{ "media_type": "text", "post_content": "Have pretty great dental insurance, covers orthodontics so got Invisalign. Dentist office submitted ~$6k bill, insurance says there is a negotiated ~$4k rate. Insurance pays X and I pay the balance on the negotiated rate. Dentist’s office then tells me I’m responsible for the remaining $2K. This is illegal, right?", "post_id": "5feb3fc58de5a3002895380d", "reply_count": 35, "vote_count": 1, "bowl_id": "552d1d24dc1c586b09d2d051", "bowl_name": "Consulting" }

Have pretty great dental insurance, covers orthodontics so got Invisalign. Dentist office submitted ~$6k bill, insurance says there is a negotiated ~$4k rate. Insurance pays X and I pay the balance on the negotiated rate. Dentist’s office then tells me I’m responsible for the remaining $2K. This is illegal, right?

like
Posting as :
works at
You are currently posting as works at
Highlighted IconHIGHLIGHTED

OP you said it covers orthodontics but what is the cap/max? I have never seen dental insurance that covers ortho 100%. Most cover anywhere from 1k to 2k. If yours has a cap of 2k they can bill you 4 k. Billing 6k, negotiate rake 4k, insurance cap 2 k, out of pocket k, dentist write off 2k. You need to check and see if your ortho work is covered 100% or if it has a cap.

like

Insurance pays 50% up to lifetime cap of $5k. So they paid $2k, I paid $2k, I thought all was good, and now dentist’s office says I’m on the hook for the additional $2k difference between the negotiated rate and what they billed.

This happens a lot with dentists, derms, audiologists...all the specialties that insurance doesn’t cover or covers little of. It’s a pain in the rear. Lesson learned— be sure you go over your OOP costs very clearly before you get a service. Not sure who your employer is, but we have a concierge type service that helps us with these issues— they can provide clarity on the billing issue, and even help negotiate the balance for you.

like
Recent IconRecent

That’s how insurance works usually sorry to say. Either you or dentist office should have checked before hand

likefunny

Unless something has recently changed this is illegal. You dont pay the difference in office fees and your insurance’s negotiated fee. The office is supposed to write off the difference. Thats the whole point of being in network. Id call my insurance and tell them whats happening. Unless youre referring to the max benefit allowed on your plan then thats a different thing.

like

Then it sounds illegal and you should get your insurance company involved. They cant go back and ask for above the negotiated price just because they feel like it. Theyve agreed to accept your insurance’s negotiated fee list. They cant pick and choose which fees to honor off that list.

like

no. the cost of your orthodontics is 6k and your insurance is paying out according to their terms which appears to have a cap associated with the particular service.

like

Agree with pt 1, but I would say ‘cost’ is not the right word. ‘Price’ would be better

If the cost is 6k and insurance paid 4K then you do owe 2k. If the insurance negotiated rate is 4K and the doc is in network and the insurance also paid that 4k then you shouldn’t have to pay anything. I think.

like

Yea - I had that issue with hearing aids. It’s definitely illegal. I don’t know how to get around it though cause I couldn’t win mine.

like

So the total was $6k. Negotiated rate was $4k. Insurance paid X% of the $4k. I paid $4k*(1-X). Now dentist office is trying to charge me the additional $2k. My understanding is that the negotiated rate means they can’t just charge me more because they feel like it? They agreed to that rate?

like

Are they in network or out of network?

like

In network.

You might be able to negotiate with the office a little bit. Like any other business they’re incentivized to keep you as a customer.

like

Don’t pay. What’s the point of the negotiated rate if you’re responsible for the difference

like

What is the value of X? If X = $2k, you are on the hook for 2k. Your out of pocket is 4k - X. If the work done included root canal, crown and such you will most likely have a deductible of almost 50%. If you got braces insurancee probably only pays $1,000 or $1,500. Without seeing your itemized bill or work done or knowing the value of X not easy to say if billing is incorrect. The dentist or the billing office should have explained how much your out of pocket will be before doing any work. Something can only be illegal when against the law and this is a policy question, not a law question:-)

like

Exactly. Negotiated rate was $4k. Insurance pays 50% up to lifetime cap up $5k. So they paid $2k. I paid $2k. Dentist is now saying I owe them the additional $2k between the negotiated rate and the amount they billed.

like

Sounds like (and we obviously don’t know from what you’ve told us) you needed to flag the insurance deal with the dentist beforehand. First question is whether this particular dentist was party to the negotiated rate.

Then you have a good basis to tell them politely to f%#k off or take it up with the insurer who referred you for a given rate

This is back billing and unfortunately legal. There was some recent bill passed that makes this illegal in 2022, but can't comment on it. The only way might be to call dentist office and negotiate. It is really unfair and ultimately what makes healthcare so non patient centric!

I believe our dental insurance covers $4k lifetime for braces/orthodontist.

Knowing and believing are two different things:-) Should be able to check that on your policy portal and that will tell you the answer

Related Posts

I’m currently at a mid tier firm as an experienced senior, just under five years in PA. Joined as a lateral hire about a year ago and compensated above market. I want to focus on tech industry but scheduled on all type of industries from nonprofit, healthcare, manufacturing, food and beverage and etc. it’s very hard to get out of the engagements I’m currently on and switched to tech exclusively. Should I consider moving to Big4 for better opportunities?

like

I amicably split from my wife in Dec 2020. After two months alone I got desperate for human touch and made an OLD profile. I quickly met a lovely woman and we're FWBs I guess? We haven't defined things (no ex talk, not exclusive) but we had a great summer (camping, hiking, biking, dinners, etc.) and I could see it getting serious. Problem is I haven't told her I'm estranged but still legally married. My ex has health issues that need my insurance and I can not cut her off after 10yrs together

likefunny

It’s so disappointing that people still don’t pay equal attention or importance to mental and emotional health.

like

What vision insurance provider do MBB use? Does anyone use VSP?

likesmart

Health Advances interview coming up - would love insights into the culture and trends in project work! TIA!

like

Can anyone share your experience /what you've heard about Kearney healthcare practice? 1) How's the exposure to pharma /biotech (as compared to pharmacies / consumer health) ? 2) How’s the hour? TIA!

like

Is it smart to buy a cash-value life insurance policy? I have a term life policy already in my name, but this second policy is to be able to use this cash in 15-20 years.

like

Have any of you quit to take a break - 3 month or a 6 month sabbatical to pursue other interests or just to clear your head and figure out what’s next. How easy was it to find a job after the break and how did you manage your health insurance? Any other things to keep in mind when considering a sabbatical beyond money?

likehelpful

Does anyone have any thoughts about a company terminating an employee within the HR team for testing positive for COVID 19 and further accusing the said employee of being the one that created the entire team to become infected by not answering the health screening questions accurately? The week prior to employee being tested the entire team was in the office sick. The company in question weeks prior wrote the employee up referencing sexual innuendo due to an accusation of a preferred name.

I have a VUL with cash value I've decided I no longer need the life insurance associated with this policy. Is there a way to get access to the cash value without owing taxes? If no, how will it be taxed and how to determine how much gain/tax? I paid maybe $20k into this policy many years ago. Since then it has increased in value and also paid the premiums from the cash value. Today it shows $70k cash value. TIA

like

Anyone work at Syneos Health and willing to chat and maybe give a referral?

like

Looking for a hungry, energetic healthcare consultant looking to get into tech sales. We are a startup custom AI consulting and dev shop, spun out of a major healthcare automation company. Looking for someone tech savvy, with an eye for real innovation, that wants to drive us forward and be a leader in the company. Not looking for a suit and tie BD with a rolodex....you must fight above your class, find in roads, and be relentless to sell big and fast. DM me if interested.

like

I realized I only enjoy chasing higher comp. Job switches every 2 years, always looking out for the next bump… it has taken a toll on my mental health. Tried to get hobbies to distract but I find myself back at websites checking comp numbers. Any suggestions to get out of the race?

like

Best term insurance policies for couple? Looking for good coverage and minimal premium 😀 On visa in US so have to make sure the policy will be valid even if i leave the country. Considering AAA but wanted to see if there are better options.

like

Hello, would anyone be willing to provide a referral for any of these companies? Health advances, Clear view, GE healthcare or Regeneron. Thank you. For reference the qualifications are 2 YOE and a masters in public health.

likefunny

Remote work opportunities? I'm looking for firms to look into. Currently in health. I think this will be disruptive (given we can't be on site... and my firm isn't used to delivering remotely).

like

I’m getting married in 6 months. How can I lose fat in my arms?! I feel like my arms in my stomach are my biggest problem areas. Or at least the ones that make me the most self-conscious. And honestly my stomach isn’t that bad, it’s really just my arms. Any advice would help! I’m 27 with no real health issues other than being overweight, and I’m allergic to fish and nuts if that is helpful. I work out at least twice a week but trying to make it more like 4 for at least for the next three months

like

Hey I am a Software Engineer with a experience of around 3 years. I am looking for a switch to a Data Engineer position. Any refferals would help. Referal from Rakuten , Tredence , Tiger Analytics, Lowe's , Legato , GE and other healthcare and Data Analytics will be helpful for me. Thank you

like

Any other women get so overwhelmed the more we learn about our bodies and waht women have to deal with? Like PCOS, Thyroid, hashimotos, chronic pain, hormone imbalance, leg pain, endometriosis, undiagnosed ADD, birth control effects, PMDD etc. WHY didn’t we learn about this is health class???? Would have saved me so much struggling as adult had I been more educated on my body, what to look for and how to help it😭I hope anyone going through it knows you’re not alone!

like

what's the firm policy for expensing health related purchases? I'm soon going to buy a bench, couple of free weights and a Fitbit. can this be expensed to the firm? if yes, how? Thanks for the help!

like

Additional Posts

HCL vs Wipro , which one is better for a person from SAP Technical background considering onsite exposure, work culture , pay and benefits ?

like

I’m currently at a mid tier firm as an experienced senior, just under five years in PA. Joined as a lateral hire about a year ago and compensated above market. I want to focus on tech industry but scheduled on all type of industries from nonprofit, healthcare, manufacturing, food and beverage and etc. it’s very hard to get out of the engagements I’m currently on and switched to tech exclusively. Should I consider moving to Big4 for better opportunities?

like

Best consulting firms to work for as a non-consultant... go!

like

For a taxable account, is there any downside to using FZROX with a zero expense ratio versus a similar but more established low expense ratio ETF like VTI or SCHB?

like

Final night of a 3 night stay at a Staybridge in a nice part of a nice city the other night paid completely with IHG points. Came back at 2am to find cockroaches all over the bathroom. Called front desk and they didnt have bug spray nor an additional room. Woke my friend up at 2:30am and my wife and I ended up crashing on her couch. As we left that night night manager said "I actually have a two bedroom but didn't offer it to you because you were only two people". Manager calls wife (continued

like

Any recommendations for interview coaches?? I’ve heard of Carrus

like

What’s the Office culture like at PwC international tax team in Houston office? I’m in mid market CPA firm and trying to get into that office.

what are some of the good corporate discounts available that you guys have used?

like

McK 🐠 - what are the differences between Round 1 (EM and associate partner interviewers) and Round 2 (partner interviewers). Recruiter assures me there is no difference with cases or structure of interviews but hearing mixed messages. Would appreciate any insight!

like

Finally got my YE! Was hoping to at least get a 3 after hearing about all the layoffs and the 4's going around. Got a 2 and I am EXTREMELY relieved! 🙌🏻🎉 Now I can really start my weekend! 😎🍾

like

Anyone have any good educational materials for participants in a 401k that you provide education for? Thanks

like

What were all yalls post-MBA salaries? What do you think the salary floor should be to make it worthwhile? HCOL city

like

Friend started networking for MBB 4 months before anticipated interview date. Little case prep. Partner asked “fun” question how they’d approach something ~ totally caught off guard 😟. Friend wasn’t structured, nervous, thinks the convo will hurt her. She didn’t get a reply to her follow up....(1/2)

helpful

Up for mgr this yr & pretty confident it will go through. Pushed for 1 but likely 2 per counselor. How much bonus and raise I can expect. Current base 120. I feel its way low. Im in tech AIM practice

like

Has anyone flown westjet? Trying to go to canada and thats the only option for return flights that doesn’t cost $1000+ for non-stop air canada/united. P.S. not flexing as I’m local 😞

like

I have a 45 minute case study interview with Facebook for a non tech strategy role. Anyone been through this process than can provide insight? How should I prep? Please help!

like

I’m turning 30 in a month. My boyfriend and I have talked about getting engaged but I’m not sure when he’ll propose (probably after the pandemic is over when we can go on trips safely). I’m realizing that if he waits until after the pandemic, it’s going to be at least a year until the actual wedding. Then I had always planned on being married for a few years before getting pregnant. I’m having major fertility anxiety. Any advice?

like

Does YE salary increase depend on location? (In other words, will it change if one moves from one location to a different location with lower tax/cost of life)

like

When is it best to leave big 4 Investment/Financial Services tax in terms of years/level?

like

I have an offer to join Commercial Assurance but I’m not sure what career path that could lead me to if I was to leave Big 4 - thoughts?

like

New to Fishbowl?

Download the Fishbowl app to
unlock all discussions on Fishbowl.
That was just a preview…
Sign Up to see all discussions
  • Discover what it’s like to work at companies from real professionals
  • Get candid advice from people in your field in a safe space
  • Chat and network with other professionals in your field
Sign up in seconds to unlock all discussions on Fishbowl.

Already a user?
Login here

Share

Embed this post

Copy and paste embed code on your site

Preview

Download the Fishbowl app

Get realtime notifications and see
what's happening in your industry
from the palm of your hand.

For account settings, visit Fishbowl on Desktop Browser or

General

Legal