- September 23, 2023
- Posted by: legaleseblogger
- Category: Related News
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Title: Discrepancy in Wisdom Teeth Removal Costs: Seeking Assistance from AI Legalese Decoder
Introduction:
Six months ago, in March, I underwent the extraction of all four of my wisdom teeth. Prior to the procedure, I proactively reached out to the dental office several times to ascertain the out-of-pocket expenses. However, they consistently advised me to wait until closer to the appointment date for an accurate estimate. Just a few days before the procedure, I received a call informing me that there would be no copay required. To my surprise, I have now been notified that I owe a substantial $400 copay. Feeling misled and frustrated, I am seeking guidance on how to address this situation. Additionally, I will explore the potential assistance that the AI Legalese Decoder could provide.
Detailed Account:
When I initially contacted the dental office to determine the costs associated with my wisdom teeth removal, I was repeatedly told that it was not possible to provide an exact figure in advance. The staff members insisted that I wait until closer to the appointment date to obtain this information. Following their advice, I did so, trusting their reassurances.
In the final communication before the procedure, I was assured that no copay would be required. Naturally, I proceeded with the extraction, assuming that there would be no significant financial burden. However, six months later, I have received an unexpected demand for a $400 copay. This sudden reversal of information has left me feeling deceived and has cast doubt on the credibility and integrity of the dental office.
Considering Legal Options and the AI Legalese Decoder:
In light of this situation, I am now left with a dilemma. I am contemplating whether it is advisable to refuse payment altogether due to the lack of transparency and disclosure from the dental office. However, what consequences could arise from this decision? Will it escalate the issue further?
To navigate this complex situation, I am eager to explore the potential benefits of using the AI Legalese Decoder. This advanced technology could assist in understanding the legal nuances involved and help me determine the best course of action. By utilizing this innovative tool, I hope to unravel the intricacies of consumer protection and contract law, enabling me to make informed decisions moving forward.
Seeking Advice:
Given the circumstances, I am reaching out to the community for advice. Have any individuals encountered a similar issue with dental costs or unexpected copays following a procedure? If so, what steps did you take to address the problem? Any insights or suggestions would be greatly appreciated to help me tackle this issue effectively.
Conclusion:
The discrepancy regarding the copay for my wisdom teeth removal has left me feeling frustrated and deceived. By seeking guidance and exploring the potential assistance offered by the AI Legalese Decoder, I aim to gain a clearer understanding of my rights and responsibilities in this matter. I am hopeful that through personal experiences and expert advice, I will be able to navigate this situation and ensure a fair resolution. Please share any relevant information or suggest any other appropriate platforms where I can seek further assistance. Thank you in advance for your support.
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AI Legalese Decoder: Revolutionizing the Legal Industry
Introduction:
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****** just grabbed a
$400 copay for four wisdom teeth? I paid $2300 for two ($300 of which was nitrous) and that was including insurance. My dentist’s protocol includes bone grafts which my insurance doesn’t pay for to the tune of $900 a piece.
What did your EOB say? That tells you what you owe and why.
You need to understand that, whenever any doctor’s office tells you how much a procedure will cost after insurance, they are giving you their best guess. Insurance is complicated, they can’t know every in and out of every policy, and it’s not reasonable to expect them to absorb whatever your insurance decided not to pay. You usually sign something saying you understand it’s just an estimate, and that you will pay your patient responsibility.
With that said, sometimes there is a coding error, so it’s always worth checking your Explanation of Benefits to find out why you owe this. (This also helps you start understanding your coverage.) If it says “not covered,” call the dentist’s office to start figuring it out, because they may just need to make a correction to fix this.
For future reference, another gotcha is any surgical procedure. In my experience, when the surgeon’s office tells me how much it will cost, it’s going to be double that. They give me the doctor’s charges, and neglect to mention the surgical facility, the anesthesiologist, x-ray, pathology, etc. I keep getting random bills for six months after any surgery.
-$400 is a normal copay; 4 wisdom teeth and sedation would be over $2000 without insurance
-Check with your insurance and their EOB
-You probably signed something stating your insurance coverage is an estimate and youÔÇÖd pay the difference with the paperwork you signed, thatÔÇÖs why they can still bill you 6 months later
Call your insurance to check how much you owe out of pocket (they usually mail you a copy). You can also check this by creating an online account on your provider’s website and navigating to Claims. If you do need to pay and you dont have the full amt on hand, you can ask the dental office if you can pay in installments (CareCredit, etc). Going forward, always ask for a written estimate of costs before any medical/dental procedure.
1. Ask for itemized bill.
2. The dentistÔÇÖs office is not responsible for figuring out what your insurance covers.
Honestly even though it’s a crappy situation, $400 is fairly reasonable for that type of surgery. When I had 3 of mine cut out 2 years ago it cost me about $900 and my wife just had all four of hers out and it was about $750 after insurance. Don’t ignore the bill, they will just send it to collections and you don’t really want that.
Does your ins require you to meet a deductible? That might be it
Def dont refuse to paythey can send u to collections. $400 is peanuts to them. They can probably accept a few monthly payments.
Honestly, anything dental related is better to take care of before it gets worse. You are paying $400 now, but what happens if you didn’t do the surgery and they impacted your molars? I didn’t get mine taken care of due to estimated costs. Once I was making more money, I went in to get it done. Two of my wisdom teeth impacted my molars. I lost one, and the second was bad enough I now have a crown. Getting the extra tooth pulled and the crown has cost me more than the initial surgery would have cost.
Also, some places will work out a payment plan if you can’t pay up front. They are understanding, and you can also check with your insurance to see if anything was coded incorrectly.
Never rely on the dentists (or doctors) for what your insurance covers. You need to call your insurance and have them send you evidence of your responsibility.
Dentists have little incentive to get the numbers right.
You likely signed an agreement with your dentist that you will pay anything your insurance doesnÔÇÖt, so if you truly do owe $400, youÔÇÖll have to pay it.
YouÔÇÖre lucky it was only $400.
What documentation do you have stating the $0 payment?
Call insurance and verify what you owe. At the end of the day the doctor can only estimate what insurance will pay and what you will owe, although copay should have been easy to verify.
Good news is medical accounts less than $500 will never appear on credit reports if you just want to ignore it. The dentist could deny future service (unless you happen to end up in an ER needing emergency dental care and that happens to be the dentist on call)
Ask for itemized from the doc. Then check your EOB from your insurance.
$400 is a great price. My 4 wisdom teeth were $1,400 and this is with insurance.
Normally you pay a copay at the time of visit, not something billed 6 months later.
Why did they take so long to bill? What is the timely filing period for your state? Did you call the insurance company, whose calls are recorded, and ask them? Did you get an EOB?
Not enough details here to help you realistically. Also $400 is NOTHING for wisdom teeth removal. If you can afford it, pay it and move on. If the dentist wants to be mean, ask them why they waited 6 months to file and make them sweat a little, but make sure they haven’t already written off that cost and are trying to double collect
You said you asked about co-pay, but co-insurance is different. Or so they tell us, anyway…
That may be the source of the $400 still owed. It’s your responsibility to know and understand your own insurance.
As for the office, there’s a federal law now that mandates doctor offices provide estimates of what something will cost the patient and their insurance company, in writing. The estimate should give a range, so there are no surprises (so long as nothing serious changes during the procedure). The estimate will be the entire cost, so again, know your insurance plan.
Ask the dentist for an itemized bill, and compare with your EOB from the insurance company and with the estimate the dentist gave you.
Did you talk to your insurance company before the procedure? What did they say about copays?
Either way, call your insurance company to verify that you do indeed owe the $400 copay, before you decide to put your credit report at risk by not paying your debts.
$400 is extremely cheap. I paid over $2000 for my copay. So seems like you just got blessed. Just pay it & move on.
Call your dental insurance and find out why you’re paying $400.
Maybe you dont have a co-pay, but you do have co-insurance. This is likely the case and your insurance probably paid like 80% of the cost and you are liable for the other 20%. The dentist has no idea what you owe until they submit the bill to insurance and then insurance pays their portion. Then they bill you the part that insurance has indicated you owe. Dont just “not pay it” unless you want to get a late fee, and maybe get sued.
Check your local laws around medical billing disclosure, ask for information on their financial assistance policy, ask if they billed your insurance before billing you.
Also ask your insurance company if they need documentation around the procedure, or an explanation from the doctor on why general anesthesia was needed as opposed to just local or anything else about the procedure.
Ask for a breakdown of your bill WITH the codes so you can see what they are billing you for and if there are duplicates.
You can also ask if they offer payment plans, etc.
If it makes you feel any better, mine cost $5,000 out of pocket because of everything needed, the particulars of my case, and all the periphery work they had to do while in there. ƒñÀƒÅ╗ÔÇìÔÖÇ´©Å
My dental insurance doesn’t cover optional anesthesia. So I had to pay for the laughing gas that sadly didn’t work. Check with your insurance to see if the anesthesia was covered or not, but it sounds like not.
Okay I am a general dentist not an oral surgeon but I think I can help explain what may have happened. IÔÇÖm sorry youÔÇÖre in this situation and trust me, itÔÇÖs common and frustrates everyone involved.
It is NOT the fault of the surgeonÔÇÖs office. Insurance is convoluted and complex on purpose so they can weasel their way out of paying for your work any way that they can – thatÔÇÖs how they maximize their own profits. The surgeons office likely provides estimates out of good will for their patients, but it is always just an estimate as the insurance WILL NOT accurately communicate with the office the details of your individual insurance contract. As a courtesy to you, the office called your insurance to get information to provide an estimate. Insurance companies only give the office a ÔÇ£fax backÔÇØ with a generic table of your benefits that for some reason that is beyond me and has never made sense, does not include every detail.
One thing that may have happened is that you met your maximum allowance for the year. Dental insurance works the opposite of medical insurance which confuses a lot of people. With medical, you will reach a deductible and then pay whatever your co-insurance is. With dental, you reach a maximum and then insurance will not cover anything beyond that. LetÔÇÖs say your maximum allowance per dental insurance is $2000 per year, but the services rendered were $2400, you will owe that $400.
Another thing that may have happened is that you received a service that isnÔÇÖt covered by your plan. For example, if you elected to receive nitrous oxide or conscious IV sedation, those services may not have been covered in full, even if the extractions were fully covered.
Also, the office may charge a specialist fee. Insurance reimbursements for dental work are LOW and decreasing every year, which is mind blowing considering your average dentist makes $130,000 and your average dental insurance CEO makes millions. Specialists, such as an oral surgeon, have invested hundreds of thousands of dollars and years of extra time into their education to provide the best quality care to patients. As such, they have the privilege of charging specialist fees for their expertise. In return for the specialist fees, you are receiving care from someone who is capable of extracting your wisdom teeth and most importantly capable of managing any complications.
Last thing I can think of is that the extractions may have been more complex than originally anticipated. ÔÇ£SimpleÔÇØ extractions often have a low fee, but more complex extractions (including impacted wisdom teeth) are billed for a higher amount due to their complexity. The front desk may have been giving you a quote for the simplest type of extraction, not the more complex ones, because they arenÔÇÖt the doctor and donÔÇÖt know whatÔÇÖs happening in your mouth.
I recommend calling your insurance, not the office. The office canÔÇÖt help you understand your plan because they simply wonÔÇÖt have the right information. You should call your insurance to have them explain the bill and why they didnÔÇÖt cover something.
Lastly, be relieved that your wisdom teeth are gone for good. Literature shows that up to 91% of wisdom teeth have cavities, periodontal disease, or another issue at some point in their lifespan. TheyÔÇÖre nothing but trouble.
Hope that helps! IÔÇÖm sorry youÔÇÖre in that situation and if you truly canÔÇÖt pay all at once, oftentimes the office will work out a payment plan with you.
Honestly itÔÇÖs incredibly cheap, and I would pay it so as not to worry about it.
But you can check your explanation of benefits from your insurance company to make sure itÔÇÖs accurate first.
They did not lie to you. You went in to it not doing your research. I canÔÇÖt think of a single time that I had a surgical procedure that I wasnÔÇÖt billed a couple extra charges for the radiologist or anesthesia or lab charge. Take this as a learning lesson and move on.
Why not just pay the bill?
A service was rendered and you owe them money.
I don’t see the problem.
It’s 400$ for something you clearly signed up for.
You signed the paperwork to allow them to remove your teeth.
Pay the bill. Or get sent to collections.
Easy as that.
That’s cheap. if you need them out, pay it. If you don’t get them taken out you’re going to have problems later in life if they are coming in slanted.
First off you got a great deal! But bottom line you need to check with your insurance about anything you do, not the doctor or dentist office. It isnÔÇÖt their responsibility. They can give you the best info they have but ultimately itÔÇÖs on you and IÔÇÖm sure you signed stating that. This is a lesson for the future to always check with your insurance provider directly.
ThatÔÇÖs $100 a tooth. Be happy itÔÇÖs that low. Wait for the EOB and see what it says you have to pay. Remember, some providers accept what the insurance pays, but if it doesnÔÇÖt pay enough they can charge the difference. How this is legal sometimes and illegal other times still boggles my mind, but itÔÇÖs a practice that still happens.
You call the office administrator. Offer to pay $200.
Tell him your proctologist was first in line and you will work up from there.
This is actually a useful post as a warning to others.
I was referred to an oral surgeon for wisdom teeth several years ago and told by the person at the front desk my insurance was good. I went through with the initial consultation and scheduled the surgery. Feeling uncomfortable about the way she’d been so sure about the insurance without really checking, I called back and asked another person to check.
Sure enough NO COVERAGE with that provider. I have decent insurance, they were just out of the network. I couldn’t believe how close I came to making that mistake, even after attempting to verify it the first time.
So I found my own oral surgeon. I repeatedly asked for out-of-pocket costs and insisted on knowing the costs. In my case at least, it was elective surgery. So they gave me specific pricing and that ended up being the cost. HOWEVER, a month later I get a bill for $450 from a lab for a test I didn’t ask for or approve. On top of that, the lab ran the test twice and charged me twice. I called the surgeons office and they verified that they did send something off to have tested on my behalf. I refused to pay it and told the lab company that I didn’t approve it and had no idea any test was ever done. I never heard anything else about it.
But even in all my due diligence, I still got a surprise bill.
let it go to collections then negotiate w collections to pay what u can afford and they have to send u a new statement stating u will pay x amount and the bill will be paid off
Surprise them back by telling them you wonÔÇÖt pay
Wish I could get my wizzies removed under GA for $400
The No Surprises Act only applies when someone is using out-of-network insurance, or is uninsured/choosing to self pay. Not with in-network insurance.
Tell them you want an itemized billing for insurance purposes
What is your insurance benefit (deductible, out of pocket, and coinsurance)? You might not have a copay on the day of but you may have coinsurance. Coinsurance is usually billed to the insurance first. So thatÔÇÖs maybe where the miscommunication is with between your dr office? And your insurance will let your dr know how much your coinsurance is. Coinsurance is when your insurance pays a specific insurance and you cover the rest. Ex: your insurance pays 90% but you will need to cover the rest of the 10%. This is why your dr would bill insurance first and then let you know how much you need to cover after.
Call the dentist and ask if some of the procedure can be billed under your medical insurance. They might be able to submit a claim for that $400. ThereÔÇÖs also a possibility that billing made a mistake, have them check what they submitted. Call your insurance and ask them to clarify the $400 charge to you even after you paid the deductible. If you are on the hook for it, set up a payment plan thatÔÇÖs suitable for you and donÔÇÖt miss a payment. $400 is very reasonable and definitely not worth ruining your credit for that amount.
Looking at the No Surprises Act, it may be that they were incorrect in their initial “good faith estimate” of $0. The law allows then to bill up to a $400 difference over the good faith estimate. Anything over $400 from the estimate can be disputed.
I recently paid over $800+ for my daughters wisdom teeth removal. A $400 co-pay would have been GREAT!