Am I wrong to consider this orthodontist's billing practice unethical?
October 8, 2019 8:49 AM   Subscribe

My dentist referred me to an orthodontist for consultation. The orthodontist's office said by email, "since you were referred, we will waive the consult fee." In the intake process, they took my insurance info, and then hit my insurance for $100. They said the "waiving" was of the co-pay, which was another $100.

This hurts because orthodontic services in most dental plans have a lifetime maximum, so while I decided not to go with these guys, I will have $100 less covered for treatment. I think it's pretty sleazy for them to tell me the fee is waived, and then essentially eat up $100 of my coverage.

Am I being too particular, and if not, what avenues do I have to remedy this? A bad Yelp review? A BBB complaint? Thanks!
posted by Borborygmus to Health & Fitness (10 answers total)
That sounds sleazy and unethical to me too. I would follow up with the office about it and tell them to fix it. Sometimes waiving a copay is against insurance rules, so you might be able to put pressure on them by threatening to tell your insurance company about that.
posted by needs more cowbell at 8:55 AM on October 8, 2019 [5 favorites]

I'm a dentist and I wouldn't refer to a practice that does this, so I would tell your dentist about this practice. I would also forward the email that mentions waiving the fee to the insurance company.
posted by OHenryPacey at 9:11 AM on October 8, 2019 [19 favorites]

Definitely report this to the insurance company ... that's not proper.
posted by mccxxiii at 9:13 AM on October 8, 2019 [6 favorites]

Waiving the patient responsibility while still charging the insurance is a huge red flag. Proceed with caution.
posted by ThePinkSuperhero at 9:39 AM on October 8, 2019 [8 favorites]

If their contract with your insurance requires collection of a co-pay, it is illegal for them to waive the co-pay to the patient while billing the insurance for the visit. They would have had to waive both your fee and the insurer's payment.
posted by citygirl at 9:42 AM on October 8, 2019 [4 favorites]

I'd call them and ask them to pull the charge, if they won't, call your insurance company. At best, very poor communication, at worst, unethical.
posted by theora55 at 11:03 AM on October 8, 2019

Is it unethical? Maybe. Is it improper? Probably. Is it entirely typical and in keeping with US healthcare? Absolutely, positively, and without a doubt.

If you want to die on a hill for your insurance company, by all means, but I wouldn't.
posted by Kadin2048 at 11:20 AM on October 8, 2019 [4 favorites]

The asker was told that they would "waive the consult fee" - not that the co-pay would be waived. If I were told that, I would assume that they meant there would be no fee at all for coming in for a consult. I.E. a free estimate.

When I was shopping for orthodontists, some had consulting fees, some would do an intial consult for free. I found that the one I went to that charged a consult fee (referred by our dentist) had game stations in the waiting room, and great stocks of keurig pods for the coffee maker. The ones with a free consult were clean, had no games, but did have coffee from a drip coffee maker. Oh, and the free-consults for Child2 were in the $5-6k ballpark, while the costlier waiting room was an $8500 quote (these are Canadian dollars).

We went with the drip coffee maker. Child2 has a smile where it's not obvious he's missing a front tooth. Child3 can now chew without pain and his bite is fixed. That's some really expensive coffee.
posted by nobeagle at 11:25 AM on October 8, 2019 [3 favorites]

Not collecting a copay is almost certainly against the terms of your insurance. If they didnt collect the copay they should not have billed for the visit.
posted by WeekendJen at 12:42 PM on October 9, 2019

Thanks for all the advice, especially ThePinkSuperhero! You are indeed a superhero if this orthodonist lives up to his response and reimburses my insurer so that I can have my lifetime maximum back.

Is it still worth making this issue public on sites like Yelp and Google? I hate letting shysters slide.
posted by Borborygmus at 6:24 PM on October 11, 2019

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