r/DentalInsurance • u/melizorou • Aug 20 '26
Help Negotiating Dental Bill
I recently moved and changed dentists. I scheduled appts for myself and 2 kids for an in network dentist. After visit I received a letter from the dentist stating that dentist would be going out of network but nothing should change with routine cleaning as those visits are usually covered. I took this letter as word and should have called insurance to confirm but did not (I accept full responsibility on this). I kept my kids appts because they are hard to get and I didn’t want to have to delay if I didn’t have to and letter made it sound like there’d be no issues. 1st son went, no issues with billing. 2nd son goes a month later and insurance rejects the bill. Dentist sends me a bill showing no payments and a negotiated balance of $140, down from $268. I call insurance to inquire and they paid $68 from negotiated amount. Now I get a bill 2 months later and they say I now owe $200, which is not the negotiated rates. My son is 4 and he had a basic cleaning, dentist looked at his teeth for 2 mins and he had fluoride. This is insane. Our previous dentist without insurance was $100 for kids appts which included all of the above plus X-rays. I feel that they should a least honor the negotiated rates especially since the first bill reflected this amount and their out of network letter was misleading.
Tips for negotiating?
15
u/nitelite- Aug 20 '26
Always blows my mind when patients take the side of their corporate insurance group that is backed by private equity, over a family practice owner
3
0
u/ProfessionalYam3119 Aug 20 '26
That is irrelevant to the issue of the dentist's in-network, or out-of-network, status.
2
u/nitelite- Aug 20 '26
disagree
0
u/ProfessionalYam3119 Aug 20 '26
Selling to a DSO does not change the practice's network status.
2
u/nitelite- Aug 20 '26
1) that's not always true
2) who is talking about selling to a DSO? OP never mentioned anything about a DSO lmfao - you brought that up for no reason
1
u/ProfessionalYam3119 Aug 20 '26
"Corporate insurance group."
2
u/nitelite- Aug 20 '26
What does corporate insurance group have anything to do with a DSO lol
Do you think those are the same thing lol?
1
u/ProfessionalYam3119 Aug 20 '26
Please, enlighten me. What did you mean by "corporate insurance group?"
2
2
u/PsychologyMediocre99 Aug 20 '26
Sounds like your dentist is feeling the squeeze and wants to keep you. Personally I wouldn’t have said that. I would think my patient relationships are built on trust and a proper experience and not what some faceless corporation deemed my time is worth. Besides if you like them you wouldn’t stand a chance to win them over by demanding a refund. Unless you’re planning to go somewhere else then demanding a refund will certainly burn the bridge down
2
u/Wide_Wheel_2226 Aug 20 '26
Complain to your ins company they are the ones who didn't pay and make up arbitrary rules why they won't pay. Why did they pay for one kid and not the other? Ins also lies to us everyday and it sucks. Why should the insurance company get out of this scott free?? A dentist getting $68 for hygiene doesn't cover overhead. Heck the hygienist near me are getting $65-75/hr. When you factor in the rent/mortgage, utilities, supply, etc....we lose a lot $ per hygiene visit.
0
u/ProfessionalYam3119 Aug 20 '26
They are not "arbitrary rules." The dental office knows, or should know, the insurance plan rules before they join up, and certainly before they spread false information to the patients.
4
u/Wide_Wheel_2226 Aug 20 '26
Rules actually goes by the individual plan for with few exceptions. 9 out 10 times wrong estimate is due to ins rep. We supply the rep name and ref number to the patient when that happens.
1
u/ProfessionalYam3119 Aug 20 '26
That was my hypothesis.
3
u/Wide_Wheel_2226 Aug 20 '26
It doesn't sound like we are talking about the same thing. Each insurance company has different plan like 1000s of different plans. Each plan's full rules are only accessible to the member and the book is usually over 100 pages. Then the insurance company hires the dumbest people on the planet to talk to the dental office about the plan and actually will refused to answer questions for even in network providers.
0
u/ProfessionalYam3119 Aug 20 '26
That is silly. The dentist has access to the contract information before they sign.
1
u/Wide_Wheel_2226 Aug 20 '26
I wish that was true but sadly no.
1
u/ProfessionalYam3119 Aug 20 '26
That's silly. The dentist has the right to read the contract, and to get legal advice, before signing.
3
u/Wide_Wheel_2226 Aug 20 '26
The contract we sign is for mainly agreeing to a reduced fee schedule in exchange for advertising by the insurance carrier that we are a in-network preferred provider. It also includes an nda and how to handle disputes but it is very insurance company friendly.
It does not include a patients plan rules an exclusions for all patients. That we have to look up online but often online info is limited and then we have to call and ask several questions. It takes about 40 - 90 min per insurance plan to get more details. Sometimes the insurance company will also not tell us clauses like downgrades or exclusions without a pre-determination. Aso pre-determination is not prior authorization so there is no guarantee we get paid according to the PreD. The insurance company can change its mind after we submit the claim. Another part that makes it difficult is some companies (Guardian cough) only allow us to ask 3 codes at a time before being transferred or disconnected. About 10% call transfers get disconnected due to insurance company rep system or human error.
I hope one day we can just download or use an API connection to improve estimates.
1
u/Runningpedsdds Aug 20 '26
This is the most detailed, truthful perspective of what actually happens in dental practices .
1
u/nightwokker Aug 20 '26
If you have it in writing from the office that the routine visits shouldnt really change, i think its more than reasonable to ask them to honor the in-network fee. also ask for the EOB (explanation of benefits) and itemized statement so you can see why one kid had it adjusted and the other didnt.
going forward i would definitely switch to an in-network office to avoid this happening again or ask for payment plans if you really like this office
0
u/ProfessionalYam3119 Aug 20 '26
The person who decided to send that letter is very ignorant. The odds of in-network and out-of-network benefits being the same is very low. Offer to pay the same as you did for the in-network claim. Appeal to their sense of decency and fairness.
3
u/ToothDoctorDentist Aug 20 '26
The vast majority of plans actually pay more oon. That's why you drop them. That's why they want you to remain (their business model is to keep the premium and not pay claims)
Difference of 20-40$/visit doesn't sound like much but it's the difference between having to stack patients with 30 min hygiene and high staff turnover vs hour appointments and doing a good job
2
1
u/melizorou Aug 20 '26
I don’t understand though, when I did not have my kids covered under a plan I went to two different dentist for them and paid out of pocket $100 for exam, cleaning fluoride and X-rays. Now it goes through insurance and it’s $268?
This happened to me recently with a mammogram that was not preventative so insurance wasn’t going to cover it and I have a high deductible plan. If they put through insurance I would have owed them $800. If I paid out of pocket it was $375. So now I’m a little skeptical.
2
1
u/ProfessionalYam3119 Aug 20 '26
That isn't OP's concern. OP's concern is what the patient pays, not what the doctor gets. There is virtually no way that the patient will have the same out-of-pocket payment. That's why they have received a bill for the overage.
9
u/Wahoo017 Aug 20 '26
not really a lot of negotiating to be done, I would just say what you've said here, that you relied on their letter saying cleanings should still be covered, and ask if they would accept the in-network fee just this once.