Denist billing my medical insurance ...is this fishy?

[kalanamak]

DENTIST, that is dentist!

 

 

They have already billed the dental insurance, and we saw the "what is covered, what we have to pay" sheet, signed it, paid our share. I have the poop sheet from the dental insurance saying all the same things.

 

Now, without a bill coming to us, the dentist's (an oral surgeon but not an MD, a dentist) office is submitting *all the same charges to my medical insurance*, which sent us a list of charges, and their denial, saying we haven't hit our HSA deductible for 2012 and also this guy isn't an "in" guy in our system. I haven't gotten a second bill from this dentist, but I'm wondering if this is a racket or a boo-boo.

 

How'd they get my medical insurance info anyway, and why bill months later? The medical insurance sent the billing info right to my HSA people, and I could have just pushed a button online and paid it to Dr. X, but I thought Dr. X is a dentist, and looked into it.

 

Would you brush it off with a "good thing I double checked" or would you think fraud and report? If I think it is really fraud, I wouldn't go to the office and ask "e-hem, are you trying to pull a swift one here?"

[Jean in Newcastle]

From what I understand how my HSA account works, they need to take off the provider discount from your insurance but since it is a high deductible account, we do pay all the rest.

[kalanamak]

From what I understand how my HSA account works, they need to take off the provider discount from your insurance but since it is a high deductible account, we do pay all the rest.

 

??

The dental insurance is not part of the HSA, although we can use the HSA money for dentists.

 

I paid our share. Our dental insurance paid the amount they said they would pay.

Now my *medical insurance* is getting a bill submitted for the same Xrays and anesthesia as were billed to the dental insurance, and a paid by them and by us.

[Jean in Newcastle]

I didn't say this well, did I? The way it works for me is that my high deductible insurance gets the bill and takes off money for the provider discount if they have such an arrangement with the doctor or dentist office. Then they apply the amount to the deductible. Because it is a high deductible insurance I've only hit the deductible twice (with ER visits) so usually then the bill (minus the provider discount) is then sent to me by the doctor's office for me to pay out of my HSA account.

[MomtoCandJ]

When we had dental insurance, the dentist would bill medical for oral surgery or any sedative/anesthetic beyond Novocain.

[Cinder]

When my ds had his wisdom teeth extracted the oral surgeon's office explained the billing, that medical insurance would cover part of the anesthesia and dental would cover part of the extraction then we had to pay the difference. If you have a similar situation that might explain billing both insurances. I don't know exactly what the bill looked like that was sent to each. Maybe your surgeon's office just knows what each insurance will pay and it's easier to send the same bill to each rather than separating out the charges for each?

[justasque]

Some dental procedures count as medical rather than dental. Do not ask me to explain the logic! For example, I think wisdom tooth removal, done under anesthetic, was covered under medical (or at least some aspect was). Now how they got your medical insurance info is another question. I'd call the office and ask. "I was just curious - I noticed that you billed my medical, and I've not had a dentist do that before?"

[StephanieZ]

Yes, some dental issues can be covered by medical insurance, especially surgical or accident related things. It varies a lot with your insurance. I wouldn't assume a scam. Be grateful the dentist is even working through the insurance directly. Plenty of medical providers won't deal and make you fight the fight yourself. Just all and clarify as needed.

[happypamama]

Not sure, exactly, but I know when my son had oral surgery, it was specifically NOT covered as one of his dental benefits -- but the x-rays (and maybe the pre-op consult, can't remember) were covered under the dental. Oral surgery was covered as one of his medical benefits, and they covered it all just fine (except for a very small amount that we had to pay, because they were in-network for dental but out-of-network for medical). So it's possible that that's what happened.

[Cera]

I would call anfd ask for a detailed bill of ALL services provided on the date in question plus a detailed explanation of their billing practices. I have found that most medical/dental billing contains errors and if you call the practice knows you are watching your bills and goes to the trouble of finding and fixing the mistakes. Plus, if you ignore it and it is right it will eventually get sent to collections.

[Parrothead]

If the dentist has been paid in full I don't understand why they would be sending a claim beyond notifying for the deductible. If anything gets paid out it should go to you not the provider since they have been paid in full.

 

I'd call the billing office at the dentist and the medical insurance to see what is going on.

[Lolly]

Routine. If medical decided to give them money, it would be credited to your account and you would receive a refund of money you have paid.

[NotSoObvious]

Routine. If medical decided to give them money, it would be credited to your account and you would receive a refund of money you have paid.

 

 

Yeah, I'd watch for this though. If you've already paid the difference, it's not fair for them to now receive more money from your medical insurance. That's double dipping unless they reimburse you.

[melmichigan]

If the dentist has been paid in full I don't understand why they would be sending a claim beyond notifying for the deductible. If anything gets paid out it should go to you not the provider since they have been paid in full.

 

I'd call the billing office at the dentist and the medical insurance to see what is going on.

 

 

I would call, maybe they are making sure that you have no medical coverage, if you did they would have to refund the amount reimbursed.

[In the Rain]

I think you could call and ask the dental office why medical insurance was billed. It isn't accusing them of fraud, it is just asking a question. When dental insurance didn't cover an oral cancer biopsy for my dd, medical insurance did. It saved us quite a bit of money. I wouldn't have thought to file it as a medical claim, but the dentist office suggested it.

[kalanamak]

When we had dental insurance, the dentist would bill medical for oral surgery or any sedative/anesthetic beyond Novocain.

 

 

Even after the dental insurance has been billed and paid their allotment, and the FULL unreduced amount is now billed to medical?

 

We paid the majority of the 4000, and yet the whole 4000 (3000 which has been paid by me and dental) is being billed to medical?

[kalanamak]

Yeah, I'd watch for this though. If you've already paid the difference, it's not fair for them to now receive more money from your medical insurance. That's double dipping unless they reimburse you.

 

 

And the dental insurance. They put in 1.2K, too.

 

Well, medical denied. I read what hubby signed, and I think we don't owe above the 2,950 we paid pre-surgery, but there might be some special small print.