Wrong Estimate

[JillD]

It is not related to braces or orthodontics, but I hope it is OK to post here.

When I went in for teeth cleaning at my general dentist's office, my doctor told me that I need fillings for my two teeth and asked his assistant to find out how much my out-of pocket cost would be. She told me $66. So I made an appointment and had them done quickly and paid $66.

Last week my doctor's office sent me a bill with additional $266 charge, which they claimed that my insurance doesn't cover. This means the total of my out-of pocket cost is over $300. I called my doctor's office and complained about their miscalculation. Without even a single word of apology, the assistant and the office manager told me that the estimate was just a courtesy and it is ultimately my responsibility to pay whatever my insurance doesn't cover. I understand that it is my responsibility to pay what my insurance doesn't cover, but if I had been informed with the right amount, I might have wanted to wait or wanted to have a second opinion (because the cavities didn't look that bad). Also who wants their "courtesy" if it is going to be that much off? I wouldn't call giving wrong information a courtesy.

I have been with this doctor a very long time starting when he just opened his office and it was only him and one assistant who did office work and helped with dental work. Now that he has more patients and assistants, his service has become sloppier, I feel. (BTW I told the assistants that I wanted to speak with the doctor directly but they said the doctor doesn't discuss any financial matters with patients.) Now I wonder if I should look for a different dentist.

Does your dentist do a "courtesy" of giving estimates? Are they normally off? If they are, are they off by a large amount like mine?

[Amanda6]

Hi Jill,
I'm not in the USA, and don't have dental insurance either, but to me $300 sounds like a lot to be charged for 2 fillings, especially if they are small fillings. It's more than I would expect to pay in where I am in England for a private dentist to do 2 small fillings, and that's without any dental insurance.
Have you spoken to your insurance company about it, and asked them what amount they cover you for?

[JillD]

Actually the total charge was $440 and my insurance covered some of it.

[Amanda6]

Actually the total charge was $440 and my insurance covered some of it.

In England the dentist is supposed to make it clear to the patient what a treatment will cost them before carrying out the work. I'm not sure how it works with dental insurance treatment, but I think they normally tell the patient what it would cost without the insurance, and then the patient claims whatever the insurance covers by dealing directly with the insurance company themselves.

[starfish88]

I don't know how American style insurance works but mine in Australia gives me 50% back and my dentist lets me know if something isn't covered. Like the mouthwash I buy from them. Does your rebate vary? I can't figure out how your dentist got it so wrong, sorry I'm not more help.

[lambchop]

Neither my husband nor I have dental insurance, and we go to a dentist who practices laser dentistry; the lasering/fillings are a little more than a traditional drilling/filling, but what he charges us is what is quoted us.

[owira]

I have never been quoted off the amount I have been charged. Sounds to me like the assistant didn't put in all the information for the first quote correctly at all. The office I use usually sends in the work needing to be done to my insurance and gets a confirmation back on my amount in addition to their math skills just to be sure. If they made a mistake in their calculations they need to admit the mistake and apologize.

[Ciara]

My dentist tells me exactly how much anything will cost and if it will be covered by the Japanese national health insurance. They have the prices of everything listed and it never varies. I wouldn't be very happy if I was told a totally different price from what I ended up paying.

[katsface]

Man, I would be livid. Was it explained to you beforehand that the estimate was basically pulled out of the air? If you ask someone what a procedure will cost, they should come back to you with something close to what the actual cost is. Not a few hundred dollars less than the actual cost.

I understand the point of a 'courtesy' estimate. They say that because there are legitimate reasons your estimate might not match what your actual cost is. For instance, you would expect the treatment to cost more than quoted if, say, you ended up needing more extensive work than they originally thought. Or, maybe if your insurance plan changed in the interim, you might get an inaccurate quote. But if they knew the procedures you were having, and your insurance coverage has remained the same, there is no good reason for your bill to be that much higher than your estimate. That just seems, to use your own word, sloppy. An office person not doing their job correctly is not one of those legitimate reasons. I would tell them as much, too.

Honestly, I would talk to the dentist about it. Even if his policy is to not talk about money. I would also probably explain that I will be looking for a new dentist, as that kind of behavior (and lack of actual courtesy - can't believe they didn't say they were sorry) are incredibly unprofessional, and are not what you, and your insurance company, pay good money for.

Sorry to get so worked up.

[OldBikerBag]

I pay 100% out-of-pocket. The accounts lady at my dentist has been pretty close with her estimates so far. I paid around $700 for one new filling, four replacements, cleaning, exam and x-rays. Did you meet your deductible before this visit? The person who calculated your estimate may not have taken that into account.

[belistic10]

i'd be absolutely fuming! here in south oz anyway when i had my extractions i got a pretty precise quote of the work to be done, at that time i didnt have Extras cover for dental etc so had to pay full price but they let me pay it off in installments. Now i have the health cover i only have to pay the medicare ''gap'' fee, so some gets covered and then i pay a bit out of pocket. So e.g when i rang my local dentist for a price for a clean, they said its $150 total, my insurance pays about half this, so i then know my Out of pocket expense. Things like x-rays etc its the same, i can ring the company ask them what the Gap payment would be on it and they will tell me exactly. With $10 leaveway either side, but mostly 100% spot on.

I cant believe how rude they were, i'd be complaining for sure and moving dentist!!

[Kipepeo]

I can't believe nobody said this...call your insurance company. It's quite possible the dentist office made a coding error when they submitted the claim. Or perhaps the insurance has not paid out yet, and your dentist office billing cycle has rolled around before any insurance payment was credited. Ask insurance what the claim was for, and what your portion should be. And as someone else asked, do you have a deductible?

[quentin]

I'm so sorry to hear about this. That's really really awful.

I don't have insurance and I pay exactly what the dentist quotes me. Before every procedure, I ask specifically how much something costs so there are no nasty surprises.

I think beyond this "mistake", if you feel that service has gotten sloppier and they're not honoring the estimate they gave you - especially with such a drastic price difference - it's now a question of trust.

I would say it's time to find a new dentist that you can trust and values you as a client.

[whiteswan]

I don't understand the cost. At my practice, a straight forward filling cost 75 dollars CDN. How on earth can they charge over 200 bucks for each filling? Or did the cost include check up and x rays?

[katsface]

I don't understand the cost. At my practice, a straight forward filling cost 75 dollars CDN. How on earth can they charge over 200 bucks for each filling? Or did the cost include check up and x rays?

In the US medical costs tent to be inflated. Why that is, I'm not 100% sure... some of it has to do with the malpractice insurance that medical practitioners carry (not sure if dentists/orthodontists have to have that?). Some of it is having to employ staff to deal with all of the insurance paperwork. I've literally heard a doctor say he was entitled to charge a lot because he went through so much extra school to be in his position. (Well, fine, then research PhDs should make a lot more money than they do... for all of the school those people go through they make very little) Not sure how pervasive that attitude is. I'm sure there are tons of other reasons. Not saying they're good or bad reasons. Just saying that medical costs here are inflated.