Dental Insurance questions

by Andrea Neill
(Augusta, GA)

Every time I went to the dentist, I was charged a certain amount. Then, after the insurance paid, I was charged again for what the insurance did not pay. And I paid whatever the clerk told me to pay. I always thought this was odd, because the clerk should have charged me the correct amount the first time around. And if she did indeed charge me the correct amount the first time around, then she should have followed up with the insurance company as to why they did not pay it all instead of just choosing the easy way out by billing me for the balance. Then, there was an incident to where the insurance company did not pay an ASTRONOMICAL amount for a procedure, and the clerk billed me. I did not have that much money, so I tried to follow up on the insurance myself many times (to no avail because they said the clerk was billing it wrong), so I told the clerk (or left messages) MANY times what the insurance company said. She would neither return my phone calls, follow up with the insurance company, nor re-bill it the right way. But she did continue to bill me. I really think that the other incidences in which she billed me (the ones that were smaller, so I paid them) were done so in error because she chose not to follow up with the insurance company. Either way, she was wrong, because she should have either charged me the right amount to begin with, or followed up with the insurance company. What can I do at this point to get this settled?

Hi Andrea, I'm not sure there is much you can do if she doesn't return your calls. I wonder if there is someone else you can discuss it with?

As the patient you are ultimately responsible for knowing what your insurance covers and being responsible for whatever is not covered. Many dental clinics are willing to help you navigate the process so you can maximize your benefits. I doubt they want to lose you as a patient over this and hopefully will work something out. If they are not willing to help or at least explain/discuss I would find another dentist.

In the future you can ask for a pre-authorization from your insurance prior to having more expensive dental treatment. It adds a step and takes around a month but is the best way to avoid expensive misunderstandings. For routine preventative care you can confirm your coverage with the insurance provider before the appointment and let your dentist know you only want what is covered or that you want to be informed of any out of pocket costs.

I hope it all works out for you.

Thanks for writing,

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