Dentist misquoted insurance coverage

No. My dentist is not in network with any insurance providers. My plan pays the same for major procedures regardless whether the provider is in or out of network. I guess it's my fault for not thinking it through more but I just figured the office would provide a more accurate estimation of costs.

mistakes happen, offer to split it with them

I have the initial treatment plan invoice and the reciept from when I paid half my responsibility during scheduling. Both of which state insurance portion of greater than $1000.

Yea my pitch will be to split it.

I agree that it seems very unprofessional to be near a grand off the estimate.

so did your dentist mess up or did the insurance Co not pay you the predetermined estimate of benefits?

Yea I knew that since they were out of network they wouldn't write off the difference and come after me for it. I just didn't expect the difference to be this different. Just seems misleading.

My dental insurance was extremely basic and something like this:
$20 copay for 2 cleanings a year
$20 copay every 2 years for x-rays
$20 copay for anything major up to $1000 maximum/ year. A certain amount like $250 unused rolls over every year up to X amount total.

I've had probably 4 different dental plans, and they have all been very basic like the above. I don't really see how you can not get the estimate almost exact unless it cost more than expected?

it's not a mistake. It's an estimate. There's no way to determine what your insurance will pay or not pay. Your dentist has a fee, that you are obligated to cover whether you have insurance or not. Your dentist is not responsible for your insurance co.'s reimbursement issues and your complaint needs to be taken up with them. You're lucky they filed the claim for you. In New York, they will give you an F.U. if you tell them you have dental insurance, so I hear. They hand you a claim form to mail.

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I don't really see how you can not get the estimate almost exact unless it cost more than expected?

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Because insurance companies don't have an even playing field and are the most despicable aspect in all of healthcare. We, as a dental office, call all our patients' insurance companies before procedures and they will give you a breakdown but state clearly they can pay whatever they want whenever they want. You can be told on Tuesday a D3330 root canal will be paid at 70%, a max of $740. You file that claim code that day and get reimbursed $540 with some notation that's complete bs.

Ultimately, the patient is their customer and a dispute between the patient and their own policy maker is what needs to happen. The insurance co. will not listen to a doctor's office and a doctor's office does not have the time to dispute the $200 difference on your behalf.


Soap Box: Dental insurance is NOT insurance. It's called that so we think it should cover things we cannot afford. It's actually a benefit savings plan with a maximum, usually $1,000 but sometimes all the way up to $2,500. Insurance covers things we cannot afford, like totaling a car or your home burning down. Dental insurance says here's a few bucks, good luck. It's not meant to take care of your needs and health. Out of pocket costs should be planned for. You are lucky if they don't deny payment altogether. I see it every day. Systemic health begins with oral health.

Dental benefit companies are paying sooooo much less these days. I got a declination from one this week for a simple $24 Fluoride treatment on a child! What?! A preventative procedure on a child. The one treatment that will likely save the patient and "insurance companies" thousands of dollars in the future. Now how ignorant is that?!

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But instead they told him "this is how much the insurance company is going to cover.

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No, he explicitly said they gave him an estimate.

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If they screwed that up, it's them

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The doctor is out of network, he says "This is how much I charge, this is what your insurance coverage % says" and the estimate is given based on that.

If the insurance company comes back and says "You charged $100 for XYZ and we only cover that up to $80" that is not your doctor/dentist fault

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the office managers, figuring out insurance coverage is literally their job.

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No it isn't. They file claims but as an out of network provider they aren't able to provide perfect estimates if the insurance providers changes their payment amount