Insurance Billing Question

For those who are pretty well versed on insurance billing, I have a question.

If you have dental insurance, should the provider always bill the insurance company first before they bill you? Even if the provider has verified you are not covered for the service? In the past, the dental office would always tell me that my services are not covered so I had to pay in full at the time of visit. This has happened to me twice a year for the past 5 years or so. My last visit, the provider went through my insurance and it was denied but I received the insurance discounted price. The dental office billed me at the discounted price.

Which is correct, pay full price or discounted price that the insurance company receives?

Insurance Billing Question

It depends if the provider is in-network with the insurance company. An out of network dr doesn't have to accept the discounted price.

Re: Insurance Billing Question

If the dentist is in network, but the procedure itself was not a covered service on your plan, then I believe they are correct with the discounted rate, because you used an in network provider.

Insurance Billing Question

the provider is in-network. this is for dental cleanings (I get 4 a year and my insurance only covers 2). so the extra 2 cleanings a year, I have to pay OOP. which is fine, except it would be nice to know if I should be paying their full price or the insurance's discounted price.

Insurance Billing Question

They should bill the insurance and then you pay the discounted rate

Insurance Billing Question

This might suck to hear, but I collect up front. I make sure we know what the patients responsibility is and collect it at the time of the appointment. I would still bill the insurance and if they paid more than expected, then a refund would be issued. It's near impossible to collect from patients after the fact, and doctors (regardless of what you may think) cannot afford to lose that money, especially since more and more insurance plans are increasing the patient responsibility.

Re: Insurance Billing Question

Insurance Billing Question

Sorry, sounds like you have been overpaying. Maybe there was a change in staff and the new person knows how the in-network insurance works?
For out of network dental, I pay full price and get what I can from insurance. In network should be at the discounted price, even if it isn't fully covered.
Good luck explaining or getting money back. I don't want to discourage you, but my DH finally, after 7 years, used a credit for overpayment at the dentist. They refused to give a refund.