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rated:
Hello guys,

Today i received a dental claim from my insurance company saying that the claim was denied and i will have to pay the total charge for the procedures done at the dentist office i went to recently. The problem is before i let them touch my teeth, I asked the lady at the counter desk several times whether i was covered by my insurance and she said yes.  $360 is a lot of money for a college student like me. What should i do in this situation?What will happen if i just don't pay?  

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Most Recent Posts
Answering the OP's question re: "just not pay": eventually they'll send it to a collections agency. Depending on your ta... (more)

arla (Mar. 14, 2017 @ 1:15p) |

For heaven's sake, do not let it go to collections and significantly damage your fledgling credit history for $360.

It ... (more)

oppidum (Mar. 14, 2017 @ 11:37p) |

Unless the world has lately gone 100% topsy-turvy (instead of just 80%), putting a consumer freeze on your credit report... (more)

oppidum (Mar. 14, 2017 @ 11:43p) |

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rated:
Why did the ins Co denied the claim?

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Can't help you much OP in this regard. But multiple times we have all seen here and learned the hard way that establishing insurance coverage/exclusions for the procedures about to be performed is the full responsibility of the patient; and the doctors' office folks only do it as a courtesy; and if anything beyond that they pretend it's all covered to get you in the door.

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Ask the Dr for a payment plan .... in the future ask them to get a "pre-authorization" for your procedure and you will know in advance and in writing exactly what you will be paying.

Then brush and floss more carefully.

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They said the service was not covered because i'm over 19. So right now it's between me and dentist office. Can't really file a appeal to the ins company

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MisterEd said:   Ask the Dr for a payment plan .... in the future ask them to get a "pre-authorization" for your procedure and you will know in advance and in writing exactly what you will be paying.

Then brush and floss more carefully.

  What if they don't want to set up a payment plan? I don't have that much money so if that happens i will not be able to pay. What will happen if i don't pay?

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jackly said:   They said the service was not covered because i'm over 19.

What was the procedure?

I had claims denied for "over 19," BUT the wording in the actual contract was "under 19 OR medically necessary." I got it paid. Now, mine as for fluoride treatments, but $360 sounds like it was something else.

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Chyvan said:   
jackly said:   They said the service was not covered because i'm over 19.

What was the procedure?

I had claims denied for "over 19," BUT the wording in the actual contract was "under 19 OR medically necessary." I got it paid. Now, mine as for fluoride treatments, but $360 sounds like it was something else.

 The procedures were an exam, 3 x-rays with 3 different prices and prophylaxis. The insurance i have is blue cross blue shield, i got it through my school with the Masshealth Premium Assistance(which helps me pay for Blue Cross Blue Shield)

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Then you need to read your plan.

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Aside from any routine check up or cleaning, I always ask the dentist office to run the procedure in my insurance co's system BEFORE I agree to the procedure, that way I know what my cost will be. I keep the print out in case there are issues later.

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Chyvan said:   Then you need to read your plan.
  Like i said, it's between me and the dental office. They said i was covered and did not even tell me how much the procedures would cost. What will happen if i don't pay at all?

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You need to call them. It could just be that they made a billing error and need to resubmit the claim to insurance. If that's not the case, explain to them that you were told that you would be covered by insurance and now cannot afford the high amount they are charging. If they don't volunteer to help with your claim, ask if they will at least let you pay the amount your insurance would have paid them (insurers pay reduced negotiated rates). If all that fails, ask for a payment plan, just be honest about what you can afford, they do this all the time.

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Am I correct that you tried to use your medical plan for dental coverage? Ouch, rough lesson that (1) most medical plans don't cover dental and (2) don't trust the receptionist regarding coverage.

Best bet at this point is to negotiate with the dental office. Find out what the negotiated rate would have been and offer to pay that, ask for a payment plan, etc. Play the broke college kid and mis-informed by receptionist cards. Best of luck.

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doveroftke said:   medical plan for dental coverage?
  
This may not be true. It's very likely that a college student is on the equivalent of expanded Medicaid and has dental coverage until 20 and 364 days old.

The problem is that this person doesn't necessarily understand what is happening to them, and isn't going in the correct direction that may be the path of least resistance.

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sealants?

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Should i call them right now or wait until i receive a bill directly from them? So far i only have the dental claim from my ins company

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raringvt said:   You need to call them. It could just be that they made a billing error and need to resubmit the claim to insurance. If that's not the case, explain to them that you were told that you would be covered by insurance and now cannot afford the high amount they are charging. If they don't volunteer to help with your claim, ask if they will at least let you pay the amount your insurance would have paid them (insurers pay reduced negotiated rates). If all that fails, ask for a payment plan, just be honest about what you can afford, they do this all the time.
  ^^^
This. You may be able to negotiate and at least reduce payment due. If you won't pay, it will go to collection, lower your credit score and make it harder/more expensive for you ever get a loan. At your age, I strongly recommend against not paying.

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MommyOfHAndK said:   
raringvt said:   You need to call them. It could just be that they made a billing error and need to resubmit the claim to insurance. If that's not the case, explain to them that you were told that you would be covered by insurance and now cannot afford the high amount they are charging. If they don't volunteer to help with your claim, ask if they will at least let you pay the amount your insurance would have paid them (insurers pay reduced negotiated rates). If all that fails, ask for a payment plan, just be honest about what you can afford, they do this all the time.
  ^^^
This. You may be able to negotiate and at least reduce payment due. If you won't pay, it will go to collection, lower your credit score and make it harder/more expensive for you ever get a loan. At your age, I strongly recommend against not paying.

  When will the dental office send it to collection?

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jackly said:   Should i call them right now or wait until i receive a bill directly from them? So far i only have the dental claim from my ins company
 Wait for a bill.  It shouldn't be due until ~ 30 days from the bill date.  As soon as you get a bill, I would call them and discuss the items I outlined above.

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jackly said:   
harder/more expensive for you ever get a loan. At your age, I strongly recommend against not paying.
  When will the dental office send it to collection?

 Don't let it go to collection.  Call the office before and explain what happened and that you will get pre-estimate before hand from now on.  Tell them you want to pay the bill, but as a college student you can't come up with the whole amount at once and tell them how much you can comfortably pay. 

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If the staff assured him he was covered, OP should at least get a discount down from the office down to the insurance's negotiated rate.

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Unexpected dentist bills bite.

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jackly said:   So far i only have the dental claim from my ins company

You need to be discussing your insurance, and how old you are?

If you are under 21, and have the equivalent of Medicaid through the health exchange, then you have DENTAL.

If you took insurance through an HMO like provider that contracts with Medicaid, then you need to apply for the dental portion, and they will pay for services in the past 90 days, but the clock is ticking.

rated:
Don't ruin your credit over $360. The dentist's office will most likely take payments and may even give you a cash discount. As long as you're making a good faith effort to pay, they won't send it to collections, because they'll only get pennies on the dollar from the collection company.
As for "the lady told me I was covered", as far as your insurance is concerned, it's he said/she said, and they're not going to care. YOU need to read and understand your policy before you have any services. That's YOUR responsibility.
Pay the bill and consider it a (relatively inexpensive) lesson learned. What if the bill had been in the thousands?

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I hate dental offices and have had this exact thing happen to me before. Many years ago I went to an office to get a review of my wisdom teeth and essentially a quote. The receptionist says "Oh you're covered!" and two weeks after the 5 minute exam I get a bill for $80. I call up, the same receptionist picks up and says "No, you have to pay this. Insurance covered X% and you owe Y-X%." Very different than "Oh you're covered!"

Luckily for me it was "only" $80 so I paid up not wanting to deal with them anymore. Unfortunately for them I have a fairly seasoned Yelp account and left a review accordingly.

Lessons learned on both sides I think. I am responsible for knowing my policy in and out, and the dental office probably tells their clients the same thing now. My new dental office always tells me an accurate cost; a couple of times it ended up being higher, but they ate the cost to keep my business.

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Answering the OP's question re: "just not pay": eventually they'll send it to a collections agency. Depending on your taste for letter-writing, you could make the collections agency go silent. They might try to report it to a credit bureau and, if your taste for dealing with it falters, it could mess with your credit for some years to come. Up to you how much you care about that. I doubt they'd sue over this sum, but it is possible. If you've been diligent about the letter-writing, you can probably make them reluctant to sue - you could create a situation where they've clearly crossed the line in collections, opening them to counter-claims, or make it obvious that you'll fight the collection on substantive grounds. They want summary judgements, not a defendant who insists on going to trial and calling the dentist's admin to testify - at that rate, it's no longer cost effective for them to be in court. But you'd be paying a lawyer a lot more to defend this than the $360 in question.

"Should do" morally? I'm of very mixed minds, but that's partly because I don't fully understand the insurance denial - I've seen situations where I thought the provider should eat something like this. But that's your call.

"Should do" practically? Probably as others have suggested and ask them to meet you halfway. If you decide not to pay, you might put freezes on your credit reports - that MIGHT stop the negative information from showing up on a credit report. (The collections agency may pull a credit report when they receive your account. If they are unable to do so, which the freeze should stop, they may also be unable to report the unfavorable account.)

rated:
For heaven's sake, do not let it go to collections and significantly damage your fledgling credit history for $360.

It sounds like that is what you'd rather do, and you want to be reassured that it will turn out okay, but it wouldn't be that simple.

Follow the steps from RaringVT above.

---
You have to be so careful when arranging any kind of voluntary medical procedures, it is sad to say. You have to pin the charges down, beyond what would seem to be necessary.
It's better to clear things yourself by calling your insurance company ahead of time; don't rely on the other party's assurances.

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arla said:    If you decide not to pay, you might put freezes on your credit reports - that MIGHT stop the negative information from showing up on a credit report.
 

Unless the world has lately gone 100% topsy-turvy (instead of just 80%), putting a consumer freeze on your credit reports does NOT prevent true information about your credit history from being added to the reports.

As far as I am aware, you can't freeze out the reporting entities from being able to report legitimate information about your misdeeds/mistakes/negligence/irresponsibility.
 

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