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Dental Insurance, Over charging dentist

Who do I call when I have a dentist that lie to me about my dental insurance paying a claim?  I had to do a root canal and my dentist at the time told me that my insurance plan would pay 50% of the cost of the root canal.   Based on that he said the total cost was $800.00 my cost would have only been $400.00. $400.00 is a lot of money but I was able to get that together to have the root canal he said I needed.

After the fact I am now being charged for $640.00 for the root canal.  When I got this bill in the mail instead of $400.00 thought it was some type of  error and called the dental office. Where I was told that my insurance plan did not cover as much as they thought it would and so I owe the $640.00.

I called my dental Insurance plan that told me since I went to an Endodontic they do not cover 50% but only 20%.  I called the dental office who told me that the dentist in their office that did my root canal  was a specialist so that is why the claim got filed that way.   I told him this was not what was told to me and I would only pay the  $400.00 which I was told.

I am so upset I only did the root canal because of the price they told me I had to pay.  I feel I was bate and switched.  Since I asked the lady if she was sure of the cost and was told yes because she called my dental insurance to confirm coverage.   I am still getting the billing for the difference and do not feel I should have to pay it but they are stating they will put it on my credit report.  Who do I call about this?

Posted on Thursday, May. 27th 2010 2:35 PM | by Dental | in Complaints, Dental help, Dentists, Root Canals | 2 Comments »

2 Comments on “Dental Insurance, Over charging dentist”

  1. Caroline Jacky Says:

    What happen to you is not uncommon. Some dental insurance plans will only pay out up to what is UCR based on general dentist pricing. Once you go to a specialist you my go over UCR therefore having a higher or unexpected billing.

    Now since you said that the staffing told you your cost would only be $400.00 they seem to be some what at fault. You may be able to work something out with them if they are willing to take some of the responsibility for giving you the wrong cost.

    However, they could say they were only giving you an idea of your cost based on your policy coverages. Stating to you that anything over that is still up to you to pay.

    In order to avoid this from happening again file all claims to your insurance company as a quote only. This way the insurance company can advise you ahead of time what your share of cost is, before having any dental work started. This not only will this help you avoid having any unexpected billings, but will let you see if your dentist cost is over the UCR rates and what your true coverages are.

  2. Benson Jeffys Says:

    I am surprised that your insurance company does not state that you have to pre file claims frist before the service it render. Many dental insurance plans that pay on claims require you to submit for approval anything over $300.00. That is to prevent what just happen to you.

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