I can't decide if this is Bad Service or just poor communication skills on my dentist's part.
I need to have two crowns put in, and had kept putting it off given that my health insurance (that has such minimal dental coverage on it that I don't know why they bother) doesn't cover them--or anything else majorly expensive as far as dental work goes.
Lo and behold, my employer offered a separate dental insurance for the first time in January, so after researching my options, I took it out, and opted for the most expensive plan given the amount of work I needed to have done. I also made sure that my dentist was part of the network so I would get charged in network contract rates. They do have to coordinate benefits with my health insurance, and bill them first, but plan # 2 (the dental) has excellent coverage (100% for cleanings, x-rays, fillings, 50% on crowns).
A pre-treatment estimate was sent out. Insurance company 1, as expected, denied the claim. Insurance company 2 told me they would pay half of the contract rate, as expected. Dentist billed his rate as $2500 (for two porcelain crowns and pins, and buildup). Contract rate was something like $1800. I was responsible for half of this, around $900. Which still is a lot, but a lot less than $2500.
I get to the dentist this morning. And he tells me that insurance # 2 told him that I was responsible for the difference between contract rate and his regular rate. And I was like, when I called the insurance on Monday, after getting the pre-treatment estimate, I was told I only had to pay the difference between his preferred rate and the contract rate, and he was supposed to write off the difference. Why would I pay 70 bucks a month for additional insurance if I was going to be stuck with the difference too? That made no sense. His billing person insisted otherwise, repeatedly,so we called the insurance company right then and there from his office.
And the person confirmed what I had said--he had to write off the difference between contract rate and regular rate, since he was in their network, and I was most definitely not responsible for the difference. Well, his billing person started saying that was incorrect, so the dentist asked if the billing person could listen in to the call, which I said fine. And the person from the insurance company repeated that I was not responsible for the difference. Dentist says something like "that's insurance fraud" which it wasn't. Would have been if the dentist submitted to insurance # 2 w/o submitting it to # 1 first but that wasn't anything close to what the rep was suggesting (who said send it to #1, then send their rejection to #2, and # 2 would pay and the dentist would have to accept the contract rate). I did ask the rep though, why I had been told the same thing twice, and my dentist something completely different, and his response: "she was obviously talking to someone who didn't know what they were talking about, or the person at your dentist's office misunderstood what was being said."
We hang up, and then dentist asks me, if the insurance claim comes back (because this was a pre-treatment estimate) and says I do have to pick up the difference, was I going to pay it? At this point, I was more than a little annoyed by the whole thing because I've been going to him for nearly 30 years, since I was a kid, and I have always paid my bills on time--and he knows this. And I told him, if that happened with the insurance, which I didn't expect it would, and I was told I had to pay him more, then yes he'd get paid and I would take it up with the insurance company. I also told him that after 30 years, he should know that I always paid my bills, and paid them on time.
So we start the work, and as I am leaving after 2 hours in the chair, I go out the the reception area, to confirm my appointment for next week, and the billing person tells me that I am responsible for my co-pay right then and there. I was like, what, when did this happen, I always pay you after the insurance pays you first? Now keep in mind, my co-pay (at contract, not full rate) was nearly $900! And I was told, that's the way it works for minor work, but not for major restorative and that they had to pay their lab (gee does the lab really expect payment up front from the dentist, or do you think they operate on a billing system?). So what I said is, you know what, that's fine, but you should have told me that you expected my share of the payment up front, not spring it on me when I'm here, if there was a difference from their regular procedure simply because it was major work, because I was not expecting to layout that much in cash today. I told them was I did not have my checkbook with me, and I would have to come in later today or tomorrow with a check (no way was I going to give my charge card # after them telling me I owed more that what the insurance said I would). The dentist was "nice" enough to take half today, and half next week, but I walked out of there majorly annoyed. As a 30 year customer, who has always paid bills on time, I was just appalled I was treated that way, especially at his insistance that I was responsible for the difference between his fee and the contract rate, not to mention that they wanted my share right then and there, but didn't tell me that until after the appointment.
So opinions please? Was this bad service on the dentist's part, or does he just need to communicate with his patients better?
ETA: I forgot to mention, and I think this is important, that the dentist was saying that because my health plan, with the practically non-existent dental coverage, was primary and the separate dental was the secondary insurance, he was entitled to the full amount, not just contract because I had dental coverage under the first (which mind you, provides zero coverage for crowns). Which still made no sense. Because why then would anyone bother getting the secondary insurance at all if you know that's the case?
Lo and behold, my employer offered a separate dental insurance for the first time in January, so after researching my options, I took it out, and opted for the most expensive plan given the amount of work I needed to have done. I also made sure that my dentist was part of the network so I would get charged in network contract rates. They do have to coordinate benefits with my health insurance, and bill them first, but plan # 2 (the dental) has excellent coverage (100% for cleanings, x-rays, fillings, 50% on crowns).
A pre-treatment estimate was sent out. Insurance company 1, as expected, denied the claim. Insurance company 2 told me they would pay half of the contract rate, as expected. Dentist billed his rate as $2500 (for two porcelain crowns and pins, and buildup). Contract rate was something like $1800. I was responsible for half of this, around $900. Which still is a lot, but a lot less than $2500.
I get to the dentist this morning. And he tells me that insurance # 2 told him that I was responsible for the difference between contract rate and his regular rate. And I was like, when I called the insurance on Monday, after getting the pre-treatment estimate, I was told I only had to pay the difference between his preferred rate and the contract rate, and he was supposed to write off the difference. Why would I pay 70 bucks a month for additional insurance if I was going to be stuck with the difference too? That made no sense. His billing person insisted otherwise, repeatedly,so we called the insurance company right then and there from his office.
And the person confirmed what I had said--he had to write off the difference between contract rate and regular rate, since he was in their network, and I was most definitely not responsible for the difference. Well, his billing person started saying that was incorrect, so the dentist asked if the billing person could listen in to the call, which I said fine. And the person from the insurance company repeated that I was not responsible for the difference. Dentist says something like "that's insurance fraud" which it wasn't. Would have been if the dentist submitted to insurance # 2 w/o submitting it to # 1 first but that wasn't anything close to what the rep was suggesting (who said send it to #1, then send their rejection to #2, and # 2 would pay and the dentist would have to accept the contract rate). I did ask the rep though, why I had been told the same thing twice, and my dentist something completely different, and his response: "she was obviously talking to someone who didn't know what they were talking about, or the person at your dentist's office misunderstood what was being said."
We hang up, and then dentist asks me, if the insurance claim comes back (because this was a pre-treatment estimate) and says I do have to pick up the difference, was I going to pay it? At this point, I was more than a little annoyed by the whole thing because I've been going to him for nearly 30 years, since I was a kid, and I have always paid my bills on time--and he knows this. And I told him, if that happened with the insurance, which I didn't expect it would, and I was told I had to pay him more, then yes he'd get paid and I would take it up with the insurance company. I also told him that after 30 years, he should know that I always paid my bills, and paid them on time.
So we start the work, and as I am leaving after 2 hours in the chair, I go out the the reception area, to confirm my appointment for next week, and the billing person tells me that I am responsible for my co-pay right then and there. I was like, what, when did this happen, I always pay you after the insurance pays you first? Now keep in mind, my co-pay (at contract, not full rate) was nearly $900! And I was told, that's the way it works for minor work, but not for major restorative and that they had to pay their lab (gee does the lab really expect payment up front from the dentist, or do you think they operate on a billing system?). So what I said is, you know what, that's fine, but you should have told me that you expected my share of the payment up front, not spring it on me when I'm here, if there was a difference from their regular procedure simply because it was major work, because I was not expecting to layout that much in cash today. I told them was I did not have my checkbook with me, and I would have to come in later today or tomorrow with a check (no way was I going to give my charge card # after them telling me I owed more that what the insurance said I would). The dentist was "nice" enough to take half today, and half next week, but I walked out of there majorly annoyed. As a 30 year customer, who has always paid bills on time, I was just appalled I was treated that way, especially at his insistance that I was responsible for the difference between his fee and the contract rate, not to mention that they wanted my share right then and there, but didn't tell me that until after the appointment.
So opinions please? Was this bad service on the dentist's part, or does he just need to communicate with his patients better?
ETA: I forgot to mention, and I think this is important, that the dentist was saying that because my health plan, with the practically non-existent dental coverage, was primary and the separate dental was the secondary insurance, he was entitled to the full amount, not just contract because I had dental coverage under the first (which mind you, provides zero coverage for crowns). Which still made no sense. Because why then would anyone bother getting the secondary insurance at all if you know that's the case?