Like Pulling Teeth: How I Won My Dental Billing Battle
I had to apply some pressure to overcome my out-of-network billing dispute. But saving hundreds of dollars and standing up for what's right is worth it.
My wife recently had some dental work done, and as you can imagine, I’m the one in our household that monitors our health care bills.
I know I wrote the book, Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win, but going through medical bills doesn’t come naturally to me. I don’t think it comes naturally to many of us. It’s a learned skill, an essential aspect of financial literacy, like balancing a checkbook or reviewing a credit card statement.
Thus, the Explanation of Benefits sat on my desk for a couple of weeks before I reviewed it. And when I looked, I was certain I had found a mistake. My Delta Dental insurance plan said the dental work had been out-of-network.
C’mon – staying in network is one of the most elementary tips I share in my book and in The Never Pay Pathway, my health literacy videos that are based on the book. It’s 101-level. In-network providers have contracted rates with your insurance plan. Out-of-network providers do not – so their prices can be much higher, and your coverage may be much worse.
Thus, I always advise people to make sure the care you receive is in-network before they undergo medical or dental services. And be thorough about it. Make sure you check with whoever is providing the services, and the insurer, just in case the medical or dental provider’s office is wrong.
I practice what I preach, so I called the dentist before my wife’s appointment to confirm. “Yes, we are in network with your Delta Dental plan,” the billing rep assured me.
I also called Delta Dental plan and they confirmed: “Yes, your dentist is in-network.
Belt and suspenders. I thought we were protected!
Delta Dental must not have processed this claim correctly, I thought to myself when I reviewed the EOB for the “out-of-network” bill. I soon learned that I had been caught up in the opaque multi-layered maze of confusion that characterizes our health care system.
I called the Delta Dental billing department, and they told me that our dentist was indeed in-network, but with a big caveat. The dentist was part of the Delta Dental “Premier” network, and that’s not the same as being “in-network” with Delta Dental.
Insurance companies build networks of medical providers, or dentists, in this case. Dentists and medical providers participate in different networks. So apparently my dentist was in-network with the “Premier” network, but not the Delta Dental network.
It turns out the Premier network isn’t so premier. It cost me about $200 more than the Delta Dental network due to higher prices and cost sharing.
I told the Delta Dental representative that I had called to confirm the dentist was in-network before my wife received the treatment and she showed genuine concern and said she would take care of the problem.
She gave me the audio equivalent of a blank stare. As if it was my fault I didn’t know about the non-premier Premier network.
I called the biller for my dentist, and she told me again that they were “in-network” with Delta Dental. I had to correct her. No, you’re in-network with the “Premier,” network, I said, and that’s not the same as being in-network with Delta Dental.
Oh, she said.
I asked nicely for her to reduce my bill to account for the mistake and she immediately showed genuine concern and said she would correct the problem.
Just kidding again!
Like many billing department reps, she acted like it was my problem. I insisted that she ask the dentist for a discount and explained that their response might determine whether I continue to come to them for services. The dentist declined to give me a discount.
There you have it. I followed my own advice and thought I did everything right – and still got hit with a bill hundreds of dollars higher than it should have been.
I could have paid the bill and forgotten about it. Thankfully, we have the money in our bank account to cover it. But that didn’t sit right with me for two reasons:
It hadn’t been my mistake, and I didn’t feel the dentist had been considerate when I asked for it to be corrected.
The dentist had done something else that bothered me. When my wife showed up for the appointment, the dentist demanded payment in full - before the claims had been adjudicated by our insurance plan. That creates access issues for patients. Many people would not be able to shell out $500 or so at the time of service. It also reduced my leverage when it came to negotiating the bill. I couldn’t “Never Pay the First Bill” because we had paid up front!
Also, I believe that people who can stand up against unfair business practices need to do so. Not just for themselves, but also for all the people who can’t stand up for themselves. We need to insist on fair treatment for ourselves, and for others.
I had already paid, so I estimated that the dentist would need to refund about $200 to make it fair. I would have accepted less, to be honest, if the dentist had worked with me.
I often say that winning these medical billing battles requires us to give whoever is billing us the incentive they need to be fair with us. In this case, I did have some leverage. I decided that I would publicize the truth about our dispute, so others could be warned. The publicity would be in the form of an online review and this newsletter.
I called the dentist and I explained that I had tried to come to a resolution that was fair for both of us, and she declined to refund any of my money. I asked her if she would like to reconsider, because her final action would show up in my review and in this newsletter.
Naturally, she immediately saw the logic of my argument and wrote me a check for $200.
Lol. Not quite.
The dentist blamed the insurance company for creating the confusion, even though her office had also misinformed me. She said there’s nothing she could do.
I told her I didn’t agree.
The dentist also said that it’s common practice to demand payment in full at the time of service, rather than run a claim through a patient’s insurance plan.
I told her I disagreed.
The conversation went back-and-forth for about 20 minutes and neither of us budged.
“So we disagree,” I said. “How do you want this to appear in my review and my newsletter?”
The dentist paused for a minute to consider my bottom line.
“You can have the $200,” she said.
I thanked her, and her check showed up in my mailbox a few days later.
That may sound like it was awkward. Yes, it was. I did have to pressure her and she didn’t like it.
It may also sound like lot of work for $200. If that’s how you feel, consider yourself blessed. The Federal Reserve reported in 2022 that more than 30 percent of American families would not be able to cover an unexpected expense of $400. About 100 million Americans are burdened right now by medical debt. Many people can’t afford to overpay a dentist by $200.
Plus, I look at it like paying myself $200 for that 20 minutes of my time - by saving my own money.
And yes, our family will be going to a different dentist - one that’s in-network, like, for reals in-network, not in some crummy “premier” network that’s just another hidden way to make me pay more than I should.
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The videos are an ENGAGING resource that will save money for your employees, their families - and your health plan. Let’s stop overpaying for our health care, shall we? Email me at email@example.com for more information.
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Thanks for sharing this! Particularly enjoyed the standoff with the dentist at the end.
How would you deal with a situation of upcoding when you get into a dispute and they refuse to budge? Level 01,02 vs 03?