First Time Using Job Health Insurance:Possible Disp ute with Doctor

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FearoftheNight

Diamond Member
Feb 19, 2003
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Hey guys I'd like some opinions on how to best resolve this issue I may be having with my dentist as this is my first corporate job with insurance and I'm not sure how to deal with this situation I'm in...

1) General dentist refers me to specialist to get something looked at.
2) I go to see specialist for an exam and then go back to have treatment done.
3) I verify before that a) the specialist is in-network b) ensure coverage after arriving for exam c) operation is covered under the insurance
4) I receive a bill that covers said operation under terms of insurance. However, now it turns out that I'm only covered for one exam every 6 months under the insurance and I'm being charged another $180 for the exam with the specialist. This was not indicated at all to me.

So what's the best way to deal with the situation? I feel that this is a bit unfair as I'm being charged after the fact without being informed of it beforehand.
 

RadiclDreamer

Diamond Member
Aug 8, 2004
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It isnt your Doctors job to verify your coverage. They do this as a courtesy. It is up to you to read through and understand their cryptic terms. Best thing you can do is call up the insurance and see if they can do anything. Sorry to sound mean, but thats just how it is.
 

shopbruin

Diamond Member
Jul 12, 2000
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1) General dentist refers me to specialist to get something looked at.
2) I go to see specialist for an exam and then go back to have treatment done.
3) I verify before that a) the specialist is in-network b) ensure coverage after arriving for exam c) operation is covered under the insurance
4) I receive a bill that covers said operation under terms of insurance. However, now it turns out that I'm only covered for one exam every 6 months under the insurance and I'm being charged another $180 for the exam with the specialist. This was not indicated at all to me.

So what's the best way to deal with the situation? I feel that this is a bit unfair as I'm being charged after the fact without being informed of it beforehand.

So as a person who maxes out their dental benefits every freaking year it seems, this is probably what happens:

1. You go see the specialist. That is all covered fine and dandy for the procedure.
2. They only checked to see if the coverage you were extended was for the procedure. The consult is considered separate
3. Or when they checked to bill you for the consult, your regular dentist had not submitted all the insurance paperwork for your regular checkup, so to your insurance, it looked like you had not used your insurance yet, but by the time the specialist billed you, they did, so you had to pay the full price.
 

MaxFusion16

Golden Member
Dec 21, 2001
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sounds like the specialist's fault, they should verify that you haven't had the exam in 6 month before doing another one.

work it out with the insurance and specialist, $180 is not that much, the specialist might agree to take less on account of his carelessness.
 

Ryland

Platinum Member
Aug 9, 2001
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Same thing happened to me with my son. You have to suck up the 2nd exam since it isnt covered.
 
Apr 17, 2003
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sounds like the specialist's fault, they should verify that you haven't had the exam in 6 month before doing another one.

work it out with the insurance and specialist, $180 is not that much, the specialist might agree to take less on account of his carelessness.

no, OP should verified the number of exams he can have at any given time.
 

SandEagle

Lifer
Aug 4, 2007
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tell him to itemize everything.
pay by credit card, then dispute it.
discuss with your insurance company about possible fraud.
let it go to collections, then negotiate it to $10.

I,ANAL
 

shopbruin

Diamond Member
Jul 12, 2000
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Also what COULD have been done, if your insurance is like mine:

Your dentist puts in the charges as a regular twice a year exam.
The specialist puts in the charges as a periodontal maintenance. (although check on the timing to see how close you have one of these done after your regular exam)
Periodontal maintenance will be charged under your annual maximum, so you'd probably have to pay like 20% out of pocket.
 

DaveSimmons

Elite Member
Aug 12, 2001
40,730
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tell him to itemize everything.
pay by credit card, then dispute it.
discuss with your insurance company about possible fraud.
let it go to collections, then negotiate it to $10.

I,ANAL

Or steal a body from the morgue and pay another dentist to change the dental work to exactly match your own.

Put the body in your car and set it on fire.

They'll never catch you!
 
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