Tuesday, August 19, 2008

Today's Mood Is...

Okay, let us get something clear here. If you have services done for an agreed upon fee, YOU HAVE TO PAY THAT FEE WHEN THE SERVICES ARE COMPLETED!!!!!!!!!!
I understand that you have insurance, however, not EVERYTHING you have done will be covered 100% by your insurance company. Your contract with the insurance company (and yes, you have a contract with the insurance company, it is part and parcel of the having of insurance) says that they will review each and every procedure performed on you, and if they deem it to be unnecessary, or if it is listed as a non covered service, that you may be held responsible to pay part or all of the cost of said procedure. This is above and beyond the contract saying that there are certain procedures that are not completely covered, and that depending on if you see a provider in our network or not, you may be held as responsible for additional fees.
When you go to the provider's office you are asked to fill out a lot of paperwork. Have you ever read that paperwork? It says (and this is pretty much standard no matter WHAT provider you go to see) that we will bill your insurance provider in good faith, but that any co-pays or denied procedures will be your responsibility. And if that we are not listed as being in the provider network for your particular insurance provider that those out of pocket fees could very well be higher than if you were seeing an in network provider.
***let me really break it down for anyone who might be a little confused. Let's say you have Blue Cross and Blue Shield (BCBS) as your insurance provider through your job. Now let's say that you are going to the dentist in order to have your teeth cleaned. Cleanings are covered at 100% (most preventative procedures are). If your dentist is contracted to BCBS as a "preferred provider" than if the dentist would charge someone without insurance $50 for a cleaning, but BCBS feels that $35 is the most they will pay for a cleaning, than your dentist has to accept the $35 as payment in full. If your dentist is not in the network, they can legally bill you for the $15 difference. So why would a dentist be in the network? So that they are listed by the insurance provider in the books and will hopefully get more patients that way. Now let's say you are having a cavity filled (yes, yes...giggity). The dentist's fee is $150. The insurance agrees that $100 is the most that the procedure is worth. A cavity is considered a "basic" procedure, which is usually (read 99 times out of 100) covered, but not at 100%. As a rule it is covered at 80%. So if you have a cavity and go to your in network dentist he will bill the insurance $150. The insurance company will say "No, that's only worth $100. We will pay 80% of that, so here is $80. The dentist says "okay, we will take the $80, bill the patient for the difference between what you say the procedure is worth and what the insurance company is willing to pay, and we will write off the remaining $50 as an insurance limitation". If out of network, there is no write off. It all makes sense, at least on a basic level.
So when you go to your dentist and have some fillings done, and after we receive the insurance payment and bill you for the balance, don't wait until you have been receiving bills for 6 months and then get one saying that you are going to be sent to collections due to lack of payment, then suddenly call me all irate and cuss me out. It is obvious to me that you got some of the previous bills, they were all sent to the same damn address. But now, all of a sudden, you have a problem? Well guess what, now WE have a problem. So refer to the 5 different sets of instructions above and follow them to the letter.
that is all.

1 comment:

  1. The customer is always right.

    The customer is always right.

    The customer is POW!! right in the kisser!

    I feel your pain, just don't bill me or my insurance for it, k?