Dentist vs. Insurance vs. Me: Tip-of-the-Day #346

I knew I needed to replace my mouthguard when I had literally bore a hole right through it. It was some 15 years old and it showed (like a well-loved childhood blanket). So, at an already-planned routine cleaning, I mentioned my desire to procure a new guard and the office manager phoned my provider to see about coverage. Happily they confirmed partial coverage (~40%) and since the cost had gone up significantly since my last purchase, that 40% was going to be super helpful. 

We scheduled the “fitting” for a couple of months out, and when the day came, I showed up, paid my portion ($300ish dollars) and got fitted for the guard (needed for bruxism in case you’re interested). Fast forward six or so weeks and I got an invoice from my dentist for the 40% that I wasn’t supposed to be on the hook for. 

I promptly phoned the office and asked about the discrepancy. Seems that my provider wasn’t going to cover it after all. And for some reason, despite the pre-authorization, I was going to have to pony up the dough. I hoped that perhaps it was a billing code error but a couple of weeks later I got a note from my dentist’s office (by mail) giving me a history of their exchange with my provider and suggesting I follow up with them directly. 

I then had to call my insurance, wait on hold, then wait again as they pulled the transcript from the call that was placed by my dentist’s office months before so they could review the situation with accuracy. Turns out that when my dentist phoned it WAS a covered procedure but in the time between that phone call and when I actually went in to get fitted, that changed.

I wasn’t alerted to this. My dentist wasn’t alerted to this. And now, no one wanted to “take the hit” for this….snafu? My insurance provider insisted it was not a misquote because when they were phoned for the pre-auth it was covered and they were under the impression I was having it done that day. Ugh. My dentist insisted it wasn’t their problem because they called and did “their part.” When I pressed them on that and asked why they didn’t phone closer to the date of the actual procedure, they scoffed and explained that they have too many patients to conduct that kind of due diligence. Huh.

My position was that I did my part. I carried insurance. I scheduled an approved procedure. I paid the 60%. Period. I was not going to be held liable for this bizarre gap in process. And so, I emphasized three things to the office manager at my dentist’s office:

1. Given that I was never sent a new card by my insurance provider, and technically nothing had changed (group number, policy number, etc.) there was no way I could have known that my coverage had shifted. It was my firm belief that it was on them to check those details closer to the date of procedure.
   
2. Before this office manager was to make an executive decision on the outcome of my case (!), she should really check with the dentist and see if due to the irregular nature of the situation, it might be let go. (Note: she was very rules oriented and made it pretty clear to me that I was not going to get out of paying this outstanding invoice.)
   
3. I have been a patient at this office for 25 years. TWENTY FIVE YEARS. Surely, all of the work I’ve had done over those years and the value of my future visits was worth more than a measly $265. I encouraged her to write it off and let it go as a one-time courtesy.

When we hung up the phone, I was feeling very frustrated by the call and the office manager’s lack of business acumen. She was willing to throw away a long-time relationship over a very insignificant sum of money (for them). But she was acting solo—she hadn’t run this by anyone else in the office. 

I immediately began looking for alternate dentists in my area when an email came through from this office manager. She was “happy to inform me that the office was going to waive the balance as a one-time courtesy.” Clearly someone over there had enough sense to recognize the long term impact of this situation. I thanked her but I kept my response short and to the point. I wasn’t happy with how she handled the call at all but I wasn't going to go into all of that. I just thanked her for extending the courtesy. She wrote again to say how she was truly pleased they could do this for me given the MANY years I’d been a client. Someone on her end had clearly coached her and it showed. 

All by way of saying, there are probably a lot of folks out there who would have just paid this bill and moved on. On principle alone I was not going to do that and by clearly stating my position and asking for what I wanted, I got the outcome I was looking for. 

Don’t forget to stand up for yourself and make a convincing case for why you want a different outcome. If you don’t ask, you won’t get!