[Kathe]

Bait and switch! My paperwork shows exactly what I would pay out of pocket and what insurance would pay. AFTER the work they said OF COURSE that’s not covered. My paperwork and Seniors Against Crime say their mistake. I won’t pay more than documented on my paperwork. But be careful!

[Bill14564]

Was the work done? Would you have had the work done if the cost breakout was different? When the insurance company disputed the charges and provided an explanation was the explanation something the dental office could have reasonably known about ahead of time?

Personal experience with this office: I needed a crown replaced and was provided an estimate of the cost breakdown. I needed the work done so I had the work done. The insurance company refused some of the charges because the original crown was put in just under five years ago (four years and ten months but still under five years). There was no way the dental office could know that the original crown had been there less than five years. I had to pay more than expected but in this situation I can't blame the dental office for that.

[EdFNJ]

Originally Posted by Kathe

Bait and switch! My paperwork shows exactly what I would pay out of pocket and what insurance would pay. AFTER the work they said OF COURSE that’s not covered. My paperwork and Seniors Against Crime say their mistake. I won’t pay more than documented on my paperwork. But be careful!

Sounds like McDonalds Happy Tooth Meal Dental, I mean How's Your Azzbeen (after you leave) Dental. They cleared my "plan" with my insurance and I ended up getting a bill for almost $300. Took weeks to get it removed. This was about 3 years ago. Was charged for things I didn't want or approve or ask for even telling them it won't be covered. Of course there are 2 sides to every story so YMMV.

[EdFNJ]

Originally Posted by Bill14564

Was the work done? Would you have had the work done if the cost breakout was different? When the insurance company disputed the charges and provided an explanation was the explanation something the dental office could have reasonably known about ahead of time?

Personal experience with this office: I needed a crown replaced and was provided an estimate of the cost breakdown. I needed the work done so I had the work done. The insurance company refused some of the charges because the original crown was put in just under five years ago (four years and ten months but still under five years). There was no way the dental office could know that the original crown had been there less than five years. I had to pay more than expected but in this situation I can't blame the dental office for that.

Actually you CAN blame them because when they submit to insurance which they should (and can) do while or before you sit there they would have known and told you (not that you wouldn't have had it done but your dentist COULD know before doing the work). They simply didn't get a pre-authorization. Had they done that you would have known.

[keepsake]

I had this 'prior work done' limit, years ago. It was the exact same dentist that did the work less than five years earlier on same tooth. No excuse. These offices should know the insurance rules BETTER than the patient.

[TedfromGA]

Originally Posted by EdFNJ

Sounds like McDonalds Happy Tooth Meal Dental, I mean How's Your Azzbeen (after you leave) Dental. They cleared my "plan" with my insurance and I ended up getting a bill for almost $300. Took weeks to get it removed. This was about 3 years ago. Was charged for things I didn't want or approve or ask for even telling them it won't be covered. Of course there are 2 sides to every story so YMMV.

Trailwends Dental on 466a was not there 3 years ago! We've had very good experiences there since it opened.

[retiredguy123]

This thread is very confusing. I'm glad I don't have dental insurance. But, I suspect that the OP signed something that said they are responsible for any treatment that was not paid for by the insurance company. It is a pretty standard disclaimer.

[Michael G.]

I never had any luck with ANY dentist here in Florida.
They all want to sell you some $1000 dental work when my teeth are fine and no problem.

I went to one not so long ago and they recommended $2300 worth of dental work, I said no thanks.
As I was leaving through a crowded waiting room, the dentist said: "You better reconsider or you'll need a root canal."
I said: Goody, "I LOVE root canals", as everyone in the waiting room laughed.

[JMintzer]

Originally Posted by EdFNJ

Actually you CAN blame them because when they submit to insurance which they should (and can) do while or before you sit there they would have known and told you (not that you wouldn't have had it done but your dentist COULD know before doing the work). They simply didn't get a pre-authorization. Had they done that you would have known.

Pre-authorizations mean nothing. The insurance company will tell the provider that the "pre-authorization" is NOT a guarantee of payment...

I have to deal with this all the time...

[Michael G.]

Originally Posted by JMintzer

Pre-authorizations mean nothing. The insurance company will tell the provider that the "pre-authorization" is NOT a guarantee of payment...

I have to deal with this all the time...

Same thing with any medical clinic when asking if they take your insurance,
all will say YES which didn't mean a thing useless their in your NETWORK.

[JMintzer]

Originally Posted by Michael G.

Same thing with any medical clinic when asking if they take your insurance,
all will say YES which didn't mean a thing useless their in your NETWORK.

Absolutely false. We ALWAYS check to make sure we are in the patient's network BEFORE seeing them. I can say the same for all of my colleagues...

[EdFNJ]

Originally Posted by JMintzer

Pre-authorizations mean nothing. The insurance company will tell the provider that the "pre-authorization" is NOT a guarantee of payment...

I have to deal with this all the time...

Maybe "pre-auth" was the wrong term? I would think when it comes to having work done on a specific tooth the insurance company has specific records of what was done and when that specific tooth was worked on previously as we experienced with Howell Dental. They first contacted Aetna and knew EXACTLY what was covered before anything was done. Tooth #5, yes #7 no because it was done 3 years ago. Obviously I know nothing about Podiatry (or dentistry) but what would be the equivalent to working on a specific tooth treated less than 5 years ago that could be denied? Seems replacing a specific crown or covering a full mouth xray for a general exam under 3 years is more specific and is clearly listed on the policy under exclusions. As an example Policy says General exam every 6 months but full mouth xray every 3 years. Dental insurance seems very specific (if one reads the policy or checks with the insurance co).

[thevillages2013]

Man I hate going to the dentist! I have all my original teeth (minus wisdom teeth) and only one filling and I go twice a year for cleaning. There is a constant fight however about x-rays. Me-“why do you X-ray my teeth?” Dentist- “ to find cavities between your teeth “ Me- “ look at my records and see how many cavities have been found between my teeth “ Dentist -crickets

[Djean1981]

Dentist office can contact the insurance company to get pre-authorization with coverage info - just like for a hospital procedure.

[MrFlorida]

Does anybody have a dentist that is not a salesman ?