Asked by dentist to pay upfront, get refunded by insurance later. Legit?
April 13, 2021 11:47 PM   Subscribe

Much to my surprise, I was told right after dental surgery that I needed to pay the whole amount right then and there (because a "specialist" was involved), and that I would later be reimbursed by my insurance company for their share of the bill. Considering that they didn't bother to mention this before the surgery, I was just wondering if this is standard operating procedure or not.

The dentist I've been seeing for over a decade retired a few years back and sold the practice to another dentist. (Can't say I prefer him over my old dentist, but I haven't had any real problems with him either). I made an appointment with his office for gum surgery and was told that, while the surgery would cost $XXXX, my share would only be $XXX post-insurance. What his office neglected to mention at the time is that I would have to pay the whole amount upfront since a "specialist" was handling the surgery, and that the insurance would cut me a check back for the $XXXX they took care of. (The office rep apologized for "forgetting" to inform me about this when I made the appointment). To say that this would be a surprise would be an understatement; however, I was still fairly numbed out at the time and agreed to a payment plan in the meantime.

This is the first time in decades that I've needed any dental/gum surgery done, so I'm admittedly unfamiliar with dental billing methods for said procedures. Is it standard (or at least not unfamiliar) practice to pay up front for dental/gum surgery and then be reimbursed by your insurance later? (The fact that his office just suddenly sprung it on me makes me wonder, though they haven't been the most organized bunch before now anyway). Worth noting that the "new" dentist is still (supposed to be) in-network.
posted by gtrwolf to Health & Fitness (23 answers total)
 
I'd say call your insurance ASAP and if necessary, conference in the office rep. This does NOT sound normal at all.
posted by kschang at 12:52 AM on April 14, 2021 [8 favorites]


This is not normal practice and you should follow up with your dental insurance provider.
posted by They sucked his brains out! at 12:54 AM on April 14, 2021 [4 favorites]


It sounds like the "specialist" was not in-network, even if your dentist was. Some insurance companies refuse to send any payment to dentists who are out of network (other times, the dentist will refuse to request it because they prefer to be paid up front rather than deal with the vagaries of insurance companies).

You're probably best off waiting two weeks to see if the insurance company pays you what they were supposed to pay. If they do, you can still be irritated at the bad communication, but there's no real harm. If they don't, you can hound your dentist's office to fix it, or even complain to the insurance company, which may possibly get your dentist in trouble if he's violating some terms of his network contract with the insurance company.
posted by alexei at 12:58 AM on April 14, 2021 [3 favorites]


This is fairly normal. Dealing with insurance companies is a big hassle for health and dental providers and if insurance pays it can take months for the checks to arrive.

Every dental software program is able to print the form needed to submit to insurance, already filled in with everything about your visit that your insurance cares about.

Many patients feel that whatever the insurance pays is all the dentist should get paid and unsurprisingly, many dentists do not agree because the Usual and Customarg Rate (aka UCR) set by many insurers is appallingly low.

It is easier for the dentist to let patients fight over money with the insurance company that to fight with both the patient and the insurance company.

Very common. Totally normal. Insurance companies are the problem. Most humans have or will have teeth. All teeth need professional care. Insurance is for things that are infrequent and do not happen to everyone.

Sure, in a perfect world they would have remembered that you hadn’t had an expensive procedure before and needed to be alerted about payment uo front. This sequence is becoming so much more common that many dental office staff forget that it even bears mentioning. Or the front office staff is new and/or forgot to collect payment before they got you back into the chair.

There is nothing nefarious going on here.
posted by bilabial at 1:43 AM on April 14, 2021 [9 favorites]


I'm less generous to your dentist than bilabial - this should absolutely have been communicated to you BEFORE the surgery. I mean, I guess it's kind of a "they didn't say, you didn't ask" kind of situation but even then it's a little sketchy. I think there's a good chance you will get reimbursed by your insurance as the dentist's office said you would but there are providers out there that would handle this better (including billing you after the claim has been submitted to insurance).

Not nefarious, but not A+ patient service either.
posted by mskyle at 4:02 AM on April 14, 2021 [5 favorites]


This is how my dentist has operated for years.
posted by something something at 5:18 AM on April 14, 2021 [1 favorite]


It’s normal to ask you to pay up front. It’s not normal not to let you know that before you have the procedure. Dentists will usually have you sign something in advance saying you know that’s the policy. Is it possible you signed a general agreement about this when you started with this dentist? If not, this is a customer service mistake, but not shady.
posted by FencingGal at 5:52 AM on April 14, 2021 [4 favorites]


+1 to idea that is normal for some dentists (like mine, who has done it this way for at least 15 years) but should have been communicated in advance.
posted by Mid at 5:54 AM on April 14, 2021 [4 favorites]


This is normal procedure (source: my wife the dentist) and not nefarious or sketch. It's bad customer service in that they didn't explain it, and super annoying for you, but it doesn't indicate something shady is going on.
posted by donnagirl at 5:55 AM on April 14, 2021 [2 favorites]


Pretty much all medical offices have a notice that they require full payment at the time of service. That said, they normally consider submitting to an insurer as fulfilling that requirement, which is why one normally gets out of the office with just a copay.

Dental is a bit of a different beast insomuch as a whole lot people don't have dental insurance, even though they have regular medical insurance. This is why things like CareCredit have become ubiquitous in dental offices.

To me, the really sketchy part of all this is your dentist involving some sort of "specialist" without informing you up-front. They had to have had that arranged before your procedure. I'd also question why they felt the need for a specialist to be involved without consulting you. I'd want a whole lot more information as to why this was necessary, who this "specialist" was, what exactly did they do, etc. etc.

It's also really effing lame that they involved another doc without checking to make sure that person was in-network for you. Whenever my docs send me to anyone, they always make sure they're in-network.
posted by Thorzdad at 6:19 AM on April 14, 2021 [1 favorite]


Just reiterating that this is pretty normal these days. It also stunned me 3 yrs ago when I finally went to the dentist after breaking a tooth a year prior and needed 2 crowns and a root canal and they could do it right that minute. So I said ok. On the way out, I was so glad I had my credit card b/c I had to charge $3k that very moment. I was still loopy from the nitrous so remained calm, but wow. They had explained it before, but I am naive and I thought "oh right, they mean insurance will pay that giant amount."
posted by jdl at 6:51 AM on April 14, 2021


It might be common but informing you AFTER your surgery, when you conceivably could have been impaired from any sort of anesthetic or pain meds, is SUPER WRONG. They should have admitted their mistake and offered to bill you, NOT expected you to pay RIGHT THEN.

I am furious on your behalf. This is wrong.
posted by cooker girl at 8:00 AM on April 14, 2021 [4 favorites]


This doesn't sound correct to me either. There are a couple of things:

If you have a deductible, they might ask for the amount to be paid upfront until you hit your deductible. That is normal - they should tell you, and you should know what your deductible is.

However, it's wrong to say that you will get a 'refund' from your provider when you are just sending in one bill - they should take your insurance and pay the contracted rate, which minus any deductibles, should be easy to figure out.

If you are doing months worth of procedures, all billed at different times and perhaps different companies, sometimes you will over-pay your deductible, and then get refunds.
posted by The_Vegetables at 8:12 AM on April 14, 2021


Pay upfront, get reimbursed by insurance later is the default and norm where I live.
posted by angiep at 8:36 AM on April 14, 2021 [1 favorite]


This is a thing that some dentists do, but not all dentists operate this way. For example, my oral surgeon's procedure when scheduling any $XXXX+ procedure is that is that patients must first meet with his billing manager to talk about the cost, the probable insurance coverage, and payment options.
posted by desuetude at 8:49 AM on April 14, 2021


This is what happened to me once my dentist's office stopped taking my insurance (directly?). They make me pay everything up front and then I get reimbursed via getting 2/3 of the money back via check 2 weeks later.

I'm not thrilled about this, but I am A Difficult Person and this is the one dentist I haven't had excruciating problems with, so I put up with it.
posted by jenfullmoon at 9:04 AM on April 14, 2021


Response by poster: This is just getting better and better (/sarcasm). In order to do the payment plan, I had to agree to apply for a loan through a dental loan company in which I'd pay off the loan within 24 months. The dentist's office just emailed me back today saying that not only do I still have to sign off via electronic signature on the application form (even though I'd already signed off on the original form) but that they (once again) forgot to tell me that there was a $395 application fee for doing the loan/payment plan! (The office rep claims that she hadn't changed the form that I originally signed, but I'm going to wait until my blood pressure goes down before checking that out).

My plan is to (again, after my blood pressure goes down) remind the office rep that they didn't bother to tell me that I would have to pay up front AND that there was a $395 application fee involved with the payment plan. Then I'll see if I can pay in installments (or even just pay the original $XXX estimate and have the insurance send the reimbursement check to them) without having to go through the dental loan company or pay the application fee. Either way though, I believe I'll be looking for a new dentist after all this has been resolved. (If they're not nefarious then they're pretty frigging incompetent).
posted by gtrwolf at 11:55 AM on April 14, 2021 [1 favorite]


In order to do the payment plan, I had to agree to apply for a loan through a dental loan company in which I'd pay off the loan within 24 months...forgot to tell me that there was a $395 application fee for doing the loan/payment plan!

This is sketchy as hell. The interest-free 24-month “loan” is exactly what CareCredit provides. But, there isn’t an application fee for CareCredit. I don’t know what, if any, fee CareCredit might charge the providers for the service, but this “application fee” smells a lot like the dental office is trying to recoup the fee (if it exists.)

I’d be tempted to tell them to bag the fee and straight-up accept CareCredit or explain to the state board their financing arrangements.
posted by Thorzdad at 2:06 PM on April 14, 2021 [5 favorites]


Response by poster: This is sketchy as hell. The interest-free 24-month “loan” is exactly what CareCredit provides. But, there isn’t an application fee for CareCredit. I don’t know what, if any, fee CareCredit might charge the providers for the service, but this “application fee” smells a lot like the dental office is trying to recoup the fee (if it exists.)


It's actually Ally providing the loan, but when I called Ally directly, they confirmed that they don't charge an application fee. Which means that the $395 "application fee" is going to the dental office. So yeah, major sketchy.
posted by gtrwolf at 2:24 PM on April 14, 2021 [3 favorites]


I work for a health insurance company but probably not your health insurance company. A dentist requiring payment in full up front is what I would expect from an out-of-network dentist, assuming your dental plan has out-of-network coverage. The company I work for requires in-network dentists to bill us first and not balance bill members as part of the contract they sign. I don't know how common a requirement that is at other insurance companies (my understanding is that's nearly universal on medical providers but might not be so on dental);I would suggest calling yours to see if they have a policy on this and also check to see if the surgeon was actually in-network.
posted by bassooner at 2:29 PM on April 14, 2021 [2 favorites]


...but when I called Ally directly, they confirmed that they don't charge an application fee. Which means that the $395 "application fee" is going to the dental office.

I have a huge feeling that would be a violation of Ally’s TOS with the provider. Similar to how cards like Amex (at least used to) forbid stores that accept the card from charging the customer extra to recoup the service fee.
posted by Thorzdad at 5:16 PM on April 14, 2021 [2 favorites]


It's actually Ally providing the loan, but when I called Ally directly, they confirmed that they don't charge an application fee. Which means that the $395 "application fee" is going to the dental office. So yeah, major sketchy.

100% contact Ally on this matter and let them know your experience with this dentist's office, and if you have any emails from the dentist's stating these fees forward them on. I would be godsmack if a company that is providing this loan, and is on the up and up, is okay with this process.

Is it possibly a 3rd party through your dentist that would "aid" in the filing process or guarantee that if the loan doesn't come through the dentist will still get paid? Whatever is going on it's incredibly sketchy, I would start with Ally and possibly escalate to the BBB.
posted by I paid money to offer this... insight? at 6:24 PM on April 14, 2021 [1 favorite]


One more note: waking up from surgery, in a loop-y state, makes one more vulnerable to suggestions. It's known as emergence delirium, though it's more applicable to full anesthesia than to sedation for oral surgery.
posted by kschang at 5:36 AM on April 16, 2021


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