Dentist's office demanding money I don't have and didn't expect to pay.
August 2, 2017 8:00 AM   Subscribe

Dentist's office demanding money I don't have and didn't expect to pay. The title is the short version - more explanation below.

This year, I've been trying to deal with an increasingly severe case of sleep apnea that my CPAP is increasingly ineffective at treating. I had a sleep test, the whole works, and the specialist who ordered/administered it wrote me a prescription for an oral device, as my CPAP by itself clearly isn't doing the trick. (One of these things.)

I called the dentist's office, told them about the prescription, and had an appointment last week to take the molds. At every previous office visit, I paid up at the end, usually no more than $150 or so, as I have/had dental insurance that they'd submit it to.

This visit, I had the molds taken, went up to the front - where they told me that this was a procedure that'd be submitted to medical insurance, not dental insurance. (This was my first time hearing this.) They also said the total cost pre-insurance was $3400, and they were asking for a minimum of $1,200 upfront to cover the initial labwork. This was my first time hearing any of this. I'm in a financially tight spot as it is. (I only have the dental insurance as part of COBRA from a job that very suddenly laid me off in May - it's an onerous cost each month, but I have medical expenses that'd be potentially debilitating otherwise.)

I wasn't sure what to say, so I said I'd try to get back to them the coming week (i.e. now) and call them with my payment information, hopefully being able to pay then. I can't pay that amount offhand, or anytime soon. (Maybe later this month I could make it work? It'd be a stretch, but it's not unimaginable.) They called me twice this afternoon, and left me an email saying to call the office by EOD tomorrow for payment.

I'm not sure what to do here, at all. If I knew the procedure was not covered like others I'd had there, I probably wouldn't have made the appointment at all. I'm also honestly a little overwhelmed by anxiety in general right now, due to a lot of other factors in my life, so I might not be seeing this clearly. (I also have immense anxiety around both money and phone calls in general.) Thank you for your help.
posted by anonymous to Work & Money (14 answers total) 2 users marked this as a favorite
Call them and explain the situation. If it's just a question of delay -- if you do want the device, just can't pay for it right now -- then tell them so and work out a payment plan. If the amount itself is just not something you can come up with due to it being under the other insurance, tell them that, and have them cancel the lab order.

(Try to talk to the dentist herself. The office person may not be empowered to deal with this sort of thing, unless they have been there a long time and have a lot of responsibility. In my experience this sort of negotiation has only gone well with the dentist and has foundered when I bothered to explain it to the receptionist/junior billing person.)
posted by fingersandtoes at 8:13 AM on August 2, 2017 [4 favorites]

So, first of all I think it's more than reasonable to let them know their procedures are way off here -- every time I have had a major procedure like this, there's been a discussion first about potential costs. It is sometimes an estimate (since they might not know exactly what your insurance will cover or how things will go once they start the procedure), but there is always an estimate and then you can decide to proceed or not. I think it's very reasonable to complain about that part and ask for a discount based on their poor procedure.

Aside from that, I would ask to do a payment plan. I had a big dental thing a few years ago, and paid it off monthly over the course of a year. As long as you are paying something and have a plan, it should be ok with most offices.
posted by rainbowbrite at 8:15 AM on August 2, 2017 [4 favorites]

If I knew the procedure was not covered like others I'd had there, I probably wouldn't have made the appointment at all.

I would tell them this. Get a little testy with them, as they were seriously remiss in not telling you. Ask them which person dropped the ball by not telling you - basically, shift from a defensive position to an offensive one. They messed up, now how are they going to fix this?
posted by MexicanYenta at 8:27 AM on August 2, 2017 [18 favorites]

My dentist will even ask if X-rays, or floride swish are ok before setting up; I can't imagine getting setup for a $3200 thing without getting a quote run by me (with my initial'ed or signed consent) first.

However, on the plus side, most of this might be 3rd party lab fees - part of why they're asking you to get back to them before X on end of day is so they can get it to the lab (I.E. they won't do this without payment), and maybe the only have lab drop offs once per week, and they're trying to prevent additional delay for you. As such, it might have only been the brief time for impressions - $50-100 total billing for the dentist that's been done and that might need negotiation/discussion.

Call them, or stop in. Let them know that 1) you're shocked that they didn't discuss the price of this for something that's significantly outside of the norm of what you spend there, and 2) let them know that you can't make this payment. From there look to discuss if you might want to do a payment plan with them or if instead you want to not go ahead with the appliance. If you want to not go ahead, don't be surprised that they'll want some compensation for taking the mold, etc. However, ask for consideration of your wasted time by their not being up front about the cost and process of this before starting. Ideally if you don't go forward with the appliance, they'll either eat the cost for the impressions, or give you a 50% reduction. Consider how much you want or don't want to keep this relationship with this office.

For future information, even simple bite guards made at the dentist typically will run from $300-$700 and won't necessarily be handled via normal dental procedure insurance. For any appliance, or anything beyond normal dental work, you'll want to know the price going into this (and potentially compare or go to your not-normal dentist if there's one who has a significantly better price even if it's a less convenient location that you'll only need to visit twice). The dental office *should* provide this, but definitely don't be afraid to ask ahead of time. Potentially an office that makes a habit of not discussing/quoting ahead of time might be higher priced than others out there.
posted by nobeagle at 8:43 AM on August 2, 2017 [1 favorite]

Since you mentioned that the dentist will be submitting to medical insurance, it would be worth figuring out (if you don't already know) how much the insurance will cover for the procedure/device, and what your actual out-of-pocket will be. Growing up, my dentist wasn't paid by our insurance company, and instead the insurance company paid my parents, who then paid the dentist. It's possible that the dentist isn't set up to be paid directly by your medical insurance, and even though they're wanting full payment from you, you can expect a check from the insurance company to reimburse you for most of it. Though if you can't float that much until the insurance check comes in, you'll still need to work that out with the dentist.
posted by yuwtze at 9:03 AM on August 2, 2017 [1 favorite]

Oh man, that sucks. You must be so stressed out right now!

Echoing what others have said, I suggest calling them back and explaining, as calmly as you can, what you've told us here: You had no idea this procedure would be so costly, wouldn't have made the appointment if you had known, and wish they had communicated costs clearly to you in advance. Ask to either forgo having the molds sent to a lab (if that is an option) or to set up a payment plan. Emphasize that they really should have communicated costs to you, because they should have.

Get a little testy with them, as they were seriously remiss in not telling you.

Unless you are 100% sure that the person you are speaking with is the same one who chose not to communicate costs to you in advance, please don't treat that person poorly. Most dentists have multiple support staff and it is not always clear which person made which choice. Being "a little testy" with anyone, especially the wrong person, is not going to help your cause.
posted by schroedingersgirl at 10:10 AM on August 2, 2017 [4 favorites]

Also, I think phone is best (sorry, I also dread the phone) but you should follow up via email (if they have one) after the call to get the gist of the call in writing.
posted by schroedingersgirl at 10:11 AM on August 2, 2017 [1 favorite]

They also said the total cost pre-insurance was $3400, and they were asking for a minimum of $1,200 upfront to cover the initial labwork. This was my first time hearing any of this.

That is a shockingly terrible business practice to the point of being disingenuous, especially as they know that you are on COBRA. The office manager should have sat down with you to review costs prior to any work being done. This benefits them as much as it does you -- it's not just a nice thing for them to do, it's a standard step to keep them from incurring the costs of both the dental work itself and the admin hours spent chasing down payments.
posted by desuetude at 10:31 AM on August 2, 2017

I agree with above -- my dentist recommended a $700 bite guard recently, and the receptionist told me the up-front cost before they made the molds. I'd push back. Ask for them to write the cost down to what insurance would reasonably pay if they covered it. And ask for a payment plan. A
posted by radioamy at 11:18 AM on August 2, 2017

Normally dentists are better about this, precisely because so much of their business is cash-semi-up-front. So this story is really surprising. If you're wondering if you're now somehow obligated to pay it, you certainly aren't for anything except the actual service of taking the mold (that was already completed) and I'd say even the taking of the mold is questionable.
posted by praemunire at 12:29 PM on August 2, 2017

Followup from the OP:
Thanks so much for your help, everyone - every single answer here has been helpful. Spoke with them on the phone - they already sent the molds to the lab work office (same-day), and when I said how disappointed I was with this process, the person on the phone suggested CareCredit, with my health insurance reimbursing me for whatever they cover of the $3,400. This might be the best option - they’ve already sent it for lab work, and so long as I pay the amount off in a year ($3400 minus whatever reimbursement I receive), interest doesn’t kick in, though it’s retroactive interest on the whole amount if I don’t. So, probably somewhere around ~$250/month for a year - which totally sucks, but not sure what else there is to do, and I will ostensibly end up with a portable sleep apnea treatment. Sigh. Thanks again.
posted by LobsterMitten (staff) at 12:57 PM on August 2, 2017 [1 favorite]

I agree that the dentist should have informed you of the unexpectedly high cost, and also about needing to submit to your medical insurer rather than your dental insurer.

It is usually routine for providers to prior authorize before embarking on costly procedures, and I wonder what their policy is. I know my dentist has to prior authorize crowns and root canals, sending in supporting evidence, such as x-rays, and they will not proceed without approval because I'd have to pay out of pocket. I usually do still have co-pays. I realize this needs to go through the medical insurance, but the same criteria should apply.

If they have already sent in the molds, the dentist will have to pay the fabrication service and would probably insist on your payment, if your insurer denies the claim. Can you call the office and ask some questions about prior authorization and co-pays? Perhaps a list with items you want to discuss would help make sure all of your concerns are covered during your call. And if you can get them to keep the molds until you have approved moving forward that would slow everything down and give you time to get a handle on the process.
posted by citygirl at 1:10 PM on August 2, 2017

If you can, try to find out if your health insurance covers this. Also be sure to ask if your insurer requires pre-approval, and if they do, follow their procedure before going ahead with the treatment.

You might also want to look into CareCredit.

I also agree that this was not well handled by the dentist's office, and I agree with the advice that you speak to the dentist directly. Be straightforward, say that you had no clue this would be so expensive, and if you had known, you would not have gone ahead with the treatment.
posted by merejane at 1:26 PM on August 2, 2017

3rding Care Credit. It's my go to for vet and dental expenses and I have a six month payoff period. Just don't forget to make those payments!!!
posted by cristinacristinacristina at 7:17 PM on August 2, 2017

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