Does this make sense -- Dental Insurance Claim
September 17, 2020 5:35 PM   Subscribe

I'm confused about my most recent dental insurance claim, did my dentist's office mess up? Or does it actually make sense? (Canada, if it makes a difference)

This might be a bit of a brain fart question, but I'm confused!!

I had a dentist appointment about two weeks ago. When it came time to pay, the receptionist informed me that their internet was down, so they couldn't submit my claim to my insurance company or process payment. I had to book a follow up appointment anyway and the receptionist told me that they'll bill my insurance company and just have me pay whatever my dental insurance didn't cover during my next appointment.

The dentist office submitted my claim the next business day and the amount claimed was ~$400 (let's say), my insurance paid ~$320 of that amount and I'll pay $80 to the dentist's office. All good.

Now, this is where I get confused. Shortly after the claim was submitted, my insurance company reimbursed me and deposited the $320 in my chequing account, but I never "PAID" that amount!?

I haven't paid for anything yet! I'm assuming that the insurance company is assuming that I paid for the full amount at the time of the visit? Right? But because I never paid that full amount, this is confusing me. Had their internet worked, I would have paid the full $400 at the time, then been reimbursed the $320 at a later date, but still paying the dentist's office $80. It just feels like they SHOULDN'T have deposited the $320 in my account, because I never paid the full $400 up front, but was it actually a mistake? Do I need to report this to the insurance company?
posted by VirginiaPlain to Work & Money (4 answers total)
Best answer: Presumably the dentist’s office is going to bill you for the full $400, at which point to will pay it, $80 of your own money and $320 from the insurance money.
posted by mskyle at 5:37 PM on September 17, 2020 [1 favorite]

There is often a box on the claim form to indicate if the medical provider is "accepting assignment" which means payment goes directly to them or not, in which case payment goes to the patient. Either the office checked the wrong box or the insurance company made a mistake.

I would expect the dental office to get an EOB that shows that the money went to you and they would then bill you for the full amount which you can easily pay using $80 of your money and the $320 you received from the insurance. The other way is try to undo it which is more headaches for everyone.
posted by metahawk at 6:08 PM on September 17, 2020 [1 favorite]

It sounds like it was mistakenly paid to you. I'd say let your dentist know what happened and let them initiate whatever needs to be done with the insurance company, then pay the money to whoever the insurance company asks you to.
posted by any portmanteau in a storm at 6:17 PM on September 17, 2020

Response by poster: Not sure why paying the full amount at the next visit didn't pop into my head as the reasonable solution, but that makes sense! It's been a long day!
posted by VirginiaPlain at 6:54 PM on September 17, 2020

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