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I went to a dentist for a tooth cleaning. He suggested me to do a deep cleaning. I am an immigrant and have not done regular cleaing for a couple of years because I was out of insurance. So I did believe a deep cleaning would be reasonable for me. So I agreed, the he handed me the estimate which said it cost $1600 for a deep cleaning and $170 for X-ray. He told me I should pay 20% of the charges out of my pocket, my insurance would cover the rest. I had no experience with dentists in this country, and I was just blaming myself for not having regular cleaning in the past years. So I payed more than $300 to get the deep cleaning done.
After I came back, a friend told me the price was ridiculous. So I called several other dentists and they would only charge about $600 for the same work. I did not know that dentists in this country could have so different prices for the same work. I thought the insurance companies would regulate the charges to a similar level. But since I had already paid, I did not want to dispute and just told myself to never go there again.
However, the nightmare was not over. I received a letter from my insurance, stating that the charges for X-ray and cleaning were too high and only part of the charges would be covered. Now the dentist comes to me and asks me to pay the uncovered part, which is about $700. I am so pissed off. Should I pay $1000 out of my pocket to do a deep cleaning even though I have dental insurance? And even if my insurance covers everything, the dentist has charged me to the maximum of my dental benefit ($1500), therefore I would not be able to do even a regular cleaning in one year.
Please advise me what I can do to dispute the charges. Is there an authority regulates the dentists so that I can complain to? Thank you.

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I'm not too proud to ask outright what my dentist will charge me when he suggests something new, and if it's high I go to the front to find out how much my insurance will cover.

You are responsible for whatever charges that are not covered by the insurance. Since it is a free market economy, people are free to set whatever prices they like. So you're on the hook to pay the balance of your bill. Having said that, I'd talk to the dentist in person and mention that he assured you that insurance would pay for anything over 20% you already paid, and you relied on that statement when deciding to proceed with the treatment. Now you want your bill adjusted to show paid in full, especially since the regular charges for this proceedure seem to be around $600.

If this fails, and you don't mind being in the spotlight, contact your local TV station - they may have a program that helps viewers with billing disputes. Having a camera crew and getting negative publicity by knowing how much the dentist overcharged may be enough of a threat for them to forgive the outstanding bill.

cityfisher said: I went to a dentist for a tooth cleaning. He suggested me to do a deep cleaning. I am an immigrant and have not done regular cleaing for a couple of years because I was out of insurance. So I did believe a deep cleaning would be reasonable for me. So I agreed, the he handed me the estimate which said it cost $1600 for a deep cleaning and $170 for X-ray. He told me I should pay 20% of the charges out of my pocket, my insurance would cover the rest. I had no experience with dentists in this country, and I was just blaming myself for not having regular cleaning in the past years. So I payed more than $300 to get the deep cleaning done.
After I came back, a friend told me the price was ridiculous. So I called several other dentists and they would only charge about $600 for the same work. I did not know that dentists in this country could have so different prices for the same work. I thought the insurance companies would regulate the charges to a similar level. But since I had already paid, I did not want to dispute and just told myself to never go there again.
However, the nightmare was not over. I received a letter from my insurance, stating that the charges for X-ray and cleaning were too high and only part of the charges would be covered. Now the dentist comes to me and asks me to pay the uncovered part, which is about $700. I am so pissed off. Should I pay $1000 out of my pocket to do a deep cleaning even though I have dental insurance? And even if my insurance covers everything, the dentist has charged me to the maximum of my dental benefit ($1500), therefore I would not be able to do even a regular cleaning in one year.
Please advise me what I can do to dispute the charges. Is there an authority regulates the dentists so that I can complain to? Thank you.

See if the new dentist you plan on going to gives referral bonus's. Then go knock out your old Dentist's teeth and recommend your new dentist to fix it....

That's how I'd fight a dentist...definitely no biting...

Now for contribution. I think you are going to have to take this one. You had an opportunity to ask about the price prior to the procedure. You could have verified how much insurance would cover. All this is in the past. I do think you are getting screwed on this one though.
My recommendation would be to
    Offer the dentist 1/3 of the amount as you don't have any extra money available (indicating he'll have to try and sue you or something to get the money)



    Take written quotes from the other dentist, go in and discuss with the dentist requesting him to remove the remaining charges. (GET THIS IN WRITING). If he doesn't. Go stand near, but off, the dentist property hold up a sign indicating the dentist screws people. Tell everyone going in your story and show the quotes from the surrounding dentists.



All this is lame recommendation, but because the amount is only $700, it's not worth getting a lawyer and in small claims I think the dentist would win given that you had the chance to ask price up front.

What's a "deep cleaning?" How is it different/better than a regular cleaning?

marketingmike said: What's a "deep cleaning?" How is it different/better than a regular cleaning?

It is like rustproofing /undercoating on a new car... unneccesary for 95% of the population...

Sounds like the dentist saw an easy mark and is taking advantage of cultural /language differences. I would check with local licensing board, and see if this dentist has had other complaint about "gouging" or performance of other unneccessary procedures...

The problem here is that the DENTIST said "I should pay 20% of the charges out of my pocket" they are not to comment or give pricing without backing it up. I would contact the dentist and remind him of what he said, tell him that you insurance will not cover 80% as you told to me and then if he will not bend tell him that you will be contacting all the local media to inform them that you as an immagraint were taken advantage of (we don't spend $1600 to clean teath, maybe $200-$300 full reatail) and want justice, in addition you could contact his licensing board and tell them that he quoted coverage pricing that was 1/4th of what it really was out of pocket and he is doing padded work - they may do a review of his records and see if he gave you a special inflated price.

You are responsible for whatever charges that are not covered by the insurance.

This is what I don't get about dental insurance as I am having the same type of problem. If I go to my medical doctor and show my insurance, I pay a certain amount and the rest is always a write-off. But when you go to the dentist and show insurance, you always have to pay the additional charges. I need to go to the dentist but I am putting it off because I simply don't want to get screwed. Why can't dental insurance be set up similar to other types of medical insurance? Is there just no market for that or are dentists resisting such plans?

Did you insurance company point you to this dentist? I.e. was it on their list of approved dentists?

I have one of the Delta dental plans. I was told that if I went to a dentist in their plan, the dentist HAD to change me the insurance plan rate (which means I have to pay the 20% for most services). They weren't allowed to charge me more than that.

I was told by one of their phone reps that a lot of dentists try to charge more, assuming you'll pick up the rest... but not to fall for it because they are not allowed to do that & still take my insurance plan.

marketingmike said: What's a "deep cleaning?" How is it different/better than a regular cleaning?

I had this done at my last dentist and they used an ultrasonic tool as opposed to the usual scraping tool. I don't recall the exact cost but it was probably more in that $600 range.

At my current dentist they use the ultrasonic tool regularly just because it's easier for them.

Technologist said: marketingmike said: What's a "deep cleaning?" How is it different/better than a regular cleaning?

It is like rustproofing /undercoating on a new car... unneccesary for 95% of the population...

Sounds like the dentist saw an easy mark and is taking advantage of cultural /language differences. I would check with local licensing board, and see if this dentist has had other complaint about "gouging" or performance of other unneccessary procedures...


For the 5% of us who actually need it (using your terms) it's quite useful. I've had it done once (1991-1992) and expect to have it done again at some future point in time (like maybe again in 10 years).

solvay said: You are responsible for whatever charges that are not covered by the insurance.

This is what I don't get about dental insurance as I am having the same type of problem. If I go to my medical doctor and show my insurance, I pay a certain amount and the rest is always a write-off. But when you go to the dentist and show insurance, you always have to pay the additional charges. I need to go to the dentist but I am putting it off because I simply don't want to get screwed. Why can't dental insurance be set up similar to other types of medical insurance? Is there just no market for that or are dentists resisting such plans?


It's the employers who aren't demanding these types of plans from insurance companies. In fact, you are lucky to even get dental insurance these days.

Typically, if the dentist is willing to work under an insurance plan then he/she also accept the rate set by the insurance company.

Why not write a polite letter explaining that you trust the rate set of the insurance company and are willing to pick up the deductable but no more and you would expect the dentist to obey #### (insert FDCA and other legal terms) and send it certified mail.

-deep cleaning is necessary if someone is having symptoms of periodontal diease. Not a dentist but I had a lot of dealing with them.

OP from England?

sknott said: Did you insurance company point you to this dentist? I.e. was it on their list of approved dentists?

I have one of the Delta dental plans. I was told that if I went to a dentist in their plan, the dentist HAD to change me the insurance plan rate (which means I have to pay the 20% for most services). They weren't allowed to charge me more than that.

I was told by one of their phone reps that a lot of dentists try to charge more, assuming you'll pick up the rest... but not to fall for it because they are not allowed to do that & still take my insurance plan.


Yes, this is how my Delta plan works too. By being an approved dentist, they agree to a negotiated fee. What kind of insurance do you have?

OP, You didn't provide enough information to determine who's at fault.
Was he a participating dentist? If so, your out of pocket should be at most $50-100 as preventive procedures are covered at full.
Most likely, he was out of network dentist and you have to pay his full fee. I would call the office and ask him that you would like to return for future cleaning but do not want to pay his full fee.

EDIT: Your math doesn't add up
$1500 max benefit utilized and he is asking for $1000 = $2500
what other work did you have done?

Zon said: marketingmike said: What's a "deep cleaning?" How is it different/better than a regular cleaning?

I had this done at my last dentist and they used an ultrasonic tool as opposed to the usual scraping tool. I don't recall the exact cost but it was probably more in that $600 range.

At my current dentist they use the ultrasonic tool regularly just because it's easier for them.


Ultrasonic manchine is not deep cleaning as the prophy tip does not go too far subgingival. You need those scraping tools with appropriate anesthetic for deep scaling and root planning. As far as pricing goes, $250 is the highest I've seen for regular cleaning. As high as $1600 for deep scaling and root planning and $3200 for Periosurgery. This is NYC estimates btw

hmm....I have dental insurance and for covered charges, it works just like other medical insurace....pays the negotiated rate...they arent supposed to then come after you for the rest...I would file a complaint with your state's insurance regulatory agency and/or consumer protection office....and when you do clean up the info. from your post...stick to the facts and there really isnt any reason to explain it costs less elsewhere (if it does, you should have went someplace else) or you are an immigrant...

maddybeagle said: hmm....I have dental insurance and for covered charges, it works just like other medical insurace....pays the negotiated rate...they arent supposed to then come after you for the rest...I would file a complaint with your state's insurance regulatory agency....

If the dentist is not a participating provider, OP is responsible for the rest of the balance remaining.

Pun said: maddybeagle said: hmm....I have dental insurance and for covered charges, it works just like other medical insurace....pays the negotiated rate...they arent supposed to then come after you for the rest...I would file a complaint with your state's insurance regulatory agency....

If the dentist is not a participating provider, OP is responsible for the rest of the balance remaining.


ok...then he should check maybe if he did that to begin with...

Pun said: maddybeagle said: hmm....I have dental insurance and for covered charges, it works just like other medical insurace....pays the negotiated rate...they arent supposed to then come after you for the rest...I would file a complaint with your state's insurance regulatory agency....

If the dentist is not a participating provider, OP is responsible for the rest of the balance remaining.
My usual dentist dropped MetLife a while ago. They sent me a letter saying that nothing would change, prices would still be the same - but the truth is they could charge pretty much whatever they wanted as they were no longer bound by the negotiated PDP fee schedule, and I'd be on the hook for the non-covered portion. I switched to a Metlife-participating dentist.

jayK said: Pun said: maddybeagle said: hmm....I have dental insurance and for covered charges, it works just like other medical insurace....pays the negotiated rate...they arent supposed to then come after you for the rest...I would file a complaint with your state's insurance regulatory agency....

If the dentist is not a participating provider, OP is responsible for the rest of the balance remaining.
My usual dentist dropped MetLife a while ago. They sent me a letter saying that nothing would change, prices would still be the same - but the truth is they could charge pretty much whatever they wanted as they were no longer bound by the negotiated PDP fee schedule, and I'd be on the hook for the non-covered portion. I switched to a Metlife-participating dentist.


That is absolutely correct! He could tell you there is no change to it but one day you could receive tremendous amt of bill from your dentist. Some dentist will reduce their fee to accomodate you, but that is considered fraud and unethical as they are fluctuating their nominal fee for each individuals.

If this is above normal procedure, he should have received WRITTEN confirmation of being pre-approved for this.

Is the dentist part of your insurance 'in network' group? If so, you have recourse. He can only charge what is 'customarily', the rest he has to write off.

It all depends upon how your dental insurance works. If you have a 'network' , then if he was out of network, you may be out of luck. Of course, I would go back to him and tell him you made your decision based upon what he said. Tell him if you knew it was going to cost $700 you would have said no. Also, tell him you have checked around and that his fees are three times higher than everyone else and you want to know what he does that nobody else does.

Also IF HE WILL NOT WORK WITH YOU try to visit during a peak time and try to compalin again. Make a scene stating that you were lied to, and grossly overcharged in front of several patients. At least that will probally cost him business for treating you poorly.

Did you go to a participating dentist, I am a dentist who used to work for Delta dental plan, all dentists used to charge whatever fee they wanted, if the dentists were in teh participating plan, they would only pay for like certain percentage. Deep cleaning (usual ICD code might be 4941) is also called as Root Planing at times i.e. The non-visible part of teeth (near the tooth sockets)is cleaned. If you are in a participating doctors plan, call your insurance company and they will tell you exactly how much you are liable for. Let me know if this works out. Good luck, I am pretty sure you can fight this out.

madscribe said: sknott said: Did you insurance company point you to this dentist? I.e. was it on their list of approved dentists?

I have one of the Delta dental plans. I was told that if I went to a dentist in their plan, the dentist HAD to change me the insurance plan rate (which means I have to pay the 20% for most services). They weren't allowed to charge me more than that.

I was told by one of their phone reps that a lot of dentists try to charge more, assuming you'll pick up the rest... but not to fall for it because they are not allowed to do that & still take my insurance plan.


Yes, this is how my Delta plan works too. By being an approved dentist, they agree to a negotiated fee. What kind of insurance do you have?


My plan also works this way. Check with Delta and see if the dentist is in the plan. if he is, then he has agreed to Delta's rates

--G

hmm....I have dental insurance and for covered charges, it works just like other medical insurace....pays the negotiated rate...they arent supposed to then come after you for the rest...I would file a complaint with your state's insurance regulatory agency....

I have MetLife Dental and it seems to me like they aren't even trying to enforce the plan rates. The last time I went to an in-network dentist, I received a letter from MetLife stating what the dentist charged and what the plan would pay. It basically stated that I would be responsible for the difference. The insurance almost seemed pointless.

I know I made a lot of mistakes going through the whole process.
The dentist was not in the network of my dental insurance. My dental plan is a PPO plan, I just took it for granted that I could go to any dentist. Actually, one of my coworker recommeneded me this dentist. I did not think much about the insurance. It turns out that we are on different dental plans. Our employer provides different insurance plans.
Before the procedure, the dentist did show me the estimate and tole me I should pay 20% of the charge. But he also asked me to sign a statement that I would be responsible for the charges if my insurance refused to pay.
With regard to the math someone mentioned, the dentist charged me about $1800 in total, I paid $350. Even though my maximum benefit is $1500, the insurance refuses to pay about $700. So now I need to pay about $1000.
I know I am totally trapped in this bill. This is due to my ignorance of the dentist system in this country. I did not know that dentists can have so huge different prices for the same work. I was so naive that I trusted him because he looked very nice. And I should say he did a pretty good job on my teeth. I have no complaint about his work.
So I just want to know the ways to dispute the price. $1000, that is really a big money to me. Now my wife is so mad at me. I not only lost a big money, but also let her think I am so stupid.

people still pay dentists?

i go to an out of network dentist cuz I KNOW HE WILL CHARGE EXORBITANT RATES to the insurance comapny and not look to me for any difference. i thought this is the way all doctors/dentists handle insurance. for instance, if dentist wants to make $800, and they know insurance will pay 80%, just charge the insurance company for for $1000 procedure. been doing it this way for 15 yrs, u mean this isnt how others do it?

solvay said: hmm....I have dental insurance and for covered charges, it works just like other medical insurace....pays the negotiated rate...they arent supposed to then come after you for the rest...I would file a complaint with your state's insurance regulatory agency....

I have MetLife Dental and it seems to me like they aren't even trying to enforce the plan rates. The last time I went to an in-network dentist, I received a letter from MetLife stating what the dentist charged and what the plan would pay. It basically stated that I would be responsible for the difference. The insurance almost seemed pointless.
I've had discrepancies before with what my in-network dentist charged me vs. the PDP fee. Sometimes it will be due to additional charges over and above what insurance covers - for example, porcelain fillings vs. metal fillings. There was one case where the covered charge was incorrect, I called my dentist and explained to them that the PDP fee on the explanation of benefits was less than what they charged, and they immediately credited my account.

Calling the insurance company first won't do a whole lot, since the dentist is the one charging you more than the PDP fee.

TheWiseGuy said: people still pay dentists?

i go to an out of network dentist cuz I KNOW HE WILL CHARGE EXORBITANT RATES to the insurance comapny and not look to me for any difference. i thought this is the way all doctors/dentists handle insurance. for instance, if dentist wants to make $800, and they know insurance will pay 80%, just charge the insurance company for for $1000 procedure. been doing it this way for 15 yrs, u mean this isnt how others do it?


Actually that's not how it works. Insurance has a max payout for certain procedures so super super billing won't increase their claim payout. Also it's illegal for dentist to fluctuate their nominal fee.

cityfisher said: I know I made a lot of mistakes going through the whole process.
The dentist was not in the network of my dental insurance. My dental plan is a PPO plan, I just took it for granted that I could go to any dentist. Actually, one of my coworker recommeneded me this dentist. I did not think much about the insurance. It turns out that we are on different dental plans. Our employer provides different insurance plans.
Before the procedure, the dentist did show me the estimate and tole me I should pay 20% of the charge. But he also asked me to sign a statement that I would be responsible for the charges if my insurance refused to pay.
With regard to the math someone mentioned, the dentist charged me about $1800 in total, I paid $350. Even though my maximum benefit is $1500, the insurance refuses to pay about $700. So now I need to pay about $1000.
I know I am totally trapped in this bill. This is due to my ignorance of the dentist system in this country. I did not know that dentists can have so huge different prices for the same work. I was so naive that I trusted him because he looked very nice. And I should say he did a pretty good job on my teeth. I have no complaint about his work.
So I just want to know the ways to dispute the price. $1000, that is really a big money to me. Now my wife is so mad at me. I not only lost a big money, but also let her think I am so stupid.


This is what you can do, call the dentist and find out why it was not approved. You should call the insurance company and tell them you needed to have the procedure done and you have every right as your primary dentist recommended. They will approve the work ASAP.

cityfisher said:

The dentist was not in the network of my dental insurance.

Before the procedure, the dentist did show me the estimate and tole me I should pay 20% of the charge. But he also asked me to sign a statement that I would be responsible for the charges if my insurance refused to pay.

So I just want to know the ways to dispute the price. $1000, that is really a big money to me. Now my wife is so mad at me. I not only lost a big money, but also let her think I am so stupid.


The best suggestion I can come up given your situation is to try to settle for less or to threaten that it is going to take you 5 years to pay this off, as this amount is more than you have up front. Tell him you only had enough money for the 20 percent handy, but you could scrape enough together for enough 30 percent if he will settle for that. Otherwise, let the payment begin.

Also, if you come to an agreement, get it in writing!!! He has you over a barrell legally. If you don't pay, he will report you to collection agency. If the collection agency calls you, try to settle for 70 - 75 percent of the charge. In other words, you have $1,000 charges. Settle for about $700 to $750 with the collection agency, should it come to that and get statement PAID IN FULL or ACCOUNT ZERO or something similiar.

maddybeagle said: hmm....I have dental insurance and for covered charges, it works just like other medical insurace....pays the negotiated rate...they arent supposed to then come after you for the rest...I would file a complaint with your state's insurance regulatory agency and/or consumer protection office....and when you do clean up the info. from your post...stick to the facts and there really isnt any reason to explain it costs less elsewhere (if it does, you should have went someplace else) or you are an immigrant...
You are absolutely clueless.

There are usually 2 types of in-network dental providers covered by insurance:
- those where the rate is set by the insurer and the dentist can either take it or leave it (meaning that you don't pay more than your deductible + copays ever, like with a medical insurance)
- those where the dentist can set his own rates as he wishes and the insurer pays only up to the usual list price (meaning that you are responsible both for the deductible + copays and the difference), sometimes-called Premier providers.

However, I agree that $1600 for deep cleaning is double the usual price. I think the OP is hiding something. There is nothing to complain about here, except the shear stupidity of the OP.

I am an immigrant, too, and deep cleaning was one of the best investments I made after arriving in the US years ago. No more bleeding gingivae.

cityfisher said: I know I made a lot of mistakes going through the whole process.
The dentist was not in the network of my dental insurance. My dental plan is a PPO plan, I just took it for granted that I could go to any dentist. Actually, one of my coworker recommeneded me this dentist. I did not think much about the insurance. It turns out that we are on different dental plans. Our employer provides different insurance plans.
Before the procedure, the dentist did show me the estimate and tole me I should pay 20% of the charge. But he also asked me to sign a statement that I would be responsible for the charges if my insurance refused to pay.
With regard to the math someone mentioned, the dentist charged me about $1800 in total, I paid $350. Even though my maximum benefit is $1500, the insurance refuses to pay about $700. So now I need to pay about $1000.
I know I am totally trapped in this bill. This is due to my ignorance of the dentist system in this country. I did not know that dentists can have so huge different prices for the same work. I was so naive that I trusted him because he looked very nice. And I should say he did a pretty good job on my teeth. I have no complaint about his work.
So I just want to know the ways to dispute the price. $1000, that is really a big money to me. Now my wife is so mad at me. I not only lost a big money, but also let her think I am so stupid.


Well, you made a mistake. It happens. Next time you'll know to be more careful. Maybe your co-worker can talk to the dentist on your behalf. If the dentist knows that your friend is unhappy about the way he treated you, he might back off rather than risk losing your co-worker as a patient.

There was a thread in FWF not too long ago about a company that would negotiate your medical bill with a physician on your behalf - should work for dental bills as well. Don't remember the name of the company, but you should be able to find a similar company if you search.

georgepds said: madscribe said: sknott said: Did you insurance company point you to this dentist? I.e. was it on their list of approved dentists?

I have one of the Delta dental plans. I was told that if I went to a dentist in their plan, the dentist HAD to change me the insurance plan rate (which means I have to pay the 20% for most services). They weren't allowed to charge me more than that.

I was told by one of their phone reps that a lot of dentists try to charge more, assuming you'll pick up the rest... but not to fall for it because they are not allowed to do that & still take my insurance plan.


Yes, this is how my Delta plan works too. By being an approved dentist, they agree to a negotiated fee. What kind of insurance do you have?


My plan also works this way. Check with Delta and see if the dentist is in the plan. if he is, then he has agreed to Delta's rates

--G

False. Check with Delta about Premier Providers.

Do not assume that dental insurance plans are similar to medical plans. They are NOT. Dentists don't take all the HMO crap that MD's have to. Most of them accept insurance only to get more patient volume, not to drive down their own prices. They don't depend on the insurers, especially since many dental plans are limited in benefits (so the patients are used to paying hundreds out of pocket).

Did you have a periodontal scaling on all 4 quadrants? The price charged at every dentist I've consulted [on behalf of my husband, who came to the US from a country with lower dental hygiene standards] in Boston and Chicago was $200-250 per quadrant. Where do you live? $600 sounds low for a city, but $1800 does sound too high. Unfortunately, given all the releases you signed, you are legally obliged to pay the bill. However, I think that if you approach your dentist in a conciliatory manner, he may be more likely to forgive the debt.

I have a dental PPO too, and my dentist recommended some work for me. I asked how much it would cost after insurance, but I knew to get a pre-estimate from my PPO first b/c my dentist is out-of-network, and it was a lot higher than the dentist had suggested. I don't think he was trying to scam me; it's not his job to know how much my insurance will pay. Previously, I had a very cheap dental HMO, where my out-of-pocket cost was a lot lower, but most of the dentists practiced in bad areas of town. I picked a clinic at the local hospital, and the dentist spent about 30 seconds with me and rudely declared I had poor dental hygiene and gingivitis. I had seen private dentists previously, and they'd never given me such a poor assessment. I switched to the dental PPO, and my new dentist explained why the HMO clinic dentist was incorrect in his diagnosis. Anyway, YMMV, but I'm happy to pay the higher fees for my out-of-network PPO dentist.

jayK said: There was a thread in FWF not too long ago about a company that would negotiate your medical bill with a physician on your behalf - should work for dental bills as well. Don't remember the name of the company, but you should be able to find a similar company if you search.
This is excellent advice. If you can not work this out yourself or with your friend, or calmly inquire with the county or State Dental Association to advise on customary charges and perhaps mediation, .....I would find these consultants, they are becoming more common and specialize in unreadable, huge hospital bills. Here's one example, who I know nothing about, it's not clear to me how they charge, whether by the hour or a percentage of savings or what. Also, it may be that everything has been coded properly-- but these folks are supposedly experts on this stuff.

billadvocates

beethovengirl said: Did you have a periodontal scaling on all 4 quadrants? The price charged at every dentist I've consulted [on behalf of my husband, who came to the US from a country with lower dental hygiene standards] in Boston and Chicago was $200-250 per quadrant. Where do you live? $600 sounds low for a city, but $1800 does sound too high. Unfortunately, given all the releases you signed, you are legally obliged to pay the bill. However, I think that if you approach your dentist in a conciliatory manner, he may be more likely to forgive the debt.

I have a dental PPO too, and my dentist recommended some work for me. I asked how much it would cost after insurance, but I knew to get a pre-estimate from my PPO first b/c my dentist is out-of-network, and it was a lot higher than the dentist had suggested. I don't think he was trying to scam me; it's not his job to know how much my insurance will pay. Previously, I had a very cheap dental HMO, where my out-of-pocket cost was a lot lower, but most of the dentists practiced in bad areas of town. I picked a clinic at the local hospital, and the dentist spent about 30 seconds with me and rudely declared I had poor dental hygiene and gingivitis. I had seen private dentists previously, and they'd never given me such a poor assessment. I switched to the dental PPO, and my new dentist explained why the HMO clinic dentist was incorrect in his diagnosis. Anyway, YMMV, but I'm happy to pay the higher fees for my out-of-network PPO dentist.


As I said, I have no complaint with the dentist's work on my teeth. He did a good job and he was NICE to me. That is why I was willing to pay $350 out of my pocket to do the deep cleaning. But $1000! Isn't it rediculous?
In response to Ervin, I did not hide anything. I just did a whole mouth deep cleaning and X-ray. The dentist charged $400 for each quarter. Other dentists would just charge $160 for each quarter, thus I would just pay $33 out of my pocket. But now I need to pay $1000 for the same work

Skipping 21 Messages...
cityfisher said: The dentist tried to charge about $1470 on my insurance, but my insurance paid him only $700. So now the dentist asks me to pay the part that the insurance refused to pay, which is $700.


This is the part that I don't understand. For example, my dentist is one that takes Delta Dental. They ask Delta Dental for the "list price" but Delta only pays set prices (think of as the "discount price"). I pay a % of the discounted price. In the OP's case one of thw things is happening. Either the dentist is trying to get the full list price for services, despite an agreement which stipulates otherwise from the insurance company, or the dentist is not a participating provider for that insurance company. In the first case, I'd send them a letter saying that you aren't laible for paying the difference between the discounted price and list price, as per your dental insurance. In the second case, you went out of network and have to pay up.

And in so far as all the comments assusing people like me of not taking care fo their teeth, it's mostly genetic. I'm practically like Howard Hughes when it comes to cleaning ones teeth, and I still have problems.



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