- August 13, 2023
- Posted by: legaleseblogger
- Category: Related News
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**Dental Procedure Costs: Unveiling the Intricacies and the AI Legalese Decoder’s Role**
Recently, I embarked on a dental journey to improve my oral health, which necessitated some extensive dental work. After successfully completing the procedures, the financial aspect demanded my attention. I had initially paid around $1500 for the dental work undertaken.
To my surprise, amidst the mundane pile of bills in my mailbox, I stumbled upon an intriguing “Explanation of Benefits” bill from my insurance provider. This document provided a breakdown of the procedure’s cost, highlighting the dentist’s potential savings, the percentage paid by my insurance, and, bonus, it also elucidated the precise amount that I was supposed to personally bear as expenses.
Surprisingly, the bill stated that my responsibility was restricted to a manageable sum of $990. This discrepancy confounded me, raising a crucial question about the true amount I owed for the dental work rendered.
Fueled by curiosity and a sense of financial prudence, I proactively contacted my insurance provider to obtain clarifications regarding the disparity between the billed amount and the amount listed in the explanation of benefits. Their response confirmed my initial belief that I was indeed supposed to pay only $990, not the higher amount of $1500.
Intrigued yet still perplexed, I decided to embark on a quest for answers and sought clarification from the dentist’s office directly. A phone call ensued, during which I hoped to uncover the underlying reasons for the discrepancy between their estimation of my financial obligation and that outlined by my insurance provider. However, to my surprise, the dentist’s office remained steadfast, confidently asserting that their calculations aligned with the original sum of $1500.
Now, caught in an intricate web of conflicting statements from the insurance provider and the dentist’s office, I find myself grappling with uncertainty regarding my next course of action. How can I determine the accurate amount I owe, especially when confronted with this perplexing situation?
This is where the AI Legalese Decoder can come to the rescue, offering an innovative and efficient solution. Powered by artificial intelligence, this cutting-edge technology possesses the ability to decipher complex legal jargon and navigate the intricacies of insurance policies. By utilizing the AI Legalese Decoder, I can efficiently analyze the insurance documentation, compare it with the dental provider’s assertions, and ultimately gain a definitive understanding of my financial obligations. This invaluable tool can save me precious time, prevent misunderstandings, and empower me to make informed decisions about disputed claims.
Therefore, armed with the AI Legalese Decoder’s formidable capabilities, I am determined to delve further into this situation, ensuring clarity and seeking a resolution that aligns with my rights as an insured individual.
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****** just grabbed a
Not a legal issue quite yet.
Call your insurance back and tell them an in-network provider is attempting to charge you more than the allowed amount in violation of their contract with the insurance. Most likely, they will dial the dentist’s office to have a three way call and insurance will tell the billing department to get their shit together and refund you.
If the dentist still does not budge, then you’re getting into legal territory and should report back.
Call your insurance and tell them. Providers in your network sign a contract with the insurance providers agreeing to UCR (usual, customary, reasonable) pricing. The contract forbids them from charging you the difference between the UCR and the price they may ( or may not) charge someone with a different carrier.
Probably just a mistake.
Your insurance may have downgraded the code. Ex fillings on back teeth sometimes they only pay for silver fillings but you consent to white fillings. Based on your estimate they probably downgraded your crown to metal or porcelain fused to metal but you consented to ceramic
Medical institutions do this all the time–they send you a bill before insurance has even processed the claim in hopes that you will pay their bill instead or even in addition to what insurance says you owe. It’s called double billing.
This can be a state by state issue. But there are two common things that can explain your situation. 1) non-covered benefits, if your insurance company doesnÔÇÖt reimburse for the procedure the dentist can charge their office fees (not the fee schedule agreed upon by the insurance company). 2) YouÔÇÖve exceeded your maximum benefits for the year, which in some states allows the dentist to start using their office fee schedule.
ItÔÇÖs also possible you had an outstanding balance, and they charged you for everything owed.
Again these specific rules vary by state but may offer a possible explanation.
Contact the insurance company and let them handle this. The dentist is being crooked
Does you state have a department of banking and insurance?
Check to make sure the EOB included ALL procedure codes in totality for the sum you have. If things were billed out of the course of time (which happens when certain procedures are billed out in steps). Yes your co-pay is typically the totality of ALL treatment rendered on your tx plan versus how it was billed out date wise. If you signed a tx plan that had say 9 codes of various tx, your EOB may only include the (ex.) 5 that have already been done then you need to EOB for the other codes and see if the total matches. also, if you maxed out your benefits then certain procedures will not be covered by your insurance company and you have to pay the OOP portion has your responsibility. Also, if you provider “accepts your insurance” you HAVE to clarify if they are in network or out of network. If your benefits are different for in vs out then typically insurances play less % of tx for OON vs in network. Say a code for service is 1000. In network they’d cover 80% (800) and you pay 200. OON, they may only cover 50% so youd be responsible for 500. Alot of this is in the contract between your employment and the insurance company. The dentist office typically only follows the policies the insurance company has in the contract but also some states will allow them to bill your their UCR fees vs insurances fees once you max out. Go into the office and ask to speak to their insurance specialist, whoever knows the insurance to see if any of the possible things listed above could have happened. Most insurances have a max of 1,200-1,500 a year then they say “hey you maxxed out, goood luck with the rest or wait til next year when the coverage replenishes at 1,200-1,500