Insured being asked to pay for medical services up front?

[Dani]

So last week I went to the dentist after feeling a back tooth crack, although I was not in pain. I cracked my very back tooth and they recommended a partial crown over a filling or full crown, saying that I had lots of healthy tooth left and they wanted to stabilize it so it didn't crack again.

Then they summoned the financial liason, who usually tells me it will be $30 out of pocket for a composite (white) filling, which I always opt for over silver fillings. Instead, she asks me to pay $800. I remind her that I'm fully insured. She says that since the recession began, insurance companies aren't always willing to reimburse or they only partially reimburse, and they promise to give me back whatever my insurance pays them (after I pay the full $800 in advance).

I told her that's not why I've got insurance, and that they wasted my time by scheduling me and not informing me that their financial policy had changed since my last visit. She said they could request a preauthorization and then at least I'll know the amount that will be approved.

I spoke with a friend who worked as a dental hygienist, and she said the practice of billing upfront is poor professionalism. I called another dentist and scheduled a free appt. to have the tooth repaired.

Has anyone else been asked to pay for medical care up front, and what lines did they feed you? How did you respond?

[lucille]

The insight I have into this is from a bad experience with one dental clinic, our new dentist and one of his business partners that happened to be my physical therapist for a while.

The first clinic didn't demand money up front. They did lie to me though. They told me they were in network for our insurance, this is a big deal since in network can't charge more than the established rate. They also lied and told me they had gotten pre-authorizations for 100% coverage for a couple of procedures that were not mandatory procedures for our kids. We found out after the fact that they lied to us about all of this when we got a bill for about $1000 for dental cleanings and molar sealing on our kids. They charged some crazy inflated rates to begin with and our insurance only paid their out of network percentage. This ended up being a long nasty legal battle involving the state attorney (investigating them after we turned them in) and them hiring a really vindictive lawyer who kept filing civil cases against us to prevent the AG's office from investigating. There are some really awful dishonest dental practices out there.

The new dentist we go to I think has a balance on this. They run pre-authorizations on any insurance to let you know how much will be covered. Your required to pay any not covered portion or copay at the time of service, but not the insured portion based on the preauthorization. This covers their backside a bit but doesn't put a big inconvenience on the patient to pay 100% and hope to get their insurance money back.

I did notice though, when we had everyone in for routine cleanings a few weeks ago that even this dentist was really pushing more services and to get people in for their routine cleanings as soon as their insurance will pay for it again. Just listening to the sales pitch we got and the sales pitch other people were getting they seemed to be selling very hard to bring in more money. I'm not sure why the recession is making dental offices quake in their boots.

[jdp]

I've not run into that at all. My dentist's office runs my insurance through online and knows pretty much what the visit is going to cost on my end (20%) and I pay that up front. If there is a difference we catch up later. That was a switch from when I first started going and they just billed me for whatever my insurance didn't pay. It was to keep from having large outstanding balances on the books.

Good for you for just finding somewhere more reasonable.

[Julie Rains]

My dentist has always required payment upfront -- there is a sign at the check out window that requests payment when services are rendered, unless arrangements have been made otherwise. I don't have dental insurance though -- I'd guess that if I did the office would calculate what my cost should be and then ask me to pay my part and let them file the insurance.

When I had to have a crown put on a couple of years ago, the office told me that it had to pay upfront to have the crown made, so I needed to go ahead and pay them. There were payment options available though.

Most of the medical offices in my area are owned by hospital networks and don't require payment at the time of service unless it is a copay. I do have medical insurance.

It seems reasonable to me that a longtime patient should be informed of a major policy change, esp. one requiring $800 rather than $30 payment.

[Milehimama]

Medical and dental professionals don't have to bill insurance, they do it as a courtesy. It's more like since the recession began, the office doesn't want to have to pay as many clerks to do the paperwork.

[dapooh1]

I bet your dentist lost more than a few patients over the poor communication and patient un-friendly billing changes.

I was afraid recently that I had cracked a tooth: pain that lasted over a week after biting on something that felt like a rock. I don't have dental insurance. My dentist only charged me for the x-ray but not for his examination of the tooth, his assistant's time, or the high flouride gel that he painted on my tooth. He advised a wait-and-see approach and said we'll know if I need a cap or root canal by the time I come in for my next cleaning in July. It's amazing how the little touches can build loyalty.

[purplefdu]

I think most dentist offices are worried that people will begin to put off medical and dental routine care in efforts to trim their budgets, I knew we do from time to time since we don't have medical or dental insurance.

Changing policies and rudeness is something I've never tolerated and I only give one chance when they do. I had one new dentist tell me I had 4 cavities when I switched to him depite mentioning I have wicked deep molar crevices that likely had worn off the sealants. Went to him because we moved 30min from the old dentist. Quick trip back to the old dentist told me the new one was an idiot. And that was back in the 80s.

[Linsey Knerl]

I agree that it is a bad business practice, but not outside of their rights to ask for the money up-front. Many dental plans provide reimbursement claim forms for the insured to fill out since they anticipate a certain number of offices to not bill for insurance. Seems cruddy to change the policy, but at least they told you BEFORE the procedure. Some places would have waited until you had it done, and then told you at the front desk that they require payment up front.

Good for you to find a dentist that will work with you.

[pidgeon92]

This is becoming a frightening trend in the medical industry. The Wall Street Journal recently did an article 4/28/08 about a woman with leukemia who was sent by her doctor to the MD Anderson Cancer Center in Houston. They wouldn't give her an appointment without her brining them a check for $45,000. Her limited insurance maxed out at $38,000 per year, so they considered her "uninsured." She was able to pay the $45,000, which was eaten up by the initial tests. To be admitted, they demanded an additional $60,000.

I can only imagine how horrifying it would be to have cancer, and then to be denied medical care because you cannot pre-pay the costs.

[Megan]

I'm having trouble with my dentist right now. When I went in, I needed to have two fillings replaced, and I'm a firm believer in taking care of my teeth, so I did it without question. I was told that my copay would be $34 for each filling, which I paid after the procedure.

I just received notice from my insurance that they were not covering anywhere near what the dentist told me they were going to pay, so I'm just waiting for the additional dentist bill to come in.

Really, it's just a minor frustration because it's something that I would have done anyway, rather than risk losing any teeth, but I hate that I got such incredibly incorrect information.