Disclaimer: This piece of writing is hypothetical in nature, and should not constitute, substitute legal advice in any form. This writer is broke, and would not worth being sued. Always consult with the associated professionals first if there is any doubt or concern.
There seems to be a “cavity” or hole with regarding some dentists in the profession, what they charge upfront and insurance companies.
How is it that some dentists can charge excessive elephant fees up front before the work is completed? How is it that some dentists advertise they will take insurance, and there respective offices will tell you that they will accept “your” insurance?
Do you feel these “tooth grabbers” if that should apply want only your money, that any mistake they make is your fault?
You are not alone. Dentists seemingly more than any other physicians charge the patient up front than almost any other profession. People gripe about retainers for attorneys. People gripe about there mechanic charges for the car they drive.
Jane Doe needs a dentist. She sees an advertising in the phone book that a local dentist “accepts insurance.” Jane calls the dental office and makes an appointment, and is told they accept Jane’s insurance, and to bring in the insurance card with her for her appointment.
Jane comes in for her appointment. Her card is copied, along with her drivers license. A photograph is also taken of Jane. Protection from fraud for Jane or the Dentist?
Jane completes her visit, pays a co-pay and has a tooth pulled. A month or so later Jane receives from her insurance company an “EOB.” also known as a “explanation of benefits.” Her insurance company pays for most of the cleaning but hardly any for the more expensive filling for her cavity. She calls her dentists office explains the “EOB” and is upset. The dental office tells Jane to call her insurance. Jane calls her insurance. At first her insurance company tells Jane to call her dental office. No Jane is truly pissed off. Jane refuses to call back the dentists office, so Jane asks for a supervisor at the insurance company.
Summary: The dentist office accepted Jane’s insurance as advertised and told by the dental office. Jane’s insurance company tells her further that although the insurance was accepted that the dentist Jane used was not specifically in a contract in a network with the insurance company, therefore as explained in Jane’s insurance guide that dentists, and physicians not in “network” will pay a higher fee.
Partial Prevention: Call your insurance company first and ask if the dentist is in your network as on your insurance card. Have that card handy. Call your dentists office and verify that the dentist is in the insurance you carry network. If the dentists office gives you some guff, that the dentist has a million different contracts, get the receptionists name at the dentists office and call back with that information and give it to your insurance company. It is a shame to hypothetically go through this and no two situations may be alike.
Opinion: “Professionals” in any field of care or maintenance who practice the above mentioned situation should probably be prosecuted under a The “Rico Statute.”
Conclusion: Do some professions deserve more upfront money than other professionals before the work is done? Is this hypothetical issue not legal, or just unethical? Is false advertising being used to lure patients and make them think that they are completely covered. Is this hypothetical situation in “real world” being even addressed? If enough in the field of dentistry or any other trade or profession being prosecuted for a practice such as this? Or or hypothetically, dentists or professionals like them who practice this just better than others like you and me?
If you are on the lookout for insurance regarding your teeth, then its best that you visit the upcoming dental convention (read conference) that is to take place later this month where you will get all the required information on how to handle dentists and get an insurance.