New Patient visit for bi annual prophylaxis and panoramic xrays

by SL
(Baton Rouge)

Hi,
I had a change in insurance at work & my dentist was not in their network. I selected a participating provider for new patient visit. Provided my information to their online portal, including dental information for previous 6 years (I am faithful about prophylaxis) and day of appointment I arrived early to ensure benefits were verified, etc. Before being seated in a room, I was told xrays were going to be taken. I've had panoramic xrays once before but being unfamiliar with this practice, I did not question it. Two weeks later, I received a bill for $60 as panoramic xrays were not included in bi annual exam. I called insurance first & was told they did not bill for bite wings, just cleaning & panoramic. I called dentist & was told this is their policy for new patents. I am upset I was informed prior to this. But my real question is, did they not bill for bite wings that would have been covered because panoramic would have been denied? Is this improper billing? I'm so upset that I will be going back to my old dentist & paying out of pocket for any difference.

Thank you


Reply:

Hi I'm sorry you're having this issue. I think they may have billed for the panoramic X-ray because often insurance will pay for one or the other (bite wings or a Panoramic) but not both on the same visit. The panoramic cost is higher so they may have billed for it thinking it would be covered. If they denied the panoramic maybe they can still bill for the bite wings?

This type of billing is not unusual and it is not unusual to take both panoramic and bitewings because both are needed for different reasons. They most likely didn't charge for the bitewings because they assumed the Panoramic X-ray would be covered and didn't want you to have to pay out of pocket.

In any case, if they verified your benefits in detail your coverage should have been clear.

I wonder if the new dentist would consider adjusting the cost of the panoramic that wasn't covered? If you were happy with the visit outside of this issue, it would be worth asking.

It is a pain to manage benefits and ultimately it is the patient's responsibility. But if you asked for benefits to be verified and were told it would be covered, you should be able to depend on that being true.

In the future you can always give your insurance provider a call before your appointment and verify your own coverage. It is an extra step but then you'd know for sure.

You can decline anything that is not covered at any time.

I'm sorry for the hassle and hope it goes smoother for you next time,
~Shelly

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Mar 27, 2018
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by: Shelly

Yes I totally understand how you would feel mislead.

I have patients tell me quite often that they only want the treatment that is covered by insurance. Sometimes they know exactly what is covered and that makes it a lot easier. It sounds like you would be in that category.

In every case, I ask for the patient's verbal approval before any treatment even though they have already given their written consent when they fill out the standard paperwork. It just feels fair to me and helps to avoid misunderstandings.

It is unfortunate that the new dentist is not willing to help you at all. It is not worth losing you as a patient and that's what may happen. I wish more dentists had a clue about good customer service.

Mar 27, 2018
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by: Anonymous

Thank you! I have tried to speak with them but I get a canned, rehearsed answer. It's been suggested have them refill to include bite wings since that was the covered item. I wasn't given the opportunity to decline panoramic. I would have declined. Did I mention I am a medical coder? I'm just not familiar with dental, but I do what is covered in bi annual visits. That's why I am so frustrated. I feel duped.
Thanks again,

Shelley

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