My husband got a dental surgery back in 2020 and he had insurance from his employer. The dentist gave him an estimate based on his insurance coverage and he paid everything that was not covered right after the surgery. Now they are telling us he maxed out and he would need to pay $900 more. Do we need to pay for this? I don’t understand how they miscalculated when they had his insurance info. I’m not from the US so not familiar with this situation :(

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An estimate is an estimate. If your insurance didn’t pay what they thought it would, that’s technically between you and your insurance.

The part I can’t explain is why it took so long for them to contact you about the shortage. And that should give you some leverage with them.

Or you can just stiff them as EY1 suggests…

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Probably some of you know this but insurance company have teams that look for places where they could pay less or in some cases retrieve some of the payment. That's a probable cause behind this delayed contact. 900 is likely not that big of a dent so probably it's best to pay them to avoid any further hassle

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This sounds about right - I did a lot of this for my previous job where we looked for instances of overpayment based on contract terms.

If we found overpayments then the insurance company would ask the healthcare provider to pay back the overpaid amount and that could potentially lead to them trying to recover some of that from the patient.

As to your obligation to pay I’m not sure

Ask for all the bills and evidence. Follow up with the insurance to confirm. Sounds like the administration at the dentist is a mess

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Dont pay them. Ignore their calls, ignore calls from any debt collection agencies. There is nothing they can do. And it wont impact your credit report

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I habitually pay medical debt late, they usually send me a collection notice from a debt collector warning me then I pay it. I’m assuming it could definitely be put on your record if they send it to collections but if it is a small dental shop they may not have the setup to do that. I’ve only had this experience with hospitals, and medical practices that are owned by private equity companies.

Most dental insurances maxes out at like $2000 in benefits

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I find it odd that they would send a bill 3 years later. Seems like a scam from the dental office: bait and switch. Usually they immediately know within a short time frame whether or not there is coverage. I would report them for fraud and not pay. Dispute this on the credit report if it ever goes on there as such.

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You also have a right to negotiate with your insurance. You can call them directly and ask for it to be paid, since that was the initial understanding. You’ll have to be ready to go in circles for a while before getting what you’re asking for - so decide if that’s worth it.

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Thanks everyone! I’m okay with paying but just wanted to understand how this happened three years after the treatment. Also from the statement they sent, the insurance payout was definitely under the maximum. Guess I’ll have to reach out to his insurance and see what happened

There should be an Explanation of Benefits document somewhere that would explain that. And you could call the provider and ask what the deal is with them asking for this years later.

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