I have really good dental insurance. My daughter has really bad teeth. She's 18, graduating from High School next week. Anyway, we started braces on her year and 1/2 ago. Well, one of her baby teeth was still in her mouth, which my former dentist said it was an adult, but it's not. They had to pull it, to make room for her adult tooth to come down. Well there is the space for the adult tooth to come down, but never did so they said they would have to do surgery and pull it down. So they did the surgery, the tooth was in the roof of her mouth and they had to bring it forward out. Well, for whatever reason, the gums grew over it and the bracket fell off. Her ortho said it had to be done again. Well, my dentist office says they don't guarantee their surgeries so I'll have to pay for it this time, but they will take off $140. So I called my insurance company, and to make a long story short, they said that's not true, because they are in network they sign a agreement saying that they do guarantee their work. And if they weren't going to, then I should file a grievance against them, and go to another dentist.
So I call the dentist office back, let them know what I found out, the lady said she'll talk it over with her manager who is not there and get back to me. After going into a long speech about that is sort of true, but for whatever reason that it didn't work, we'd have to pay a portion because the insurance company will not allow them to bill it twice. They are giving me $140 break; I still have to pay $500. I don't think this is right. I just wanted other opinions, if anyone has gone through this, what would you do? The other problem with this is, that I'm in the middle of a double root canal that they haven't finished; my daughter still has the braces on which this place has both dentist side and ortho side, so we are connected in some strong ties here. After I got off the phone with the dentist office, I called my insurance again, to make sure I did understand what I was told the first time, talked with a different agent and she said the exact same thing. That they do guarantee their work but being in network and I shouldn't have to pay anything.
Please give me advice, and Thank You!
Here's what I would do if I were you. I'd get a conference call between the insurance company and the dentist's office and have them talk about it in front of you. Write down the names of those on the phone. Make sure you have an insurance supervisor on the call. This way, they can talk about how to code it properly.
I've had stuff kind of like this happen, and this is how I handled it.
Good luck to you AND your poor daughter!
I am really not sure. There is a difference between a guarantee on the work and a guarantee for life.
What I mean is look at the braces. Do you really expect her teeth will stay straight for life? Okay if you do find any adult who had braces, they don't. If you wear your retainer they will stay straight longer but they will move because what they are doing is an unnatural process that your body will correct to some extent.
Take that to pulling the tooth down. They did that. The question is whether anything in their procedure caused to tooth to recede or whether there was something that could have been done during the procedure to stop it.
What I am saying is only the procedure is guaranteed. They may not have control over what the tooth does at that point and if that is the case there is a good chance you signed something acknowledging you understood that.
So I am saying I don't know enough to say one way or another.
My husband went to a dentist once for a root canal, and the lady did the procedure, put a crown on his tooth, and then a few months later he developed an abscess. He went back to the dentist and they had to send him to a specialist (an endodontist) to clean up the tooth, and the original dentist had to refund the insurance company the payment that they received for the root canal, because the endodontist had to re-do the bad root canal.
So, I am assuming that your dentist is going to have to return the payment they received from the insurance company for the surgery, and then re-bill it when the corrective surgery happens. They're sure to resist this, since it means they will probably end up losing money on your daughter's case, but that's what they've contracted to do.
Good luck!
ETA: It was definitely a bad root canal--even the owner of the practice said so, and eventually fired the dentist who performed it. She left material inside before finishing up.
ETA2: I'd get a 2nd opinion from another oral surgeon. They might be able to give you a better idea of how the procedure went wrong.
I'm surprised the insurance company isn't handling this. In the past I have had inaccurate charges and the insurance called and took care of it. I'd asked your insurance to do this for you.
I would ask the insurance if you can get a second dentist to do the work since the first won't and if the insurance would pay THEM instead.
Get the insurance company to send you the actual paperwork/agreement that says what their providers are supposed to do. The dentist office may be confused as they deal with tons of paperwork. If you have it in writing from the actual insurance company as to what the provider needs to do, then they should do it.
And use the super nice tone of voice, because they did make mistakes but if you can be "understanding" while requiring they provide customer service (instead of going on verbal "attack mode"), you may get a more helpful attitude from them. You know, the whole "I know this is confusing, so I contacted the insurance company to make sure they gave US the right info..."
It sounds to me that if their work was faulty than they need to correct it and not bill the insurance company a second time (eat the cost).
Just tell them to bill the insurance company, call the company and have them fax you or mail you their policy regarding I'm network dental care
bill the insurance company
Go back to the insurance company. Get the name of the person you speak with and log it - date and time of call - as well as the nature of the call. Ask her to follow up the conversation with a letter confirming their ability to pay, the guarantee the dentist office signs and what the insurance will do in this case.
Your questions should be:
the dentist refuses to guarantee their surgery. I have been told the dentist office signs a form guaranteeing their work. Can they provide that guarantee?
The dentist office stated that you will not allow them to bill twice for the same procedure. There are different dates on this procedure, what is your stance, will you pay twice?
We would like to go to another dentist within network due to these issues, can you recommend one and also can you confirm that the procedure will be paid?
Get everything in writing. Get another dentist within your network and ensure, in writing, that they will pay for the procedure again due to the problems at hand.
Good luck!
The insurance company is saying its covered.
What more answer is needed.
Tell the office to submit it and pay what's not covered.
Am I missing something?
That's between insurance company and dentist. Let them figure it out.
Never have I met a dentist or doctor to guarantee anything. S--t happens.
An abscess several months after root canal is a perfect example of it. I am sure dentist did nothing wrong. S--t happens. Queenofthecastle: a bad root canal. It would be known immediately not months later. Boy did that dentist have the screws put to him unless there is more to that story
Let the dentist and insurance company. Depending on how contract is written, you may have to pay something.
Let the insurance company fight it out w/ the dentist office. I am guessing that they are asking for payment upfront for your portion so you may need to pay the amount your insurance says you would owe up front, let them fight out the rest.
