I have full coverage dental insurance, but was charged in full for dental services
So I have a dental PPO plan though anthem bluecross/blueshield that I get from my job. My plan states that I should be getting the preventive dental services for free or paid out at 100% which is the same thing.
Anyway before even making the appointment for my office visit, X-rays and cleaning I asked them if they accepted my dental insurance. I was told yes they did. When I got down their for my appointment I asked again that they did accept my dental insurance and was told yes again.
So I paid my $20.00 co-pay and had my preventive done.  Now I am getting a billing from the dental office wanting $110.00. I called them up about this and they stated my plan did not pay off the complete billing and $110.00 still due.
I called anthem to be told that I did not go to one of their provider therefore my coverages are lower. Not only that but the dentist rates was above a UCR fee so that is why they only paid what they did.  I do not get what is going on here! I was to get what I had done for free less the $20.00 co-pay. Why would the dentist office tell me they take the plan when they do not! Should I have to pay this bill? I feel that I got taken by the dental office.
Wednesday, Sep. 29th 2010 9:37 AM at 9:37 am
I would be very upset as well. But here is the problem dentist know that on PPOs you can go out side the network. That being said you asked it they will take the plan and they did.
By what you wrote you did not ask if they were a in network provider of the plan. PPOs will show in their coverages that when going out side the network your coverage are reduce. Where as if you stay with in the plan network of provider your coverages are higher.
Also in theory staying within the plan network helps you to avoid an UCR fees because inside network provider keep their cost to what the plan is going to pay out for.
Out side net work providers will not and therefore may be over the max amount for the dental service render and therefore you get hit with the UCR cost
Normally when you buy a PPO plan you get the list of plan provider with your packet information. If not many companies have their provider data base on line for you to have access to. In the end as much as it is messed up that the dental office did not clarify things with you before having the work done, It is your fault for not know your plan and asking the right questions.
Wednesday, Sep. 29th 2010 9:44 AM at 9:44 am
That messed up! If you are asking a dental office if they take a dental plan it is assumed that you mean they are a provider of it. If they are not a provider they should have told you a head of time to let you know that so you could have choose to go with them or not.
I would tell the dental office this is on them since it clearly a case of bate and switch. If it was me there would be no way I would pay it and I would tell everyone not to go to that dental office since they like to rip people off.
Wednesday, Sep. 29th 2010 9:54 AM at 9:54 am
Now wait a minute. I feel bad for you because it does suck to get hit by a billing that you did not expect to have to pay.
However I disagree with the last reply about it being the dental office fault. It is not up to the dental office to be a mind reader. You clearly asked if they accept the plan and they did. The dental office did their part by filing the claim.
It is up to you to make sure they are a net work provider of the plan. You could have called them ask if they are a provider of your bluecross/blueshield plan. Then you also could have call bluecross/blueshield to confirm as well.
Also it does sound like this dentist was preaty costly for just an office visit X-ray and a basic cleaning if you paid 20 then they are billing you 110 for which your company did not pay. How much was the total billing anyway ?
Most plans advise you submit the claim to them for approval or quote only when it is going to over $300.00. They do this for your safety so you do not get hit with UCR fees with out knowing about it a head of time.
There was steps you could have taken so all of this could have been avoid. I say take this as a learning lesson and move on. It is more your fault then the dental office or the insurance company.
Wednesday, Sep. 29th 2010 9:59 AM at 9:59 am
A person should not have to jump though hoops just to have correct information told to them. I think by asking the dental office if they accept the plan they should have said yes they would bill the insurance company but as an outside network dentist.
I do not think it is fair for you to have to pay the $110.00 at all but I do not think you should not pay it. Why have it mess up your credit score. It is normally not worth fighting over and not worth you getting upset over each time. Unless the dental office is willing to accept some blame and cut you a deal I would just pay the $110.00 move on and never go back to that dental office.