Dentist did not take my insurance. Advice on getting charge forgiven?

August 16, 2023 2:46 PM

I had an appointment with a new dentist. I gave them my insurance over the phone at the time I scheduled the appointment. After the appointment, they told me they didn't take my insurance and to pay the full amount myself. Any advice on contesting this charge with them?

I scheduled a dentist appointment in July with a new dentist. They asked for my dental insurance when I scheduled the appointment and I gave it to them.

The day of the appointment I filled out some paperwork when I got there. They did a cleaning, x-rays, and fluoride. After the appointment, they told me that they did not take my insurance, and I had to pay the full amount myself, which was $330. This was Manhattan, New York City.

They agreed to a payment plan of three payments, and I paid the first third that day ($110). I would like to contact them and say they should have told me in advance that they didn't take my insurance, and that they should cover the remaining cost.

I have scheduled appointments with doctors/medical professionals in the past who did not take my insurance or needed a prior authorization or referral. When they took my insurance in advance they checked it first and then always told me what the issue was and if it could be corrected or if I would have to pay myself. Then they gave me the option of canceling the appointment or not if I did not have insurance coverage.

I have never had someone ask for my insurance info, and then not follow up to see if I had coverage with them or not.

The issue is that when they asked me for my dental insurance information I gave them the plan name and information (Liberty Dental) but it's a plan through my medical insurance (Blue Cross Blue Shield), which is a Medicaid plan. They said if they knew it was Medicaid they would have warned me I couldn't have used it, but I don't understand why they asked me for my insurance information if they didn't check it.

Another $220 is a lot of money for me, but probably not so much for them. I'm going to email them to ask them to forgive the remaining charge. Is there anything that I can try to say to them that will persuade them that they should have checked my insurance in advance and not to require the remaining balance? Obviously, I learned a lesson that I need to confirm coverage details and not just give them the insurance information, but I would appreciate any advice about how to follow up with them about this. Thanks!

posted by davidstandaford to Health & Fitness (16 answers total)

Can you manually submit an out of network claim with your insurer? You may be able to get some of this reimbursed.
posted by Blue Jello Elf at 2:57 PM on August 16, 2023 [2 favorites]

Response by poster: Can you manually submit an out of network claim with your insurer?

Assume no.
posted by davidstandaford at 3:04 PM on August 16, 2023

This might be something that your state senator's or assemblymember's office might be able to push back on them about, and that office might be able to help you also file a complaint with the relevant state-level regulatory authority.
posted by brainwane at 3:12 PM on August 16, 2023 [3 favorites]

It's very common for dentists not to accept medicaid. It's one of those dumb things that if you accept it at all you must not turn away medicaid patients, and the payment rate is often below other insurers, so it incentivizes dentists to just not accept it at all. It annoys dentists too, they'd like to not come off as jerks and just take a sustainable percentage of public-pay clients but rules are rules.

I wouldn't plan on filing a complaint, but since medicaid is for low income folks, it's reasonable to ask them to forgive it since you may be judgement proof. It sounds like this is a new dentist, but I would write that it will be difficult to cover your other expenses and ask if they would write off the remaining fees as charity care due to the misunderstanding.
posted by Narrow Harbor at 3:27 PM on August 16, 2023 [6 favorites]

I just saw an endodontist who after a charge for the fancy scan, submitted the bills to my insurance company (delta dental). Perhaps given they didn't tell you about your noncoverage, they might be willing to do that as a compromise.
posted by bluesky43 at 3:50 PM on August 16, 2023

I 'm very sorry this happened to you. I know so many people who have been burned with a high bill after asking a practice if they accepted their insurance but not confirming specifically that their plan and the provider they are seeing are in network. (And, unfortunately, it is very common that dentists don't accept Medicaid plans. ) As some others have mentioned, in the future it's a good idea to call your plan as well as confirm with the provider. (Online and printed directories are often incorrect/out of date. Especially with Medicaid acceptance.)
I would continue to see if the practice will work with you on a lower bill but I imagine the paperwork you signed has provisions that ultimately make you responsible. Again, I am sorry.
posted by fies at 4:08 PM on August 16, 2023

So, hey, certain states have laws that prohibit providers from directly billing Medicaid patients for covered services regardless of whether the provider is within network. For states with a dental option, covered services typically include stuff like cleaning, x-rays, and preventive services, like what you received.

I'm not sure whether New York is one of those states, but it's worth checking in with your plan. There should be a customer service / member services number on your Medicaid card. Please give them a call and let them know what happened, see if you might be covered after all.
posted by mochapickle at 4:32 PM on August 16, 2023 [4 favorites]

Research the new laws about good faith estimates. I don't know if they apply to dentists but other medical professionals are now required to give you a written estimate of the cost in advance for things that are not covered by insurance. There are penalties for failure to do so. See if it applies.
posted by metahawk at 4:58 PM on August 16, 2023

I'm sorry you had a bad experience doing something good for your health. You're not due for another cleaning for a while; if you should gods forbid suspect a tooth infection or something before your next maintenance appointment with an in-network provider, please know that NYS Medicaid plan members can access dental services at certain academic dental centers that contract directly with your insurance. For Manhattan: NYU College of Dentistry Medicaid info page & Columbia's College of Dental Medicine Medicaid info page.

I hope the remaining debt is written off; if it's not, definitely negotiate a lower amount and smaller, more-manageable payments (i.e. $10/month).
posted by Iris Gambol at 5:39 PM on August 16, 2023

I know it’s generally not permitted for non-Medicaid-contracted therapists to accept self-pay from clients covered by Medicaid. It’s possible there’s a similar protection that would apply here. Call the number on your insurance card and ask whether you’re protected. I wouldn’t be surprised if this dental office was actually prohibited from trying to collect payment from you.

Particularly when a Medicaid plan is administered through an insurance company that also offers commercial plans, it’s important for providers’ billing offices to make sure they’re clear about which plans they accept. But it’s also worth verifying on your own because not all billing offices are well-trained or careful.
posted by theotherdurassister at 6:57 PM on August 16, 2023 [3 favorites]

So, dentists are covered by the no surprises act which requires them to give you a good faith estimate of costs in advance if you are NOT using insurance (which you aren't since it isn't a covered service. Here is the way to complain - perhaps you can use that as a threat before you actually try to file one.
posted by metahawk at 7:51 PM on August 16, 2023 [4 favorites]

The No Surprises Act only applies to discrepancies of $400 or more. The bill in question was for $330.
posted by aquamvidam at 3:19 AM on August 17, 2023 [1 favorite]

As a datapoint, I can see that while my dentist in NYC tells the insurance company the charge for a cleaning/xrays/exam appointment [not sure about the flouride -- I think that's a non-covered upsell at my place] is between $500 and $625, the "accepted fee" they actually receive is only $125 or $150.

So there's a good chance what you already paid them is pretty close to what they'd get from insurance anyway, and they really might be easily willing to forgive the rest without much hand-wringing.
posted by nobody at 7:22 AM on August 17, 2023

That's really crappy, possibly intentional, certainly incompetent. Call your insurer, ask what they reimburse for those services. Write a letter. I am paying you the balance of what my insurance would have paid. You should have informed me at the time that the services were not covered. They are unlikely to pursue further payment.
posted by theora55 at 7:57 AM on August 17, 2023

Ask for a superbill for the visit and submit it yourself to the insurance company. The bill needs to have diagnosis codes on it.
posted by summerstorm at 1:49 PM on August 17, 2023

Response by poster: Based on your suggestions, I sent them a nice email describing the misunderstanding, saying how I had already paid $110, and asking if they could forgive the rest or if they have any kind of charity care. This was their response:

Hi XXX,
As of right now your remaining balance is $221.00. We can give you a discount of take $71.00 off from the remaining balance of $221.00 and charge $150.00.This is the best that could be done at the moment.
-XXX
posted by davidstandaford at 3:54 PM on August 17, 2023 [1 favorite]