Discrepancy between my receipt and the insurance company record

[JoJoJoJo 170]

So I went to my dentist for the first time in America with the insurance provided through my employer. I have a question about the discrepancy between my receipt from the dentist and the insurance company record.

 

The dentist told me that they worked on a tooth on four surfaces, which has  a copay of, say $100, which I paid.

 

But according to my insurance company, I did a tooth on one surface, which has a copay of, say $60. So my out of pocket spending on file with the insurance company is less than what I actually paid.

 

This is the gist of my experience. I feel this is really strange, but I do not know what. Have you had similar experience that you could share? Thank you!

[bakphx1 789]

It was a miscalculation, and you should be refunded the difference.  It happens a lot.  Don't feel awkward telling them to refund you.  They usually do without you telling them. 

[Websters202 149]

16 minutes ago, bakphx1 said:

It was a miscalculation, and you should be refunded the difference.  It happens a lot.  Don't feel awkward telling them to refund you.  They usually do without you telling them. 

You can ask for a refund or the office can hold a credit on your account and deduct it from future dental visits that require payment. 

 

 

[JoJoJoJo 170]

25 minutes ago, bakphx1 said:

It was a miscalculation, and you should be refunded the difference.  It happens a lot.  Don't feel awkward telling them to refund you.  They usually do without you telling them. 

Thank you @bakphx1 They told me that I needed four surfaces done twice in person in a general check-up session and later they sent me an email confirming that I need four surfaces done and get $100 ready for that. I would be a little surprised they only found out that I only needed one surface done at the moment when they were working on my tooth. Yet, after doing one surface, they still charged me $100.

 

To make things worse, there is another tooth that was done and I was charged $55 copay, and it is not on insurance company's file at all.

 

16 minutes ago, Dee elle said:

Dental office billing and insurance benefit statements are often 2 different languages.  Get a statement from the dental office of the billing they sent to the insurance so you can compare apples with apples... then sit down with the dental office billing clerk and ask to be talked through their billing... then if you need more clarity you can request that the insurer clarifies things with the dentist. Good luck !! 

Thank you @Dee elle The dental office emailed me before the procedure:

Tooth 1 needs code X1234 (four surfaces) with copy $100.

Tooth 2 needs code X1235 (something else) with copy $50.

 

Two month after the procedure, the insurance file shows only (no Tooth 2 at all):

Tooth 1 done with code X1234 with copy $50 (one surface).

 

I am just wondering if I should find a new dentist......

Edited May 26, 2018 by JoJoJoJo

[bakphx1 789]

It sounds like they may have more billing to submit. Definitely talk to them. From what you said later it sounds like they had a plan of treatment so you have to go back for more surfaces and the billing will follow with that. I wonder if they made a mistake when they charged one surface instead of 2 or if the second service is following shortly after submitting the first. What can make the American system maddeningly complicated is that the billing can lag sometimes four months after the procedure to let you know where everything stands. It sounds like they charged you the co-pay for the entire plan of treatment so that you don't have to keep paying here and there which is fine. But I think that now that you are being treated and the billing maybe behind it is too soon to say where you should stand.

[yuna628 9,673]

You are going to have to speak to both the insurance, but more importantly the dentist. If they have overcharged (which is a common problem with dentists), then you must request them to refund you. Don't expect them to kindly cough the money up front... as they typically say nothing and just try and let it slide or hold the money on the account.

 

However, if you feel that the dentist is not properly submitting claims into the insurance, this can be problematic. You can call the insurance company and also discuss these questions with them too. If you feel uncomfortable with improper charging practices, it's okay to seek a new practice.