Quote:
Originally Posted by 911_Dude
What gets me is dental insurance. A regular cleaning and xrays was supposed to be covered. Before the appointment they even showed me a print out with all the charges and what insurance will pay and what I will owe, which was $0.00. I agree, get the work done, and a few weeks later I get a bill for $75 because insurance shorted them.
How is that right to jack the price after the amount was agreed upon? Where is the disconnect in the amount they show insurance will pay prior to service and then after? Seems like someone is ripping me off and Im not happy.
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"Everything is covered" is pretty common in a medical office just as "we will bill your insurance company" is. In the real world the provider will bill the carrier. What gets paid is determined by limits of the policy, policy language, deductible as well as any exclusions. "Everything is covered" less your deductible is the norm.
Medical billing errors occurs on both the provider side and carrier. I find myself verifying CPT codes regularly for accuracy.
If the provider has an agreement (contract) with the carrier a cafeteria menu of "services" exists with a pricing structure. Some insurance carriers pay from the invoice if it is reasonable and customary (common in dental).
If you believe your carrier may have made an error contact them and have them explain the bill breakdown and why it did not meet your expectation.