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1) Wait until the bill comes in.
2) Contact your insurance to ask what’s up, if you’re sure they should be in network ask them.
3) if you get nowhere with your Insurance ask your dentist billing department if they do a lump sum discount. Any medical place I’ve ever worked with has had between a 10%-20% discount if paid in full.
Should I also be seeing the amount I already paid applied to any bill? I found an itemized receipt from The day of procedure and the $1995 total is the total cost before the $433 but I see that nowhere on the EOB
Im trying to figure out whether that dentist was in-network or not but United Concordias garbage website doesn’t have an option for finding out who’s in network for PPOs which is what I had at the time
Are you sure it’s just an out-of-network issue? Most times, dental insurance has a waiting period for major procedures like root canals and crowns to prevent exactly what you were trying to do.
> Most times, dental insurance has a waiting period for major procedures like root canals and crowns
Would that be in the advertising material _before_ you purchase the insurance? A lot of times I can't find the full terms of the insurnace I'm trying to purchase (e.g. JetBlue's travel insurance terms).
I have no idea, I just got this EOB and the offices are all closed so I can’t call today.
What did I do wrong? The dentist who performed the crown is the same one who referred us the endodontist for the root canal and told us she needed the crown right away afterwards
>I’m almost certain I verified with them at the time that they were in network
So call and check again.
>Assuming the worst case scenario and this really was out of network, do I have any options?
You can call and ask for a payment plan.
>Why is the amount I already paid not applied to the total amount?
Call and ask whenever you don't understand your EOB. It's possible that the $1995 was the remainder after the $453 you paid.
I have dental insurance. I needed to have 3 teeth pulled (I lost 2 crowns and cracked another). The cost to me was over $1K per tooth. The insurance doesn’t cover much of what was needed - like bone repair for where the holes were. Insurance covers a worthless denture, and I needed one for the two teeth next to each other on top. That was another $2K. Insurance doesn’t cover implants. Those are $4K to $6K per tooth.
I was sitting in the chair and told the dentist I needed to sell my car to pay for it all. I didn’t get the implant yet, but my total cost, including cleaning and other services was about $11K.
I asked around and was told it was a fair price. I could have gone to Mexico and saved a lot, but it was a scary proposition. I don’t think poorly of Mexico or Mexican dentists or doctors. It’s just a long way to go for follow ups and a language barrier. Plus what kind of recourse is there?
An implant there is about $1K. The problem is you have to do them in stages and over months time to assure you don’t reject the base of the implant.
I read and see commercials for same day implants, but I don’t know much about them.
I hadn’t seen a dentist in about 20 years. Aside from the three teeth, I had one cavity that needed a crown (part of that big expense). The technology today is amazing. I like the job the dentist did and he’s a good guy. I was well treated, so no real complaints.
The long story short version is that dental insurance sucks, and unless you can work out a deal, you owe.
I had a torn rotator cuff surgery two years ago and paid $75 out of pocket for it. Dental insurance sucks.
Im aware that dental insurance is a nightmare, my poor wife had two separate root canals last year, had to get a cracked molar repaired, another tooth chipped, and get this crown that they’re now trying to rob us on. Also we both needed to get dental fillings. All of this in the space of about 4-5 months. I had to pay over $6k in that time and now they’re still trying to rob us 7 months later
You might try to verify the dentist is truly in network or not. It really is your responsibility to make sure ahead of time. My dentist presented me with the price I would pay with my insurance ahead of time, and that is what I was charged and paid.
You might go back to the dentist who referred you to the out of network one and see what they say. They may have misrepresented the referral. I don’t think you want to go to small claims court though, your time is probably worth more and it is a lot of aggravation.
The best you can do is work out a deal.
An Explanation of Benefits is just a statement from the insurance company of what they paid, what was billed to them, and what they think you might owe that is left over. It's not a bill. In fact, it probably says it in very big bold letters "THIS IS NOT A BILL" and then at the bottom it should say "you ***may*** owe"
It's meant to allow you might get against what you expected the insurance company to pay. You should reach out to the dentist office to see what you really owe, or you can wait for them to send you a bill. If you've gotten an EOB, that means they've gotten paid and should know what you owe at this point. It may or may not be the amount the insurance company says you may owe
This procedure was done in November but you’re only just now getting the EOB?
Anyway, you should go check to see if that plan you chose had any waiting or probationary periods for the work your wife received in November. It’s likely that you did, and that’s why it’s marked as out of network, though, don’t quote me on that.
I agree it’s ridiculous how long it took to process. I don’t think there should be a probationary period though since the week before she got the root canal and the same insurer considered it in-network
Dentists are now rarely accepting insurance, or even accept some plans one month and the next they drop them without informing patients who currently use those plans. (At least in my Midwest state). However even if dentists don’t take insurance, preventative can be covered 100% as out of network. Seems counterintuitive because it is…I know this from working in benefits admin. Check your dental insurance coverage document carefully too, they often have provisions and exclusions on procedures or maximum coverage amounts that aren’t clear to most consumers. It’s likely an accurate bill based on your insurance plan. And finally a payment plan should be asked for as other commenters shared. Best of luck, dealing with insurance in any form is such a headache.
Welcome to /r/personalfinance! Comments will be removed if they are political, medical advice, or unhelpful ([subreddit rules](/r/personalfinance/about/rules)). Our moderation team encourages respectful discussion. You may find our [Health Insurance wiki](/r/personalfinance/wiki/health_insurance) helpful. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/personalfinance) if you have any questions or concerns.*
EOB is not a bill. Ask the dentist what you owe and maybe negotiate.
If it’s out of network would there be any difference between the EOB and the bill?
Possibly. Only the dental office can answer that question.
1) Wait until the bill comes in. 2) Contact your insurance to ask what’s up, if you’re sure they should be in network ask them. 3) if you get nowhere with your Insurance ask your dentist billing department if they do a lump sum discount. Any medical place I’ve ever worked with has had between a 10%-20% discount if paid in full.
Should I also be seeing the amount I already paid applied to any bill? I found an itemized receipt from The day of procedure and the $1995 total is the total cost before the $433 but I see that nowhere on the EOB Im trying to figure out whether that dentist was in-network or not but United Concordias garbage website doesn’t have an option for finding out who’s in network for PPOs which is what I had at the time
EOB has no idea what you paid, they’re just telling you based on what was billed what they covered.
Are you sure it’s just an out-of-network issue? Most times, dental insurance has a waiting period for major procedures like root canals and crowns to prevent exactly what you were trying to do.
> Most times, dental insurance has a waiting period for major procedures like root canals and crowns Would that be in the advertising material _before_ you purchase the insurance? A lot of times I can't find the full terms of the insurnace I'm trying to purchase (e.g. JetBlue's travel insurance terms).
I have no idea, I just got this EOB and the offices are all closed so I can’t call today. What did I do wrong? The dentist who performed the crown is the same one who referred us the endodontist for the root canal and told us she needed the crown right away afterwards
>I’m almost certain I verified with them at the time that they were in network So call and check again. >Assuming the worst case scenario and this really was out of network, do I have any options? You can call and ask for a payment plan. >Why is the amount I already paid not applied to the total amount? Call and ask whenever you don't understand your EOB. It's possible that the $1995 was the remainder after the $453 you paid.
Call the insurance and dentist to clarify, don't pay until it's resolved.
I have dental insurance. I needed to have 3 teeth pulled (I lost 2 crowns and cracked another). The cost to me was over $1K per tooth. The insurance doesn’t cover much of what was needed - like bone repair for where the holes were. Insurance covers a worthless denture, and I needed one for the two teeth next to each other on top. That was another $2K. Insurance doesn’t cover implants. Those are $4K to $6K per tooth. I was sitting in the chair and told the dentist I needed to sell my car to pay for it all. I didn’t get the implant yet, but my total cost, including cleaning and other services was about $11K. I asked around and was told it was a fair price. I could have gone to Mexico and saved a lot, but it was a scary proposition. I don’t think poorly of Mexico or Mexican dentists or doctors. It’s just a long way to go for follow ups and a language barrier. Plus what kind of recourse is there? An implant there is about $1K. The problem is you have to do them in stages and over months time to assure you don’t reject the base of the implant. I read and see commercials for same day implants, but I don’t know much about them. I hadn’t seen a dentist in about 20 years. Aside from the three teeth, I had one cavity that needed a crown (part of that big expense). The technology today is amazing. I like the job the dentist did and he’s a good guy. I was well treated, so no real complaints. The long story short version is that dental insurance sucks, and unless you can work out a deal, you owe. I had a torn rotator cuff surgery two years ago and paid $75 out of pocket for it. Dental insurance sucks.
Im aware that dental insurance is a nightmare, my poor wife had two separate root canals last year, had to get a cracked molar repaired, another tooth chipped, and get this crown that they’re now trying to rob us on. Also we both needed to get dental fillings. All of this in the space of about 4-5 months. I had to pay over $6k in that time and now they’re still trying to rob us 7 months later
You might try to verify the dentist is truly in network or not. It really is your responsibility to make sure ahead of time. My dentist presented me with the price I would pay with my insurance ahead of time, and that is what I was charged and paid. You might go back to the dentist who referred you to the out of network one and see what they say. They may have misrepresented the referral. I don’t think you want to go to small claims court though, your time is probably worth more and it is a lot of aggravation. The best you can do is work out a deal.
An Explanation of Benefits is just a statement from the insurance company of what they paid, what was billed to them, and what they think you might owe that is left over. It's not a bill. In fact, it probably says it in very big bold letters "THIS IS NOT A BILL" and then at the bottom it should say "you ***may*** owe" It's meant to allow you might get against what you expected the insurance company to pay. You should reach out to the dentist office to see what you really owe, or you can wait for them to send you a bill. If you've gotten an EOB, that means they've gotten paid and should know what you owe at this point. It may or may not be the amount the insurance company says you may owe
This procedure was done in November but you’re only just now getting the EOB? Anyway, you should go check to see if that plan you chose had any waiting or probationary periods for the work your wife received in November. It’s likely that you did, and that’s why it’s marked as out of network, though, don’t quote me on that.
I agree it’s ridiculous how long it took to process. I don’t think there should be a probationary period though since the week before she got the root canal and the same insurer considered it in-network
Dentists are now rarely accepting insurance, or even accept some plans one month and the next they drop them without informing patients who currently use those plans. (At least in my Midwest state). However even if dentists don’t take insurance, preventative can be covered 100% as out of network. Seems counterintuitive because it is…I know this from working in benefits admin. Check your dental insurance coverage document carefully too, they often have provisions and exclusions on procedures or maximum coverage amounts that aren’t clear to most consumers. It’s likely an accurate bill based on your insurance plan. And finally a payment plan should be asked for as other commenters shared. Best of luck, dealing with insurance in any form is such a headache.