Insurance / Dentist both disagree

[cdoll]

What is the name of your state? Illinois

when i swicthed jobs i learned it would cost an additional 147.00 a month (1764/year) to give my son dental insurance (500.00 extra a month for health). So we went without dental insurance for him. after the first uninsured dental visit I knew I need help. I was not interested in a dental "plan". I found Unicare offers children dental insurance for 15.50 a month. preventative care is 100%, and then there is a discount for other things like fillings/etc. The next visit with insurance was great. I didnt have to pay for anything as its part of the preventative care.

Then recently, we went back for another 6 month visit, the receptionist told me I owed 27.00. I wrote out the check and then thought "why am i writing a check for this?" I questioned if it was because he had xrays. she said no, that thats part of preventive care, but i have to pay whats left over of the fee that the insurance doesnt cover for all prevenative services. I argued that I dont and i didnt last time. I got on the phone with the insurance, they confirmed what i had thought. but i left because the girl said she would call the main office.

I have been on the phone many times since with the dentist office. she told me she was supposed to charge me the first time we came in with insurance too and that she made a mistake. she keeps telling me "its only 27.00". thats not the point. I bought insurance for a reason. I got my EOB and it states right on there "because you went to a contracted dentist you are not responsible for any fees". The insurance told me they sent me and the dentist the EOB at the same time. i got mine 3 weeks ago. the dentist office claims they didnt get it. though the admit that if it says that i get a refund.

I know medical offices cant charge fees if they are contracted with an insurance plan right? and even if its only 27.00 thats a good weeks worth of gas which i need. who do i go to next? the biggest problem, my son, 11, had a dental nightmare as a child. he is very untrusting of dentists. he is very happy and comfortable with this one. I dont want to have to switch.

 

[ablessin]

Here is what you need to do, since provider claims to have not received the EOB (stands to reason they didn't get their check either, because it's "usually" attached) - -you need to make a copy of yours and mail it into them.........this will show them that according to the insurance you don't owe anything.

You might owe a small copay for the x-rays, your next EOB after the xrays will say so. You can pay up front to appease the office, and then once you get your EOB from the insurance - if indeed you don't have a balance due, request the refund from the providers office. They must comply. Although they may drag their feet.


But, no if the EOB says Zero patient balance, the office can't bill you.

 

[cdoll]

Thank you for the advice

That is what I will do. I will call back next week, therefore giving them another 10 days to receive that EOB... if they claim to not have it I will mail them a copy of mine.

I have since found out the xrays are all 100% prevenative, so I should get all the money back. I hate conflict, so that is why let them have the check I wrote out even after I questioned them why I was paying.

I feel silly since the receptionist keeps saying "its only 27.00", because shes right. But thats not the point. That doesn't mean they can just charge people because they want to. (not to mention that can possibly buy a can of paint for my new house )

Thanks again!