Dental Costs Not Making Sense

[mikegray]

I recently had to do some dental work, in which the dentist charged me $565 to do. It appears they are filing 3 separate claims for all the work (in-network with FEP Dental). Of the claims, there is:

1. • Amount Submitted: $64
   • Deductible: $0
   • Amount Paid: $25
   • Patient Responsibility: $0
2. • Amount Submitted: $433
   • Deductible: $0
   • Amount Paid: $108.70
   • Patient Responsibility: $58.30
3. Work hasn’t been done so they haven’t submitted yet

The questions I have are:

1. Why is Amount Paid + Patient Responsibility less than Amount Submitted by a good margin
2. Why did they charge me $42 dollars at my second visit, claiming “insurance did a no-pay so we used credit from your account” (something like this I didn’t really understand what she meant)
3. Am I owed any money from the dentist/insurance? The EoB/claims show that I only owe $58.30 so far, even though I paid the dentist $607 altogether.

3a. Do I owe $58.30 MORE to the dentist?

Insurance is confusing to me. Please help!

Edit: for example, bitewing X-rays were $82, they estimated my insurance would cover $42 so I paid $40, but the claim says insurance paid $14 and I owe $0. So how much is really owed here? Also, my wife, under my plan, got some of the same services, and her bill came out to a big fat $0 paid… what the heck!?

Edit 2: it’s getting weirder. I paid that $42 today. Just looked at the receipt they handed me, and it says “Outstanding Patient Balance: -$253.00”… negative balance? Do they owe me that money???

 

[valentinusheretic]

@mikegray Wait for all dental work to be done, then show them the EOBs and get your money back.

They’re overcharging you and trying to balance bill between their negotiated rates is what it seems like.

 

[yhjmkiop]

@mikegray (1) It is likely that “Amount submitted” is the out of network cost for the procedure. Assuming the dentist was in network, that got you a discount, which is where this difference comes from.

(2) Little bit of a guess here, but I think what happened here is either the dentist submitted either the estimate or the final bill under the wrong plan code. Whichever it was, the result was your insurance ended up covering $42 less than the dentist originally thought.

(3) It sounds like you overpaid your dentist at some point, which happens sometimes.

I’ve personally had it happen two times: one time I got a check from my dentist when my upfront deposit for my wisdom teeth was more than I ended up owing for the procedure, then the other time it just was used as a credit on future visits at my primary care doctor’s office.

You can probably request a check back for the overage, but just make sure you deposit that money to the same account it came from. If it came from an HSA or FSA account, then make sure it goes back into that account. There’s tax advantages for those accounts, and it’d technically be tax fraud/evasion to spend any money that originates from those accounts on non-medical expenses.