Paying up front?

July 14, 2009 5:22 PM

Is this a universal billing policy for dental work that I should have known about?

Last week I went to the dentist for the first time in 15 years and need to have some fairly minor work done. Fine, no problem. I made an appointment for yesterday but ended up having to cancel unexpectedly on short notice. I'm now told that because the dentist lost two hours of work that he'd set aside for me, I now need to pre-pay for my services and then have the insurance reimburse me.

And I totally get that. He's got a business to run. But nobody mentioned anything about this or about cancellation policies up front. Is this just a standard operating procedure that anyone would assume if they were in the loop? (The last time I was pursuing dental care, my mom was handling the administrative end of things.) This practice has been exceptionally kind and helpful, so I don't want to give them a hard time, but am I wrong in thinking that I should have been told about their policies before making an appointment?

posted by corey flood to health & fitness (14 comments total)

All my medical care providers have a 24-hour cancellation policy. It makes financial sense to me and I've never had a problem with it.
posted by peanut_mcgillicuty at 5:29 PM on July 14

Pretty common policy...You're probably lucky he didn't charge you for the time.
posted by HuronBob at 5:36 PM on July 14

Notice of this policy was probably buried in fine print in the packet of papers you signed at intake. It was for the doctor I recently associated myself with. I might have missed it if I was just trying to get through the paperwork as quickly as I could. By the way, my doctor charges a fee if you miss an appointment without giving proper notice.
posted by kindall at 5:52 PM on July 14

Most of my doctors charge fees if I cancel with less than 24 hours notice. You're lucky they're not billing you for the missed appointment.

If you really don't want to go through the hassle, just find a new dentist.

But yes, this is very normal, and you should expect it.
posted by decathecting at 6:08 PM on July 14

I think it's pretty standard to charge a modest fee (I've seen many doctors charge $15-30, or a psychiatrist charge 1/2 the rate for the time). Every doc I've ever worked with would waive the fee for the first missed appointment. Personally, I would be unwilling to pre-pay for dental services and await reimbursement, I've never heard of any medical provider doing that and I would switch practices over it unless they were doing something beyond the call of duty or otherwise remarkable. There must be plenty of dentists with kind and helpful practices in Los Angeles.
posted by bunnycup at 6:09 PM on July 14

I've heard of cancellation fees for appointments canceled with less than 24 hour notice, but I'd never of this particular policy. In your shoes, I'd find a new dentist: I'd rather be penalized once with a fee for canceling too late than be punished again and again at each subsequent visit.
posted by Meg_Murry at 6:52 PM on July 14

Most doctors will charge a fee for a missed appointment or a sudden cancellation and will also usually include that information somewhere on paper if they do not mention it explicitly. Just remember to look out for this in the future and be sure to ask up front if you are at all unsure.

With that said, I do not think that it is common practice for doctors to impose a pre-pay restriction on services if you miss your appointment. I haven't heard about this happening and haven't experienced it myself. And this particular policy seems a bit unreasonable to me. Not only will you be paying (potentially a lot of money) up front every single time you visit, you also run the risk of paying for your services and having the doctor cancel on you for some reason. I actually had a dentist cancel a wisdom tooth extraction while I was in the chair and under some sedation because he realized he wasn't qualified to perform the procedure.

If I were in your position, I would probably try to find another dentist unless there was something about this one that made him worth the trouble of this penalty.
posted by inconsequentialist at 8:12 PM on July 14

Having worked for a dental clinic, I can say that new patients are often no-shows and it seriously disrupts the schedule of the clinic because by the time you're aware of a vacancy it's often impossible to fill it at short notice and over the course of a month it runs into serious lost revenue. Most health-care providers have patients who cancel appointments on a serial basis, and they will either double book those spots or charge the offender a cancellation fee. That said, they reserve the right to charge cancellations fees, require payment in advance, etc - they'll probably drop the "pay in advance" requirement once you've attended a few appointments as scheduled.

Remember that health-care providers don't work for your insurance company - when they're dealing with your insurance company on your behalf, they're actually handling administration which is technically your responsibility and they're well within their rights to decline to do that. While they do it in order to get paid quicker, it also saves the patient a lot of hassle - they'll stop doing it altogether once the administrative burden gets too high.
posted by Lolie at 8:31 PM on July 14

I think they're trying to get rid of you as a patient, corey flood. Making you pay upfront for future visits for which you show up on time is ridiculous if you obviously have insurance - the punishment does not fit your offense at all. You might want to consider offering to pay at least something for your missed appointment if you think it'll be less bother than their new rule. Bottom line if you like the dentist: apologize profusely and try to negotiate something aside from paying up front. I'd start asking around for other dentists, myself.

I can say that new patients are often no-shows and it seriously disrupts the schedule of the clinic

Yeah, but Lolie, there are two issues here: 1) the issue of some sort of last-minute no-show penalty, which is completely fair and 2) the issue of the particular penalty this particular dentist is handing down, which continues for multiple appointments, seems excessive and strikes me as very odd. Most people with dental insurance have insurance precisely so they *won't* have to pay large out-of-pocket expenses for things like dental visits.
posted by mediareport at 9:00 PM on July 14

Most people with dental insurance have insurance precisely so they *won't* have to pay large out-of-pocket expenses for things like dental visits.

From what I've read, it takes a while for providers and patients alike to get re-imbursed by health insurance companies in the US, so I agree that the policy could cause serious inconvenience to a patient who has high cost treatment and then has to wait weeks for reimbursement from the insurance company. But I suspect that's the point this particular practise is trying to make - that they're entitled to on the spot payment and any alternatives they offer to that are a courtesy and a convenience they extend, not "right".

Not saying it's good business, but from what I've read there's a serious administrative burden involved in dealing with health insurance providers in the US, so I can understand why a practise would want to discourage patients who complicate that process even further.
posted by Lolie at 9:51 PM on July 14

My dentist's phone droid calls two days before, reminds you of your appointment, pointedly notes that you'll pay $50 for being late or a no-show, and then has you confirm or deny your attendance at said appointment.

I missed one totally by accident once and they bent over backwards to get me back in (serious endo work), but they never said "OK, pay in advance first," and they also failed to ding me the $50. I guess they like me, which would be harder to pull off as a first-time patient.

I'd go somewhere else and be more careful next time. There's a lot of dentists out there.
posted by fairytale of los angeles at 9:57 PM on July 14

Also, remember that the rates your dentist bills may not be the same rates that the insurance company reimburses. IE, your dentist could charge you $800 for a procedure, but the insurance would reduce it down to $500 based on agreements between the two of them. If you are paying out of pocket and getting reimbursed, it is not at all certain that you won't be stuck with the difference in the rates.
posted by bsdfish at 3:14 AM on July 15

Thanks, everyone. I had fully expected to pay a fee for having to cancel without 24 hours' notice, but it's good to know that I'm not crazy for thinking that the pay-up-front thing is a bit unreasonable. Like I said, this practice has been exceptionally helpful, so I'll talk to them before going someplace else.

Thanks again.
posted by corey flood at 6:25 AM on July 15

Update: I called the office and left a message thanking them for all their help and wishing them well, but I told them in no uncertain terms that I was not on board with paying up front and that I'd be finding another dentist.

I got a frantic message, a page, and a phone call later that day. They were happy to accommodate my needs. I've agreed to pay the percentage not covered by my insurance before making an appointment, which I think is fair. They said that they were having problems with no-shows and I completely understand that.

Cheers, everyone.
posted by corey flood at 5:01 PM on July 26