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Medical Billing (orthodontist) Question
Posted on 12/29/25 at 10:55 am
Posted on 12/29/25 at 10:55 am
So....I'm running into the racket that is Orthodontist billing while trying to settle up all my flexible spending account stuff for the year.
Our price is $5,280 for the braces. Payment structure was to be as follows:
$1,000 to be paid by insurance
350 starting payment
24 (0% interest) payments @ 163.75/month
-All this adds up to the $5,280
The initial claim was filed with my insurance for the full amount. That EOB shows a member discount of $4,203. So if this orthodontist has agreed to participate with BCBS as a member of the PPO, why have I paid $4,280 out of pocket?
Our price is $5,280 for the braces. Payment structure was to be as follows:
$1,000 to be paid by insurance
350 starting payment
24 (0% interest) payments @ 163.75/month
-All this adds up to the $5,280
The initial claim was filed with my insurance for the full amount. That EOB shows a member discount of $4,203. So if this orthodontist has agreed to participate with BCBS as a member of the PPO, why have I paid $4,280 out of pocket?
3
Posted on 12/29/25 at 2:52 pm to AUjim
quote:
if this orthodontist has agreed to participate with BCBS as a member of the PPO
Is he a member? Most dental specialists are not members of PPO's.
Posted on 12/29/25 at 3:48 pm to deathvalleytiger10
According to the website and the EOB, he is
Posted on 12/31/25 at 12:49 pm to AUjim
Was the discount applied after the insurance made the payment?
Posted on 12/31/25 at 1:06 pm to AUjim
I thought EOB always uses the sticker price so the insured feels they are receiving value from the plan.
Braces for less than $5k hasn’t been an option in my lifetime.
Braces for less than $5k hasn’t been an option in my lifetime.
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