payment.

This past August, my DH needed a gum graft. It cost close to $1000. We paid about 10% of that. Easy enough. This past February, my DS26 (still covered under my insurance due to a disability) needed the same procedure. I knew it would cost more than DH's since DS needed anesthesia. He has massive anxiety about dental and medical procedures. I figured we would pay about the same percentage as we did for DH. The dental office never gave me an estimate of benefits/out-of-pocket costs, and I had no reason to believe it would be any different.

So last month, we received a check from our dental insurance company. I had never received any kind of check from them before as they had always paid the dentist directly. I called the dentist's office to ask about it. The dentist, herself, returned my call and explained that as of January 1, 2022, she is no longer on contract with our insurance company. I asked her why we were never told. She said the insurance company "forbid" her from informing any of her patients who use their plan. They would inform us themselves. I never received a letter or email stating that our dentist would no longer be accepting our coverage. I told her that since we are such long-time patients, I would expect her office to have told us as a courtesy. When we booked DS's gum graft, she still never told us she was off-contract with our insurance nor gave us an estimate of the charges, which totaled over $2300. For that procedure, the insurance company sent us a whopping $164. Since then DH, DS and I have been in for cleanings. We are now being billed at full cost for those. I assume the insurance company will send us checks for some portion of those charges, but I don't expect it to be much. Our total bill right now is over $2800! And we have dental insurance! There's absolutely no reason for us to be spending so much on dental care. What really bothers me is that neither she nor the insurance company told us that she was going off-contract with them.

So my question is: Who should have told us so we could make an informed choice? The insurance company? The dentist? Or was it up to me to ensure she hadn't dropped our insurance before booking the procedure (keeping in mind that she's taken our insurance for the 20+ years we've been seeing her). My other issue right now is that she made a night guard for my son using an old impression. She never had my son come in to get it fitted, just sent it home with my DH after his appointment. It doesn't fit. DS can't even get it to snap down onto his teeth. No way I'm paying for it. I realize it's time to get a new dentist, but I'm trying to navigate the current charges from this one.

I think it's equally a three part fault... the dentist, the insurance company, and you. Now, I also do not check each year to see if the dentist/doctor/optometrist still takes my insurance. But, if I had the same situation you had, I'd like to think I would have asked about what the procedure would cost for DS. It might help to call the dentist, explain the situation and see if they would be willing to reduce the bill.

 

[Luv Bunnies]

I'm also not sure what exactly the insurance company can do to "forbid" any medical provider from disclosing that they left a network. If they are out of the network now what are they going to do? Leave a bad Yelp review?

Exactly! The dentist said, "The insurance company forbid us from talking to their patients. I said, "Well, I'm your patient too."

 

[Sinder]

The same thing happened to me, my kid’s dentist stopped accepting our insurance and never told me. I blame myself, it is my responsibility to check and make sure we are going to an in network provider.
Having said that it would have been a nice gesture for the dentist to let me know, my kids had been going to him for many years.
When I told him that I would have to find an in network dentist he got real nasty with me. Good riddance.

I noticed at the doctors I visit there is always a notice posted at the receptionist desk alerting patients of insurance changes. It’s a simple way to let people know.

 

[tvguy]

I'm also not sure what exactly the insurance company can do to "forbid" any medical provider from disclosing that they left a network. If they are out of the network now what are they going to do? Leave a bad Yelp review?

It may have been part of their contract with the Dentist. So what can the insurance company do if a Dentist discloses that information in violation of the contract? Sue them for breach of contract. As the Judge said in Jury instructions on the law in a trial I was on the Jury for.........."something can be ethically wrong, but required by law"......in this case, a contract with the Dentist.

 

[Lisa_lvspplmvr]

It really is bad business on the part of your dentist. You weren’t just getting a regular cleaning . Not a good way to keep patients. She could have told you ahead of time so you could make a decision on such a big procedure. Most places won’t work on you unless they know you have insurance. To get an MRI or surgery they call to get an estimate. My dentist also gets an estimate before fillings , crowns etc . I would pay this dentist $25 a month until the bill is gone . They can’t come after you if you are making an effort. I would also see if you can negotiate this bill . Your dentist knew what they were doing . Not good business at all .

 

[Skippy918]

Wow! That sucks! That’s so odd they couldn’t tell you. They should have given you an estimate prior to the procedure so you would have found out sooner rather than later.

I ran across another issue recently with my doctor that she left the practice and I got no notification whatsoever. I only found out cause I was calling to schedule a vaccine appointment for my son and ran into issues trying to get it at Walgreens.

 

[Allison]

I don't believe the insurance company wouldn't let the dentist tell you. They should notify patients when they are no longer part of a network.

 

[mikehn]

This past January my dentist sent out an email notifying patients that he was no longer a provider in such and such insurance. It didnt impact me, but it was nice that he gave a heads up to his patients. Also, when you go in for services, the front desk is supposed to reconfirm your insurance. And if they no longer participate with your insurance, they should tell you. Something shady just went down.

 

[kymom99]

Sounds like she didn’t want to lose a patient

 

[Mackenzie Click-Mickelson]

I sorta doubt the insurance company wouldn't allow her to say anything. I agree with others as much of a pain as it is ensuring you are in-network vs. our of network is our responsibility. That said it is a nice thing if/when a place stops accepting to them patients know, even a sign by their door is at least something. This makes me think it's like the PP said that they were more reluctant to lose a patient and you did play right into it because you didn't move elsewhere even after finding out they were out of network.

I would say you were making an informed decision already because you were told after your son's procedure they were out of network but you continued to go back for cleanings not once but three times between y'all. This isn't to mean you wouldn't have wanted to know before your son's gum graft but that you were informed and still went to the existing practice. If that procedure was $2300 and you owe $2800 this means you incurred excess costs knowingly.

I'd pay it and be finding a dentist in-network if that was my desire (I agree it's frustrating the frequency at which that aspect can change).

 

[JenBush]

My dentist is no longer in network with my insurance as of this year. I got a letter from my dentist office last year explaining my insurance is no longer in network and informed me of the self pay rates as well as a sort of “subscription program” they have available to patients without dental insurance. It would have been nice for them to inform you as you are a long time patient, but I’m sure somewhere in the paper work you signed something acknowledging that you are responsible for knowing if you insurance is in or out of network and what payments you should expect.

 

[Dan Murphy]

Ultimately it is up to you to confirm your providers are still in network but it is really bad of your dentist not to inform you. Mine re-confirms insurance every time. My experience with dental insurance is they are moved in and out of network much more often than other doctors. I've had my same insurance for about 7 years now but am on my 4th dentist because they keep moving around.

I'm also not sure what exactly the insurance company can do to "forbid" any medical provider from disclosing that they left a network. If they are out of the network now what are they going to do? Leave a bad Yelp review?

I don't believe the insurance company wouldn't let the dentist tell you. They should notify patients when they are no longer part of a network.

I agree 100% with the above thoughts.

I would be looking tomorrow for a dentist in your dental insurance network. No notice to the current one that you are leaving, regardless the previous relationship, which in fact, meant little to the dentist anyway.

 

[lanejudy]

I can't get past not asking for an estimate upfront. Either you've had some super-fantastic dental insurance or your family has not really needed much work done until recently. Dental work is expensive and most dental insurance primarily covers the "little" stuff like cleanings and fillings; more extensive work is typically only 50% covered with an annual benefit max of $x,xxx. If your son's procedure required anesthesia, is it possible your medical would kick-in for part? I think that depends on the situation but might be worth checking.

I think you have 2 choices: 1) find a new dentist who is in-network with your insurance, or 2) decide that you really like this dentist despite the insurance snafu and you are willing to stay with her as out-of-network, paying upfront and submitting to insurance for partial reimbursement.

 

[mjkacmom]

This past January my dentist sent out an email notifying patients that he was no longer a provider in such and such insurance. It didnt impact me, but it was nice that he gave a heads up to his patients. Also, when you go in for services, the front desk is supposed to reconfirm your insurance. And if they no longer participate with your insurance, they should tell you. Something shady just went down.

Our dental office does not confirm insurance at every visit, but they did let us know when our insurance no longer participated with our dentist. We work it out, our insurance pays some, we pay some, the office discounts. We love our dentist and have been there 25 years. Our insurance never contacted us.

 

[mjkacmom]

I can't get past not asking for an estimate upfront. Either you've had some super-fantastic dental insurance or your family has not really needed much work done until recently. Dental work is expensive and most dental insurance primarily covers the "little" stuff like cleanings and fillings; more extensive work is typically only 50% covered with an annual benefit max of $x,xxx. If your son's procedure required anesthesia, is it possible your medical would kick-in for part? I think that depends on the situation but might be worth checking.

I think you have 2 choices: 1) find a new dentist who is in-network with your insurance, or 2) decide that you really like this dentist despite the insurance snafu and you are willing to stay with her as out-of-network, paying upfront and submitting to insurance for partial reimbursement.

This is also true, even in network, there is usually a yearly cap.

 

[DisneyHardin]

Sounds like she didn’t want to lose a patient

That's what I was thinking too. It seems very odd that the insurance company made the Dentist sign an agreement that they wouldn't tell their patients that a certain insurance was dropped.

My dentist's office tells me my expected out of pocket price on every procedure before they begin the work.

 

[JLTraveling]

I'm at a loss. That is such a bad business practice, not only from a customer service perspective but also from a financial one. I have no doubt that you have the ability to pay (even though you absolutely shouldn't have to), but there are an awful lot of people out there who could NEVER, even at $25 a month, ever pay off a $2800 bill. They can send it to collections, wreck people's credit report...still doesn't get them paid. I'm sorry this happened. I can't even imagine what they were thinking.

 

[SandyinMonterey]

I think it's up to the patient to check if a doctor or dentist is in or out of network. And that's done by calling the insurance yourself, not the place providing the service(s). I stopped going to our previous dentist because he was not in network anymore, though the office called me and said "we take your insurance." Well, sure you do but it's going to cost a whole lot more. I also make sure before any "major" appointments, medical or dental, that I know what my out of pocket is. I had many instances, too many, when I'd go to the office and was told to pay X amount and the office is charging more.