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I visited a dental office to have a deep cleaning and root canal. I have an individual dental plan from Delta and the dentist is in network. Before each procedure, I always asked the accountant at the front desk whether the procedure is covered and how much is covered. They told me both are covered at 50%. So I have the treatment done. After several months, I received a bill of more than 1200 from the dental office. Because in addition to the deep cleaning and root canal, they also charge huge amount for so called consultation, evaluation and several Xrays which they told me are covered by insurance and I am not responsible for those. I later found out that the insurance company denied their claim as there's a limit on the service claimed. But I was not informed before and at the time of the treatment that it was COVERED. Had they informed me correctly, I will not let them take the Xrays and the consultation and examination was not performed without letting me know (Each time I went their office, I sat down and they finished the procedure, I was not even aware there is a procedure called consultation and evaluation!)

Long story short, here is my problem:
1. They told me some procedure was covered before the treatment but turned the responsibility to me after they failed to get money from the insurance.
2. They charged consultation and evaluation without letting me know there is a charge.

I accepted that I am responsible for the deductible and charges beyond the yearly max ($1000 for me). But that is only around 500. the rest ($700) are from the services that I am not aware of or due to their false information on the coverage. I am willing to pay the $500 but not the total $1200!

Any suggestions on this will be greatly appreciated.

Member Summary
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First of all, what you are describing is not the scenario I described at all. There is no "crappy insurance tier" that r... (more)

AlwaysWrite (Feb. 15, 2012 @ 9:04p) |

I wasn't directing my post on your experience. From reading your OP, your dentist absolutely scammed the shit out of yo... (more)

Pun (Feb. 15, 2012 @ 9:15p) |

How would you propose a dentist evaluate what your dental needs are without an xray or examination? Laying on of hands? ... (more)

lcweber (Mar. 04, 2012 @ 12:16a) |

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This may not help you in the present case but ALWAYS keep one thing in mind regarding any kind of insurance:

It is your responsibility to check with YOUR insurance as to what is covered, what the ded./co-pay is etc. Preferably get things in writing if you are talking about big pre-planned procedures.

Don't pay. That should teach them a lesson

Call them up and negotiate a lower fee.

Maybe they need to resubmit the bill in a different fashion. Would the clean and xrays maybe not count against the 1k max? Some just do that a a proactive and don't count that against the max coverage.

Yeah, call and say you do not have that much money, claims were denied, offer cash for a discount. Don't yell at them and try to be reasonable.

I have a friend that is a dental hygienist. She worked in an independent dental office that was taken over by a managed dental network. They instantly went over the ways she could make the office more money and they main one was pushing deep dental cleaning. They also suddenly realized that a lot more teeth needed root canals that could have been filled. She quit after a month.

I would send them a letter stating:
I have received the bill for $1,200 when I was quoted $xxx. I believe the amount is in error. Ask for copies of everything you signed, initial estimates, changes to estimate and explanation of insurance payments. "Who knows if they need to provide them but doesn't hurt to ask." Make a reasonable counter offer. Tell them what you will do if they do not respond or accept your offer. "I feel that if this is resolved unfairly; I will make my case on yelp.com, google reviews, etc...

I can't be the only one who expected to see $25k dental bill here...

What did the dental office say when you called?

So this $1,200 bill was from one visit? What's the exact breakdown of the bill?

quaters said:   I can't be the only one who expected to see $25k dental bill here...

That would be huge, ridiculous, outragous, and preposterous

Sue em

Ask them nicely to lower the bill.

Bad mouth them.

Hey! Somebody had to say it.

Anytime you visit a doctor's office there will be an initial visit charge. Usually the followup appointment visits do not incur additional visit charge unless you come in for a different reason from the initial problems. X-rays do need to be taken. Your dentist is not a superman and cannot see through hard and soft tissue. Insurance is something that patient selected and is used to help pay the bill. It's not the dentist who should take a loss for his service because your insurance wants to make excuses to avoid paying out. Dental office can only give you an estimation of the insurance coverage. If you want to have more accurate estimation, ask the office for pre- estimate of the recommended service. Or you can submit the pre-estimately directly to your insurance company. But ultimately whether you have an insurance or not, you are obligated to pay for the service you received.

BitemeIamtoxic said:   Bad mouth them.

Hey! Somebody had to say it.


You only heard one side of the story. What if the dental office did actually provide the services as listed on the insurance claim. Is it fair to bad mouth them? Think first before you open your mouth.

civilzhang said:   I visited a dental office to have a deep cleaning and root canal. I have an individual dental plan from Delta and the dentist is in network. Before each procedure, I always asked the accountant at the front desk whether the procedure is covered and how much is covered. They told me both are covered at 50%. So I have the treatment done. After several months, I received a bill of more than 1200 from the dental office. Because in addition to the deep cleaning and root canal, they also charge huge amount for so called consultation, evaluation and several Xrays which they told me are covered by insurance and I am not responsible for those. I later found out that the insurance company denied their claim as there's a limit on the service claimed. But I was not informed before and at the time of the treatment that it was COVERED. Had they informed me correctly, I will not let them take the Xrays and the consultation and examination was not performed without letting me know (Each time I went their office, I sat down and they finished the procedure, I was not even aware there is a procedure called consultation and evaluation!)

Long story short, here is my problem:
1. They told me some procedure was covered before the treatment but turned the responsibility to me after they failed to get money from the insurance.
2. They charged consultation and evaluation without letting me know there is a charge.

I accepted that I am responsible for the deductible and charges beyond the yearly max ($1000 for me). But that is only around 500. the rest ($700) are from the services that I am not aware of or due to their false information on the coverage. I am willing to pay the $500 but not the total $1200!

Any suggestions on this will be greatly appreciated.


Did you select this insurance?
If so, why didn't you read your enrollment packet and see what your insurance covers and don't cover?
Dental office can only get a limited information in regards to your insurance coverage. As an insurance subscriber, you have more information. Next time, do your homework instead of complaining after receiving the service. Ask before the treatment....not after...very simple.

When dealing with medical/dental services follow this cardinal rule:

1. Call the provider 15 days in advance,give them all your insurance information, tell them to do a pre certification/ cost of coverage quote.

2. After you get that, call to confirm that there will NOT be any surprise(s). If they say there is a possibility, ask them the amount it will go up.

3. Do not get all the work done in one sitting at the office. That way you will know , as the COB arrives whether they are sticking to their original estimate.

4. if a dental or medical provider dislike you asking upfront the cost, or don't give straight answers , you just say thank you and look elsewhere.


Lastly, 1200 is a lot of money, but in comparison to other unwanted expenses, if you spent that money on quality care...its worth every ounce in my opinion. I never cringe on money I spent for my well being. Quality of service is of utmost importance esp in a dentists office. If the dentist is doing a good job and charging you 50% more than the competition, you still will come out way ahead...in my opinion.

docjoo said:   BitemeIamtoxic said:   Bad mouth them.

Hey! Somebody had to say it.
You only heard one side of the story. What if the dental office did actually provide the services as listed on the insurance claim. Is it fair to bad mouth them? Think first before you open your mouth.
Lighten up. I think it was a joke. Get it? Mouth? Dentist?

My wife had a similar situation -- doctor told her she was in-network and the procedure was "covered," then we got a surprise bill because the doctor used an out-of-network tax ID.

Why is it that health care -- which is one of the most expensive things we get done -- seems to be the ONLY case where the client/patient/buyer isn't informed ahead of time how much something will cost? Would you drop your car off somewhere and just come back and pay whatever repair bill they made up? Would you give a lawyer carte blanche to work on a case without even asking his hourly rate? Would you buy a bunch of groceries with no prices, go home and eat them, then get a bill in the mail for some astronomical random number? Why is it OK when doctors/dentists do that? Unless they're sure it's covered by my insurance, they should at the very least tell me how much this procedure could potentially cost me so I have some ability to give informed consent for the procedure. Otherwise, they can just make up whatever prices they want after the fact.

I had something similar happen to me with extra "consultation" fees added on to my bill that the insurance company would not pay. I told them if they continued to ask for these fees I would call my ag about insurance fraud.never heard another word from them.

There is huge difference on the fees charged by Delta dental in network dentist. They are in network or accept your insurance does not mean anything. I went to an in-network dentist for my daughter. We have PPO but they are a premier provider. We are suppose getting $2000 max coverage a year, but we only get $1000 in a premier provider office. The quote I got for the procedures should be done on my daughter was $1300, not including oral sedation. Instead, we went to a PPO provider (I checked with Delta before I went). We have more procedures done on my daughter and we walked out of the office for only $100. The dental office has no idea what is the difference being a PPO provider or premier provider.

I have no patience for anti-dentites.

gonewiththewind said:   When dealing with medical/dental services follow this cardinal rule:

1. Call the provider 15 days in advance,give them all your insurance information, tell them to do a pre certification/ cost of coverage quote.

2. After you get that, call to confirm that there will NOT be any surprise(s). If they say there is a possibility, ask them the amount it will go up.

3. Do not get all the work done in one sitting at the office. That way you will know , as the COB arrives whether they are sticking to their original estimate.

4. if a dental or medical provider dislike you asking upfront the cost, or don't give straight answers , you just say thank you and look elsewhere.


Lastly, 1200 is a lot of money, but in comparison to other unwanted expenses, if you spent that money on quality care...its worth every ounce in my opinion. I never cringe on money I spent for my well being. Quality of service is of utmost importance esp in a dentists office. If the dentist is doing a good job and charging you 50% more than the competition, you still will come out way ahead...in my opinion.


How will they give you a full list of the fees without seeing you? They would be doing you a disservice and then you will call them they liar when they need to charge you more than an office visit. Every patient is different and the cost is different, especially at a dentist office.

After the first visit they should have a good idea of how much it will cost tho, but without seeing you then it would be shooting in the dark.

I had the same problem. My wife actually paid it using AMEX. So filed a dispute with AMEX and sent a letter to the Dentist explaining why the amount charged was ridiculous and whatt the real amount should be (insurance company told me what it needed to be). AMEX gave me the difference back and I never heard from the dentist or AMEX again. This was about 5 years ago.

my wife has dental insurance, went to surgeon for 2 wisdom teeth removal. paid her part of the bill and left, insurance company sent us a letter saying they paid their part of the bill, but now the dental office sends us a letter saying we have to mail then $133 payment, i got pissed and called them, the lady agent says, we didn't receive the $133 from insurance company, i told her well, insurance has paid you about $700, not just $133, and we received the letter 3 weeks ago. I told her, be honest and i don't want to file a complaint against this dentist and write a bad review and told her stop trying to rip us off and we are not stupid. She says don't worry, you don't have to pay anything now, once we receive payment from insurance company, we will let you know. The dental office f***in lied, Insurance company mailed us a letter of bills they paid to the dentist. This kind of things happens in USA?

I had 2 filling, 1 crown, paid 21,000 cash rupee= $300. that was when i went to a trip in nepal last year. no insurance, no doctor rip offs no nonsense, it just took about 5 days due to crowning cos they had to order a tooth.

I had something similar happen, but it was only $50. I paid it and never went back even though they are just down the road from my house.

My dentist never charge any consultant fee. That's ridiculous.
If you do not sign any paper for the fee, I believe you can refuse to pay. They have to present you the estimation cost and ask you to sign prior to proceed. My dentist always do that, it is best interests for both parties.

Write your feedback on YELP, so other people beware of them.

Always ask for black & write on paper.

took out 2 wisdom teeth down in colombia (medellin) and the cost was about $180 including everything. if i need any dental work, i would go down there.

oh, fyi, coke is about 3-5 bucks per oz

What do your insurance statements from Delta Dental say? They will mail you a letter when they process claims stating what was paid and how it was billed.

Trying to understand your claim - you had a deep cleaning, consult/exam, x-rays, and a root canal. Which level of network was the dentist in? Delta has two different levels of "in-network", on one of those levels the dentist has to write off any difference between the amount Delta pays and the amount they billed. How much did the dentist charge your insurance for each item and how much did they receive as payment?

FWIW I wouldn't stick it to the dentist and not get them paid. At worst, they would be within their rights to send your bill to collections. But there could be billing errors that need to be dealt with *now*.

What was the total bill for everything? If you did get an exam, deep cleaning, and root canal (did you get a crown?), $1700 (can't tell if that was the total bill) is not unrealistic.

My dentist always tells me the total charge for whatever he is doing and then he tells me what they expect insurance will pay, but I already mentally know roughly what they cover for the different categories (preventative/minor/major).

I'd agree with the other poster, you're ultimately responsible to know what your insurance covers. If they are an in-network provider then you should be paying negotiated rates with the dentist, anything above the negotiated rate should be written off. Your EOB from your insurance co should outline exactly what you're responsible for paying.

It kinda sounds like you just don't want to pay since you feel like they should know exactly what your insurance coverage should pay. That's just not realistic nowadays. Too many insurance companies and too many coverage situations for any medical or dental office to guarantee what your insurance will cover. The only thing they can guarantee is what they charge. The contract with insurance company (if they are in-network) will guarantee that you pay only the negotiated rate, which will be outlined on your EOB.

Okay - Others have hinted at it, but nobody exactly got to the point.

I'll say it! $1200 out of pocket for a root canal and deep cleaning does not seem totally out of the line. I think the problem is more with what you expected the cost will be rather than the actual bill. We all know there are various issues with the medical system. Not knowing the cost beforehand is a huge issue. But I assume those big, hairy and nebulous issues are not what you are trying to address here. These are just as much out of your doctors control as they are yours.

I've had to pay for a root canal and deep cleaning in the past. Even with my "good" (good as far as dental coverages go) coverage - I remember forking out $800 out of pocket. This was after I was very proactive knowing what my insurance covers and what it does not (read the damn document already!!). Without this I'd have paid for a couple of extra x-rays (I have a limit of one panoramic x-ray in 3 years and 1 bitewing every 6 months - pretty standard coverage) and my bill would have reached closer to yours.

What you can really do to save money (I learned it the hard way. You've already got the hard part. I hope you get the learning out of it.), is to get into a daily flossing regime.

A VERY similar thing happened to me a few years back and I just eventually paid the bill because they were very aggressive about collecting it and wouldn't negotiate to lower it. In the future, make sure you get all estimates in writing up front so you have a better leg to stand on to fight them over this. I think this can be relatively common at the dentist office -- since unlike medical insurance, you're normally left paying a good portion of the charges.

You can also ask the dentist to submit a pre-treatment Estimate claim (not sure of the exact term) with the insurance. I know this is possible because I had my dentist do that while removing wisdom teeth and I knew exactly how much it would cost me before I got on to the operating chair.

Many dentists will tell you that it can not be done. I think it is more because they don't have any coding specialist in their office and they don't want to take the additional headache of dealing with the insurance company (with the possibility that the patient may walk away once he knows the cost).

Husband had a root canal done last yr. I had wisdom teeth out. Both were done by different dentists our dentist referred us to. Our reg dentist verified our benefits/coverage/provider network before referring us.

We also checked our benefits online to double check. After all, it's our money, so we're making sure first.

Each dentist did an initial consultation/exam appt first. At that time we were given a written quote for what our costs would be after the office managers verified our benefits with our ins co. We were told what we needed to pay upfront, if any, and were offered payment or care credit info. And then we needed to sign off on it. If we didn't like it, we could walk.

No surprises. And knowing what we paid, $1700 seems pretty reasonable.

Same thing happened when we signed the kid up for ortho treatment.

But then, just like before purchasing lawn service, a house, or outfit, or anything, I'm not blindly going into it without knowing exactly what it's going to run me.

See if you can politely negotiate it down. If you can't, pay it and lesson learned.

With any procedure, provided you have the time, the insurance company can do a "Pre-Authorization" or "Pre-Determination" for the services. They basically process the claim and send out an EOB as if you had the procedure that day. It will show exactly what your out-of-pocket will be.

In this case, the dentist only knows what is normally covered. They don't know that you only get one set of x-rays per year and that you've already had them. They don't know how much you've already applied to your deductible or what other one-time services you've already used. You can't really blame the dentist in these cases.

my wife works in the front office of a dental practice, so i have some indirect knowledge of how this works.

you guys need to understand that insurance companies pay a percentage of the 'usual, customary and reasonable' (UCR) amount, which is not public information. also, there is no price regulation of dental practices. they can literally charge what the market will bear. so you can go to one dentist who will charge $750 for a crown, or one who will charge $2000. in addition, they can charge more for a 'difficult patient' who has previous issues that make an otherwise straightforward procedure more difficult. the dentist will not know how difficult the procedure will be until he starts working so it is impossible to give an exact upfront cost to the patient.

ie. UCR for a crown is $1000. your insurance pays 80% of that, $800. you go to a really good dentist who charges $1500 for his premium quality dental work. but it turns out that your tooth is in worse condition than originally estimated and it takes the dentist an extra 30min or more to prep the tooth so he charges $1500 to prep and place the crown, then an extra $200 for the time it took to prep your tooth.
so upfront they told you it's going to be $1500, but you end up getting a bill for $1700 minus the $800 paid by insurance. net $900 you have to pay when you expected to pay $700.

fwiw, billing is a lot more complicated than that but that's basically how it works. i think the OP assumed he was getting a firm price up front, and the front office person should have made it clear that the price is not set in stone. if OP is worried about getting ripped off, be polite and ask for an itemized breakdown of charges. then ask politely if they will explain each line item. i'm sure they will take the time to do this because every dental practice that is worth a crap will want your repeat business.

so OP, and others.. stop thinking about recourse and how you got ripped off, and get yourselves informed of how things work. a friendly call to the office will get you started.

supersnoop00 said:   With any procedure, provided you have the time, the insurance company can do a "Pre-Authorization" or "Pre-Determination" for the services. They basically process the claim and send out an EOB as if you had the procedure that day. It will show exactly what your out-of-pocket will be.

In this case, the dentist only knows what is normally covered. They don't know that you only get one set of x-rays per year and that you've already had them. They don't know how much you've already applied to your deductible or what other one-time services you've already used. You can't really blame the dentist in these cases.


i agree this is the best way to get a ballpark amount but there will still possibly be different charges depending on what the dentist finds when he starts working.

for each procedure there are codes for varying levels of difficulty, the easier it is, the less you pay. you can ask for the code they use when they do the pre-auth and match that with the code they actually bill. if there is a discrepancy, you can ask the office for clarification and negotiate from there.

civilzhang said:    in addition to the deep cleaning and root canal, they also charge huge amount for so called consultation, evaluation and several Xrays which they told me are covered by insurance and I am not responsible for those.

This smells to me. I have never heard of a dentist charging for consultation or evaluation, and I've never heard of an insurance company not reimbursing for X rays. I suspect that the dentist knows just how much the insurance company will pay, and is padding to get more.

1. Ask the insurance company why they're not covering the X rays. I suspect they'll answer that there was no need for the ones that were taken.
2. Contact the ADA and complain that a dentist is charging weird fees.

dcwilbur said:   docjoo said:   BitemeIamtoxic said:   Bad mouth them.

Hey! Somebody had to say it.
You only heard one side of the story. What if the dental office did actually provide the services as listed on the insurance claim. Is it fair to bad mouth them? Think first before you open your mouth.
Lighten up. I think it was a joke. Get it? Mouth? Dentist?


Ha ha??? He shouldn't get a job as a comedian. I think a dentist can tell a better corny joke

StevenColorado said:    I've never heard of an insurance company not reimbursing for X rays.

OP's explanation of benefits will tell him why they were denied, and a phone call can verify this. If OP thinks the ins made a mistake, he can appeal. And yes, x-rays can not be reimbursed. Our ins, for ex, limits the amt, frequency, and type we can get per calendar yr.

Skipping 40 Messages...
How would you propose a dentist evaluate what your dental needs are without an xray or examination? Laying on of hands? If a dentist truly performed a root canal (abcessed tooth or tooth with decay to the nerve) and root planing and scaling the roots of teeth to remove debris for a patient with periodontal disease (real description for "deep cleaning") without performing an examination or taking xray's they would be at risk of losing their license! I'm sorry...I completely understand the lousy situation you are in regarding a surprise bill. The annual maximum is a known number for the dental office and should be a known number for the patient that has purchased the policy but...to say you would never have had the exam or xray's is just a ridiculous statement.



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