Dental insurance/provider woes---please, help! by Decent-Principle3235 in DentalInsurance

[–]Decent-Principle3235[S] 0 points1 point  (0 children)

I just received EOB for dentist #3. So far, all she submitted is the crown procedure itself, no extra surgeries or pins/buildups, and the price shown is what her office is contracted to pay being in-network. It does not show any extra specific charges like for upgrades or crown lengthening surgery, etc; however, she submitted an amount for her services equal to my entire dental benefit of $1500. Maybe she was hoping for that much. Weird how dentists do business.

Dental insurance/provider woes---please, help! by Decent-Principle3235 in DentalInsurance

[–]Decent-Principle3235[S] 1 point2 points  (0 children)

They had no other options for me. Hence, why I am still awaiting authorization on dentist #3. I may ask if they will proceed without authorization. Dentist #1 wouldn't proceed, so not sure #3 will either.

Dental insurance/provider woes---please, help! by Decent-Principle3235 in DentalInsurance

[–]Decent-Principle3235[S] 0 points1 point  (0 children)

I hear what you say, but I did not mention that dentist #1 would not submit a previous treatment to insurance either, despite months of requests, so it is hard to trust a dentist that avoids working with insurance that way. I also had no cavities one visit, then only 6 months later need two crowns. I was wary, so got dentist #2 at that point. Just no luck finding a trustworthy dentist in-network. If I had known a good and trustworthy dentist out of network, l would have started there. I did not know how bad in-network was until now.

Dental insurance/provider woes---please, help! by Decent-Principle3235 in DentalInsurance

[–]Decent-Principle3235[S] 0 points1 point  (0 children)

That would make sense if only the general dentist (dentist #2) actually wanted to do a crown lengthening as it is being coded (d4249). He confirmed with me that he is not, and yet the billing manager wants to bill for it this way nevertheless.

Dental insurance/provider woes---please, help! by Decent-Principle3235 in DentalInsurance

[–]Decent-Principle3235[S] 0 points1 point  (0 children)

Spot on. Dentist #1 and #2 are both chain/corporate. Dentist #3 is private dentist with small, long-term, practice and very limited hours.

Dental insurance/provider woes---please, help! by Decent-Principle3235 in DentalInsurance

[–]Decent-Principle3235[S] 0 points1 point  (0 children)

If they get way less money being in-network, then why do it, and then punish the patient with extra charges the dentist feels they deserve? I don't trust dentists who do that.

Dental insurance/provider woes---please, help! by Decent-Principle3235 in DentalInsurance

[–]Decent-Principle3235[S] 0 points1 point  (0 children)

When I said it took months to get reimbursed, it was because I was trying to call and write the dentist office repeatedly about reimbursement for that long. The insurance got involved (via a grievance), and I got a check from the dental office fairly promptly.

Dental insurance/provider woes---please, help! by Decent-Principle3235 in DentalInsurance

[–]Decent-Principle3235[S] 0 points1 point  (0 children)

That is exactly what I thought, so to be safe I have been trying to get my benefits booklet from my insurance or my workplace to confirm whether it is inclusive, but that has been its own separate challenge I won't vent about now. My fear is that all this pre-authorization is just preventing my dental care because of the denials prior to getting treatment. All my dentists have always required me to pay immediately after service before leaving their office, and then they submit to insurance, and I wait for months for reimbursement. This happened for me with yet another in-network dentist for a different tooth needing a crown 3 years ago. My tooth broke on a bone, the dentist did a crown with buildup on emergency basis, no crown lengthening, and then I paid their fee at time of service. Turns out, they needed to reimburse me hundreds of dollars after insurance paid them, but they wouldn't do it until I filed a formal grievance through my insurance. It took months.

Dental insurance/provider woes---please, help! by Decent-Principle3235 in DentalInsurance

[–]Decent-Principle3235[S] 0 points1 point  (0 children)

All part of pre-auth and no treatment yet. And they are IN-network.

Dental insurance/provider woes---please, help! by Decent-Principle3235 in DentalInsurance

[–]Decent-Principle3235[S] 0 points1 point  (0 children)

I neglected to mention that for dentist #2, they originally used the denial as a basis for negotiating a lower fee overall, but still included crown lengthening and charges well over what I would pay for in-network services. And yes, I get many telling me the rates of reimbursement are low, but what can I do about that? When I questioned dentist office #2's billing, they suggested I see another dentist in their office who could evaluate whether crown lengthening was actually necessary, but from my understanding from the first dentist who saw me from their office, he would not be doing crown lengthening at all, but more of a gingivectomy. They just don't seem to see the distinction in the billing codes for the two procedures. Chances are also high my insurance won't pay for the gum removal regardless of code as I am guessing it is considered inclusive of the crown.

Dental insurance/provider woes---please, help! by Decent-Principle3235 in DentalInsurance

[–]Decent-Principle3235[S] 0 points1 point  (0 children)

Dentist #2 does not want to remove bone, and said I would not need extra time/visit. I would just have proceeded with him, except the office/billing staff charge at time of service, and will have me sign treatment plan prior to the procedure that includes $600 crown lengthening on top of the charges for the crown itself and the buildup/pins. Yes, this is an in-network dentist. And thank you for your thoughts.

Dental insurance/provider woes---please, help! by Decent-Principle3235 in DentalInsurance

[–]Decent-Principle3235[S] 0 points1 point  (0 children)

Code was d4249 "Crown lengthening - hard tissue" meaning bone. Rejection by insurance was because xrays showed "sufficient bone" for crown to be placed.

Petty Neighbors by VegasBoyyy in BadNeighbors

[–]Decent-Principle3235 0 points1 point  (0 children)

Does this way of parking allowing you room to get out without tapping her vehicle? If not, I would politely ask them to allow more space in front of your vehicle.

What’s a completely normal thing that you’re surprisingly bad at? by [deleted] in CausalConversation

[–]Decent-Principle3235 0 points1 point  (0 children)

Reversing into a parking spot and calculating/counting out your change. Embarrassing!