I would never expect my dentist to charge me illegally, but that is exactly what happened.
This goes to show why it is imperative to read every type of bill, in detail. I will explain what happened in hope that my experience might help save someone else money.
CONTRACT BETWEEN INSURANCE COMPANY AND DENTIST
The dentist has a contract with “approved” insurance companies, in my case, Delta Dental Insurance.
The dentist sends the bill to the insurance company. The insurance company has a limit for the max they will pay for each given procedure.
In my case, Delta Dental Insurance pays 100% for preventive care, such as teeth cleaning.
After receiving payment from Delta, my dentist sent me a bill for $60. Why? Because that was above what Delta was willing to cover. But wait!
I called Delta Insurance and learned that their contract DOES NOT ALLOW the dentist to charge the patient more! So their bill for $60 was illegal, according to their contract.
Delta Insurance offered to call the dentist for me and inform them they could not bill me for $60. The dentist’s employee told Delta the $60 was a “balance forward.” But that was FALSE.
At the top of my bill it said: Balance Forward $0. Plus, if I had owed money, they would have been asking me for payment.
So then I called the dentist to get that false and illegal $60 bill removed. She said, “I will remove the $60 but you still owe $10.”
“What is the $10 for?” I asked.
“A PPE fee. That is for extra Covid precautions.”
“You mean I have to pay for your Covid masks?” I asked, incredulously. “That was not on my previous bill.”
“Yes,” she said. Now I was even more annoyed! Why were they adding a new fee? Like a junk fee?!!
I called Delta Insurance again. The insurance agent laughed and said, “They are not allowed to charge you any PPE fees for Covid-related expenses. At the beginning of Covid, I sent out a memo telling them how to handle PPE fees.”
Now I called the dentist again. This time I said, “Who is the top person in charge of billing?” She gave me the name April. “I want an appointment with April,” I said. “I am coming in to straighten out my bill, because it is a mess.”
Two days later, I went to my appointment with April. Guess what happened?
April started off my saying, “Let me first apologize to you.” She said she reviewed my bills going back to 2019 when they went on a “new billing system.” Then she handed me this check for $209.70.
They had been illegally sending me a bill for the difference between what the insurance company allowed (and paid) and what they wanted to charge (over-charge). Not knowing it was illegal, I had always paid it.
But because of that stupid $10 PPE fee and my insistence on speaking with the person in charge, I received a nice refund check.
I wonder how many other dental patients are owed a refund but who will never receive it, because they don’t question their bill or call the insurance company and ask.