Math Problem on Reimbursement Driving Me Crazy

[LostDollar]

Assuming the entire billed amount is within the allowable limit for the time period, it seems to me the carrier (insurance company), is not following the trail too well. It's easy enough to get lost in the soup when you have this 3 way credit/pay situations. I would go back to the carrier and speak with someone that knows what they're doing...and good luck with that one....to go over the details? Based on your accounting, the company has not reimbursed the full allowable amount to either you or the dentist.
In avoidance of future snafus, I would take the reimbursement and put it in my pocket after paying the dentist, that way there's a clean-slate after every visit and procedure. Dental is such a pita, no wonder the highest suicide incidence among professionals are dentists/Dr's. Hey how come we all ain't in that group?.

(Caveat, not an agent.)

First, we don't know if Dad has signed an agreement with the dentist indicating that all insurance payments go to the dentist. I've had claims with 4 dentists and 1 endodontist since Dec 2018 and Ins Payments direct to dentist is the norm-based on new patient setup documents I signed.

Second, this is not a dental insurance issue. It is an insurance carrier error, processing a provider's statement of account presentation as the actual bill for services rendered on a specific date. This could just as easily have happened with health services as dental services.

 

[LostDollar]

i would personally never argue dental coverage with LostDollar as he has 3 dental plans himself.

Hey! you gotta get current here! Only two now!

(Although with the tooth pain I have been experiencing the last 3-4 months, that may turn out to be a mistake because I doubt I can get the third one back again right now.)

(And unfortunately, although your dental option comes up for some other states, it doesn't come up available for me in KS.)

 

[Limozine]

(Caveat, not an agent.)

First, we don't know if Dad has signed an agreement with the dentist indicating that all insurance payments go to the dentist. I've had claims with 4 dentists and 1 endodontist since Dec 2018 and Ins Payments direct to dentist is the norm-based on new patient setup documents I signed.

Second, this is not a dental insurance issue. It is an insurance carrier error, processing a provider's statement of account presentation as the actual bill for services rendered on a specific date. This could just as easily have happened with health services as dental services.

No agreement signed; on the contrary, the dentist has made it very clear in the past that they do NOT do insurance filing of any kind. In hindsight, we obviously should have just taken the original check when it came in rather than asking for it to be applied to the account.

 

[Limozine]

This is just ONE of the reasons why I never mention dental coverage.

Honestly, I've done this dozens of times before for my Dad with no issues. His dentist doesn't accept insurance yet he gets $1000 of dental work each year at no extra charge. It's normally very easy to file (all online now). My mistake was telling the dentist's office to put it on his account when they called. I won't make that mistake again.

 

[goillini52]

The dentist already issued $149 credit on the latest bill. They billed a total of $149+$224 = $373 and received a total of $149 from the member, $149 from the carrier, and another $75 from the member for total of $373. I don't see how they owe anything.

You said; "The dentist's office calls, wanting to know what to do with it. He advises them to give him a credit for the $149 toward his next cleaning/checkup."

 

[somarco]

Dental insurance is a problem waiting to happen.

 

[Limozine]

You said; "The dentist's office calls, wanting to know what to do with it. He advises them to give him a credit for the $149 toward his next cleaning/checkup."

That's correct. The dentist issued the credit at the second cleaning, so the dentist has fulfilled his responsibility. He's also been paid in full.

 

[goillini52]

That's correct. The dentist issued the credit at the second cleaning, so the dentist has fulfilled his responsibility. He's also been paid in full.

OK, that wasn't known when I made my post.