Dental Insurance Issue

[jackcv]

Had a couple periodontal procedures done, one 4/2 the other 4/3. Before the procedure I called my insurance, and called the dentist, both said my portion would be 141.80 for both procedures. Fine, paid the first day the full amount, and I think everything is fine.

Fast forward to today, and I get an email from my dentist, and they say I owe another $112. I pulled up the detailed bill and also the EOB, and basically it breaks down like this:
Day one:
Section 1 periodontal
Section 2 periodontal
First X-ray
Additional x-ray
Additional X-ray
(These are all showing on the day one EOB)
Additional X-ray
Additional X-ray
Additional X-ray
(These three were not listed on EOB)

Day 2:
Section 3 periodontal
Section 4 periodontal
(These show on EOB)
First X-ray
Additional X-ray
Additional X-Ray
(These are not showing on EOB)

-called insurance and they said the second day not showing X-rays is normal as they are required to do X-rays so it won’t show them a second time
-the dental office said second day I still owed $40, which is fine because I saw they credited the larger portion of the payment to day 2.
-insurance said if the office fights it, they will get involved and if they still fight “higher ups” will be involved.

My question, does the dentist have to follow the contracted amount through the insurance? They are in network, and I’m not seeing it in the math, but I’m wondering if they are still calculating the missing X-rays on the EOB as what I owe on their end? Not sure if I have to pay this additional $112? Feel like there might just be an error on billing?

Thanks in advance. I just really don’t have the money to come up with this additional amount.

 

[btyler101]

@jackcv The provider agrees to the contracted rate when they join your insurance network, they cannot bill you for more than what your EOB states is your responsibility. Contirm this with your dentist and call your insurance back if they don't budge.

 

[jackcv]

@btyler101 Thank you. I went and talked to the office and it was all situated. They forgot to clear out a couple of X-rays and were going to charge me for them

 

[btyler101]

@jackcv Glad it worked out!