Dentists, medical billers, insurance populace...support!!?
We have Aetna DMO and I just have 3 crowns done by my PCD. They told me my co pay would be $750 per crown!! That's how much I used to pay up to that time I had insurance. I asked her if she was sure and she said yes. I go ahead and had the work done and left paying the $2250. 4 months after that my teeth are still hurting so I went to another dentist and they told me my co-pay should have be $305 NOT $750! So I called Aetna and they said I have to bring it up next to the dentist office. When I went contained by there I asked to see the contracted price sheet for aetna and she claimed there wasn't one. So how do they subtract my co-pay if they don't have that information? Do they owe me a refund?? Both Aetna and my latest dentist told me I was overcharged. What do I do if the dentist won't refund my money or what info can I bring beside me to show they overcharged me??
"> The most importatant thing would be to make 100% sure that this dentist be a contracted provider for this insurance. My office is out-of-network for all insurances, and when a tolerant calls us they always ask "Do you nick my insurance?" Our answer is usually "We can file on your insurance but we aren't contracted with them." These patients come into the bureau for their exam and xrays and want to know why they have a copay. They also want to know why the insurance company isn't paying 80% of fillings or 50% of a crown. We after remind them that we aren't a contracted provider, and 95% of them say that they don't know what a contracted provider is.
If a dentist is a contracted provider, they can only charge you the amount that the insurance company sets. For PPO's to be precise called UCR. For HMO or DMO it is usually called their "Fee schedule".
You inevitability to #1 find out if this dentist is a contracted provider. If he isn't, he can charge you whatever price he sets. If he is then you stipulation to get a copy of the Aetna fee agenda. Since my office isn't contracted, I don't have one to facilitate you out. You should be able to get this from the insurance.
If it turns out that they are contracted next to Aetna, and you get the fee rota, you should be able to use that to show them that they overcharged you. This just sounds strange, because if they are a contracted provider, they know already what the contracted allowance schedule is. Source(s): registered dental assistant for 11 yrs.
Are you certain that your dentist be in network for the DMO? If he wasn't contracted near the insurance company, then the fees would have be his regular price instead of discounted.
You can bring something to the old dentist that shows his fees are above reasonable and customary (you'll find that more dentists are - the insurance companies are pretty slow contained by staying updated with the rising cost of living) and ask him to split part of the difference near you.
The office I work in is not contracted beside any dental plans. We offer this information up front so the patient is not suprised subsequent. Whenever there is any dispute, the insurance company always blames our fees verse what they are willing to pay.
The lower price does nouns more like a DMO co-pay, double-check that you were surrounded by network - that's the only leverage you'll hold with the dentist regarding the glorious fees.
Good luck.
Related Questions:
"> The most importatant thing would be to make 100% sure that this dentist be a contracted provider for this insurance. My office is out-of-network for all insurances, and when a tolerant calls us they always ask "Do you nick my insurance?" Our answer is usually "We can file on your insurance but we aren't contracted with them." These patients come into the bureau for their exam and xrays and want to know why they have a copay. They also want to know why the insurance company isn't paying 80% of fillings or 50% of a crown. We after remind them that we aren't a contracted provider, and 95% of them say that they don't know what a contracted provider is.
If a dentist is a contracted provider, they can only charge you the amount that the insurance company sets. For PPO's to be precise called UCR. For HMO or DMO it is usually called their "Fee schedule".
You inevitability to #1 find out if this dentist is a contracted provider. If he isn't, he can charge you whatever price he sets. If he is then you stipulation to get a copy of the Aetna fee agenda. Since my office isn't contracted, I don't have one to facilitate you out. You should be able to get this from the insurance.
If it turns out that they are contracted next to Aetna, and you get the fee rota, you should be able to use that to show them that they overcharged you. This just sounds strange, because if they are a contracted provider, they know already what the contracted allowance schedule is. Source(s): registered dental assistant for 11 yrs.
Are you certain that your dentist be in network for the DMO? If he wasn't contracted near the insurance company, then the fees would have be his regular price instead of discounted.
You can bring something to the old dentist that shows his fees are above reasonable and customary (you'll find that more dentists are - the insurance companies are pretty slow contained by staying updated with the rising cost of living) and ask him to split part of the difference near you.
The office I work in is not contracted beside any dental plans. We offer this information up front so the patient is not suprised subsequent. Whenever there is any dispute, the insurance company always blames our fees verse what they are willing to pay.
The lower price does nouns more like a DMO co-pay, double-check that you were surrounded by network - that's the only leverage you'll hold with the dentist regarding the glorious fees.
Good luck.
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