I recently was under the care of a dentist who describes his practice as a “holistic” practice. The foundation of a holistic practice is to be truly interested in the care of your patients. My experience turned out to be anything but.
In the area of payment and insurance billing, my former dentist office describes their services as “an out of network, out of pocket service that bills”. Well, they properly billed me for my cleaning services. They even told me what my insurance reimbursement would be prior to that service, PLUS provided me with a discount of $100. When I had my $1400 porcelain overlay (not cap), they took an entirely different approach. Which has led me to believe it was entirely for their financial benefit. This is definitely counter to holistic treatment.
My insurance is provided by Saratoga County. I have a part-time position with the county as a clinician/dietitian. My health coverage is the same provided to full-time NY State and County employees – so it is a GOOD plan.
I was reimbursed approximately $250 from my insurance company for the $1400 overlay procedure. Previously, the billing staff at my “holistic dentist” told me that they bill my insurance for all services and they told me that a patient with similar coverage was reimbursed about $1000 for the $1400 service I needed. When I received my reimbursement from my insurance company for approx $280, I phoned my insurance company to ask more about this. They were extremely helpful in explaining the process and told me that I could get a substantial amount more insurance reimbursement if my dentist would simply re-bill and provide them with more information about the procedure. This meant more “codes”.
In addition, my insurance company told me rebilling was a very common process. I knew this from past health services I have had. Many health care providers re-bill and you may not even know they do while they are doing it. When they receive a denial from the insurance companies and/or a low reimbursement, they try to re-bill and use different billing codes. This is common practice and totally legal. It benefits everyone – except the insurance company. It allows everyone to fairly receive the insurance coverage/payments that the patient and the patients company are paying for.
My dentist would not re-bill. In fact they told me they did not know what codes to use and asked me to get the codes for them and call them back with the codes. They also tried to take $1200 out of my checking account, without ever discussing that with me. Had I had that amount in my account, they would have taken it. In addition, despite the fact that I told the dentist I had no problem with paying for what I signed up for, they accused me of not wanted to pay for my services. This was stated to me in a letter written by the office manager. What I was clear about with this dentist was that I was not getting their help that I needed for rebilling. And of course, it was the insurance company who knew that rebilling would favor me for a better reimbursement. My issue was resistance and lack of cooperation from his billing staff and manager in terms of giving the insurance company what they were requesting. I realized I was responsible to pay whatever was covered. But weren’t they responsible to bill in a way that was favorable to the patient? Apparently not.
Please be careful of out of network billers that are not interested in helping you with insurance coverage. I am an out of network biller myself, but I am available to provide whatever I need for my patients to receive the highest reimbursement possible. I work with my patients and give them whatever they need to accommodate them for the best reimbursement possible. When you are searching for a health care provider and are asking billing questions, please ask them to be specific in how interested they are in helping you get reimbursed from your insurance company. They should be interested in using whatever codes they can for you to get reimbursed for the services you purchased, and for using the insurance you and your employer have purchased…period. It is very simple. This is why we have insurance! They should not hesitate to discuss the process of “rebilling” – which is a very common process many health care providers do with insurance companies’. If this conversations seems “foreign” to them, they look at you cross-eyed, or claim there is no such thing as rebilling – find a dentist who knows how to bill. And go to a GUY you can really SMILE about.
At this point, my situation is in the hands of the NYS Attorney Generals Office. After contacting several NYS organizations and speaking to friends who are physicians, I was led to this office. I will let you know of the outcome.