C.J.
#1 Verify if they are or are not "in-network" with Aetna, by contacting Aetna directly (phone number or website listed on your membership card)
#2 If they Are in-network contact the customer service dept at Aetna to explain the circumstances. The dentist's contract can be terminated for violating the contract if they are charging you above & beyond the contracted rate.
Find out what the TRUE contracted rate is for that procedure. The dentist MUST charge this whether they like it or not. (Believe me, there are fees that we don't like!)
#3 If you work for a large company you can get your HR company to do the leg-work for you... Aetna tends to give a more speedy response when speaking to the decision makers of companies instead of just one member.
If the office chooses to drop the insurance that's fine, but all fees charged in the past MUST be honored at the in-network fee according to the date charged.
Before calling I would find out the ADA code and the fee submitted on the original claim.
Make sure that the fee and the code are still the same as reflected in Aetna's system TODAY. I would hate for them to have resubmitted with another code and fee in an attempt to re-coup some dollars. (unlikely, but still, be educated when you call so you can check.)
I work in dentistry so please feel free to contact me directly with any questions.
- C.