Dental insurance - huge bill

5d 41 Comments

Hi all,

I am in a big problem and need advice. I have premera dental plus plan from Microsoft. Recently I was having a tooth ache and decided to visit a dentist. The insurance covers regular check-up and cleaning at 100%. When I called for an appointment, the receptionist asked for my insurance member ID which I provided. She said she will confirm if the insurance would work. Later she got back saying that it would work and scheduled an appointment for me. In the appointment the dentist suggested deep cleaning, and since that was covered under insurance I decided to go for it. I asked them how much would it cost and they said no need to worry, your insurance will cover it.

Now it turns she is not an 'in-network' dentist, so the insurance company will only cover a part of the bill (~30%). I did not know there was a difference between being 'in-network' and 'accepting insurance'. Shouldn't it have been the doctor's responsibility to inform me that they are not in-network and that this insurance company would not cover the full bill? They did not even give me a break up of costs and specifically said it would be covered by the insurance company. They have now sent me a bill of over 5000$ which is an insane amount. Moreover I am a recent grad from a private university with a huge student loan. I am barely able to make rent at the bay area prices. There is no way I can pay this amount. What should I do in this situation. I am very stressed and can't concentrate on work either :( please advise.

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TOP 41 Comments
  • Amazon FishNChips
    There’s not much you can do. It’s just an expensive lesson for the future. (This happened to me before too, but it was only 1k, not 5k).
    5d 3
    • Microsoft nidmoneys
      OP
      Isn't the doctor at all responsible for this? They specifically said to me that the insurance would cover everything. Either they did not know, which is incredibly hard to believe or they lied through their teeth. Had it been 1k, I would have paid and moved on. But I really can't afford the 5k. After CA taxes and student loan payments, I barely make the rent and food.
      5d
    • Amazon FishNChips
      It’s likely they purposely lied, but that’s not against any laws as far as I know. It’s your responsibility to make sure that are in-network and to ask for a pre-authorization (they actually go to the insurance company and get authorization and an estimate).
      5d
    • Microsoft nidmoneys
      OP
      Alright. I agree I should have asked the in-network part, but I only came to know it's a thing yesterday. 😔
      5d
  • Facebook public2
    There's no such thing as a deep cleaning? Isnt that just code for scam? Regardless you get an invoice and out of pocket cost estimate before work is done. Did you sign that? If not would say you said insurance would cover so please send me an invoice for 0.
    5d 11
    • Wayfair Haldas
      And like $150 filing fee, but that depends on the court
      5d
    • Microsoft nidmoneys
      OP
      Ah I see. This has been really helpful.
      5d
    • Facebook public2
      CA has a max fee of $50 but will vary by state
      5d
    • New VEKg62
      There IS such thing as a deep cleaning. If you’re at risk for periodontal disease. Don’t take medical or law advice from tech.
      5d
    • Facebook public2
      That's why I asked. 5k+ for a gum cleaning sounded scammy to me!
      5d
  • Oracle Flynn20
    Always ask if the doc is "in network" vs if the office "accepts" insurance. They can technically "accept" Monopoly money and then bill you after. Sucks so much, I'm sorry it happened to you. You could call the office to see if they can assist with a payment plan and/or reduction of cost due to your experience.
    5d 3
    • Microsoft nidmoneys
      OP
      Thanks for your advice. Is it generally possible to negotiate the billed amount?
      5d
    • Oracle Flynn20
      It totally depends on the doctor. But I'd mention you made choices about your care based on the in office advice that this was covered by your plan, you feel deceived, etc. They might negotiate a bit.
      5d
    • Microsoft nidmoneys
      OP
      Alright I will try this out too.
      5d
  • Expedia Group lackey
    Ask for an itemized breakdown. Your bill will suddenly shrink
    5d 7
    • Expedia Group lackey
      Then ask questions, lots of questions. Idk what state your teeth are in, but 5k for deep cleaning is ridiculous. There’s some fuckery goin on
      5d
    • Microsoft nidmoneys
      OP
      My co worker recently got a root canal done, and even that cost him lesser than this. My teeth are fine. It was just a slight tooth ache because of wisdom teeth.
      5d
    • Expedia Group lackey
      Then start questioning. Your dentist is likely not providing the right billing codes in the hopes of scamming the insurance
      5d
    • Expedia Group lackey
      Look up the billing codes after they give you a breakdown and make sure it matches your work exactly. Ask for written explanations of work done in plain English. It’s an insurance scam
      5d
    • Microsoft nidmoneys
      OP
      Alright I will try this.
      5d
  • Apple Berlin007
    Tell the doctor you owe nothing and you have been cheated.

    You were told it will be $0. Threaten them to go to small claims court, also complaint to the dental medical board fir malpractices

    Go to a small claims court.

    Its not expensive, as others have suggested. Read online the process is simple. $50 for filing and then you need to send then detist a notice, which is nother $100 or ask a friend to do it.

    Don’t pay these scumbags
    5d 1
    • AT&T MsdR32
      Regardless of insurance, they told you it was at no cost to you. Try to make them honor their word.

      I did this and they cut a bill on half, and in still bitter. Dentist said it would be $10, so I said why not... American Medical Industry/Insurance is such a crapshoot.
      5d
  • LinkedIn kebab2
    They are scamming you man deep cleaning shouldn’t even be close to $5k

    That’s like getting braces level expensive
    5d 0
  • BigCommerce Vxjd54
    Planning to buy a house in the next 7 years? If not, just do what everyone else does and simply dont pay it.

    They'll charge it off and sell the debt to a 3rd party collector for the amount the bill should have been in the first place. The collector will make token efforts of getting you to pay, but mainly just enough so you remember who to pay when you go to buy a house and the loan officer says you need to clear those collections off your report.

    After 4 years (assuming CA) you can't be sued (unlikely anyway) and after 7.5 years, the debt will fall off your report and you're home free.
    5d 2
    • Microsoft nidmoneys
      OP
      Oh, so they can't take legal action if I refuse to pay? Also, will this negatively affect my credit score?
      5d
    • BigCommerce Vxjd54
      They can take legal action and sue you for the money, for up to 4 years after the due date. But there's a very good chance they won't (which means there's also a small chance they will). And yes, it will affect your credit score. There is no free lunch. I mean, if you've got the money, then pay the bill. That's clearly the best choice if you have that option. But if you don't have the money, dont kill yourself trying to pay it. Temporarily bad credit isn't the end of the world.
      5d
  • Hortonworks
    ke8hw4zw

    Hortonworks

    PRE
    VersionOne
    ke8hw4zwmore
    Have you tried to call the dentist and negotiate? They can lower the price. I was able to lower by more than 50% for eye and other out network expenses.
    5d 1
    • Hortonworks
      ke8hw4zw

      Hortonworks

      PRE
      VersionOne
      ke8hw4zwmore
      Also maybe try to switch to HMO like Kaiser. Then there will be less of these in and out network issues.
      5d
  • Aspect AvKW75
    30 % of a discounted deep cleaning through insurance is $5k? Seems fishy
    5d 1
  • Oracle baxby
    Name and shame them
    5d 0

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