Dental Insurance

Updated on March 01, 2010
M.L. asks from Los Angeles, CA
4 answers

Hi Moms,

I'm hoping you all can help. My 7 year old son needs a retainer for his lower teeth. We have Aetna Dental and the dentist office is charging us 1200 dollars. Aetna and our dentist have a contracted rate of 300 and some odd dollars. I thought this was great until the dentist said the the contracted rate was incorrect and has been charging us over 700 dollars in fees (automatic credit card payment) and continues to do so. The dentist office has said if they don't change the rate they will just drop the insurance. The insurance company says they can't do that because they have a contracted rate within the contracted year. They will investigate but it will take 4-6 weeks. Meanwhile, I am stuck between a rock and a hard place. I really do like the dentist and obviously don't want to continue paying. What do you all suggest and what our my legal rights? I'm thinking of telling the dentist office that until the rate is fixed I shouldn't be charged and if they don't stop the autopayment that I will stop it through my credit card. Also, I was thinking of telling credit card company not to pay the disputed amounts until we've reached an agreement but I don't want to make enemies with the dental office as well. Please help.

Thanks!

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So What Happened?

Hi Everyone,

Called the insurance and they are investigating . . .meanwhile the dentist office has heard me finally and they say they will be stopping the automatic payment since the insurance company faxed them a letter this morning. They are pretty upset with me because it is a mark against their office, but armed with all of the encouragement and info. from you moms I feel good about my decision. I'll let you all know what happens. Thank you.

More Answers

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C.J.

answers from Dallas on

#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.

2 moms found this helpful

L.B.

answers from New York on

Call your states insurance commissioners office. They should have someone available to answer your questions.

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D.G.

answers from Las Vegas on

Great advice from Liv, Christine & Keren. Follow ALL of their advice. Also, until you get this resolved cancel the autopayment and dispute the amount above $300. To prevent problems like this in the future (applies to medical insurance also) for major procedures have the provider send in a request for predetermination. That way you and the provider know exactly what the insurance company will pay and exactly what your remaining, if any, financial obligation is. It's also a good idea to check your insurance policy because often, the insurance company requires a predetermination/prior approval for some procedures, and if you don't get one they apply "out-of-network" deductibles/co-pays. Oh, be a 'squeaky wheel' on this one. Good luck.

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K.P.

answers from Los Angeles on

As much as you like your dentist, it sounds like you're getting the short end of the stick because of someone else's mistake. A price was set and agreed upon. It doesnt sound right that money which you didnt authorize was being charged to your credit card. I'd definitely dispute this and/or come to an agreement with the dentist. This doesnt sound right to me...

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