My dentist is robbing me!!!!?

Question

My insurance (United Health Care) is supposed to pay 80% of some procedures and 100% of others. I received a "deep cleaning" the other day and they tried to say I owed out of pocket $400!!! So I did some investigating and found I was being dooped. In the mean time my dentist office calls back to say that I was right, I would only owe about $129....But my deductible is still only $50. Am I still being dooped can they over charge me even though they take my insurance and there's a set price?

Answer 1

Dental insurance has not kept up with the economy.  I have been in the field 30 years, and patients still have the same coverage but Dental fees have sky rocketed due to inflation.  So 25 yrs ago you could get 4 crowns for $1000.00, today that same $1000 doesn't even cover 1 crown.  Also do you have an HMO? It could of been a clerical error, it was a good thing you are on top of it.  Today you have to be your own adversary.  Deep cleanings also are not covered by some insurance or it has limited benefits, you will have to inquire or ask the dental office to do a pre-estimate so you will know money wise how you stand.

Answer 2

I went in and got my cap replaced 6 times in 1 month, (they worked on the wrong side of my mouth) THEN they had the nerve to charge me for putting in a filling in tooth #10 $119.00.They never put a filling in my mouth or worked on that tooth. I called the corporate office and they are investigating. It's been 2 weeks n I still have heard nothing. I have been calling for past 2 days n they will or have not yet called me back. I am finding out that dentist offices n the managers are some scandalous people. I think i will go pick some money tree's n bring a bouquet of them in just for shitts n grins. And tell them when my teeth are fixed n im billed properly i will pay them. Untill then they can enjoy the fake money tree.

Answer 3

I would totally call your insurance and figure out your deductible. Also i would recommend checking out dental prices before you go into the dentist office. Also try to figure out what exactly the dentist is charging you for, because deep cleanings can entail many different procedures. I use a pretty usefully website www.smarthealthbuyer.com. Check it out it allows you to search by procedure using your zip code to see average prices. The only thing you need to do though is know exactly what you dentist did during the deep cleaning. Here are some listed prices for some possible procedures that your dentist could of done using my zip code (San Diego)

Full Mouth Cleaning (Debridement)                    $174.52 - $240.84

Scaling and root planing                                   $203.61 - $337.40

Answer 4

Call your insurance company and ask them.  We do not know what kind of coverage you have.  

Answer 5

This all depends on a couple of things.  First, does your dentist participate in the PPO program with UHC?  Second, a "deep cleaning" can mean a general term to describe a procedure that is performed under a local or topical anesthetic, called root planing & scaling (RPS).  As an example, our usual & customary fee for this procedure is $780.00, and involves 1.5-2 hrs of chair time with the hygienist.  Usually paid at 80%, after deductible.  However, with the reduced PPO fee schedule, 80% of the PPO fee will result in a lower out-of-pocket cost to you.  Make sense?

If you had a "deep cleaning" that was more of a diagnostic procedure, as in a full-mouth debridement, then the fee should be much less.  These two procedures have different ADA codes; RPS is D4341 & Debridement is D4355, usually.  I would check your visit receipt for a code to determine exactly what is being billed.

Answer 6

I wouldn't pay unless they clearly stated it beforehand. I've run into this problem with a few low-end clinic-type places and when push came to shove they backed down. They know your insurance company has your back and they won't s***w you fearing you'll turn the insurance company loose on them. They're trying to bully you, but if press them about it they probably don't have a legal leg to stand on.

Answer 7

you do some more research

Answer 8

I had my wife refuse to pay. It's disgusting, especially when you consider that they know how much your insurance is going to pay them. I would tell them that unless they fix your problem, and have a set price based off of the premiums that you will bad mouth them.

They can overcharge you, but you can fight it. You should also kindly threaten to report them as lying to you to your healthcare.  

Answer 9

That would mean that a deep cleaning costs $645.... no, you're being gouged.  Unless you haven't brushed your teeth in 3 years, how much work is involved in "deep cleaning?"

Answer 10

I would contact your insurance provider and ask them to explain your charges.

Answer 11

Actually, it's going to depend on what your doctors terms are with the insurance.  They are not required to accept only what the insurance will pay.  Most likely when you first went there and filled out paperwork you signed something saying that you were liable for whatever your insurance would not pay.  Most times the insurance company sets a limit on how much they will pay for any procedure and anything over that can be billed to you.  Some doctors will just waive whatever the insurance won't pay and take what they can get. Others will stick to their original charge and stick it to you.

Answer 12

you need to call your insurance company and get to the bottom line about your exact coverages, because then, you can call your denstist back and say look this is what they are telling me i have to pay and thats all im going to pay.  sounds like you have met your deductable already if they are paying 80% of it. that deductable just means once it has been met, they will cover 80% of the procedure..which accounts to you paying out of pocket 80 dollars.. (80% of 400 is 320)dunno where they are getting 129 unless there is something you had done that was not covered by your insurance..good luck

Answer 13

ok for one dental terminology:

prophylaxis (this is usually your 6 month cleaning)-generally consists of "polishing" your teeth with that gritty stuff.  This is (usually) basic dental 100% covered.

deep cleaning?  Can mean several things.

gross debridement:  generally this means removing (years of) tartar and calculus to enable a diagnosis.  

quadrant scaling and root planing.  The mouth is divided into four quadrants.  This type of procedure usually involves numbing each quadrant and deep scaling below the gums and onto the root surfaces of each tooth.

  

In general,

prophylaxis can run anywhere between $50-150

gross debridement $100-$200 not including a prophylaxis.

quadrant scaling and root planing can between $150-250 a quadrant.  So yes the fee can be over $1000 not including 6 week follow up and prophylaxis.

Ask which code they used and have them explain which procedure was done.

Also keep in mind, that your fee may include your yearly deductible and even if the dentist is participating, if your insurance says 80%, that still means that you pay 20%.

Also another thing to keep in mind is: you may have already maxed out the maximum billable amounts.  I've had treatment plans totalling $5000.00.  If your insurance max is $1000, then yes you still have to pay the other $4000.

by the way, I hate insurance.  Be grateful your dentist even takes it.  We don't accept any insurance but will help you fill out your own paperwork and let you deal with the hassle of reimbursement.  

--dentist