12 September 2000: Dental Purgatory

Gazing into the Abyss: Michael Rawdon's Journal

Dental Purgatory

I really, really hate doing business over the phone. I've been known to drive four miles to a store to see if they have something rather than phone them to find out.

I especially hate it when I'm dealing with something somewhat confrontational, or which has the potential in my lively imagination to be confrontational.

Today I finally got up the gumption to make some phone calls about my dental bills from last spring.

Here's the lowdown: According to the dentist's "Usual and Customary Fee" (UCF) fee schedule, they did about $2400 worth of work, of which I wrote them a check for $1000, and the insurance was supposed to pay the other $1400. Well, the insurance only paid $700, and so they sent me a bill for the remaining $700.

I did a little number crunching, and realized something interesting, which I confirmed with my insurance: Since the dental group is contracted with my insurance, they're not supposed to be billing for the UCF rate, but instead for a contracted rate which works out to only about $1700 worth of service. Of which the insurance covers about $1000. (At this point, Tracy - my former partner in Managed Care software crime at Epic - is rolling her eyes or maybe having a flashback-induced seizure.)

See the problem? There are two ways to look at it:

The $1000 I already paid them plus the $700 they billed me for equals the $1700 which they're supposed to get in total. So if I'm supposed to pay them that much, then the insurance wouldn't have covered any of it, which is flat wrong!
I only owe them about $700 total, so not only is this $700 bill spurious, but they might owe me $300 from overpayment in the spring!

After talking to my insurance and verifying that the contracted rate is what they're supposed to have paid, I called a number the clinic had given me for the Accounts Receivable guy. Apparently they contract with him to actually do their accounting, but they do their billing themselves. In theory this could work for me since he doesn't have a vested interest in fleecing me; on the other hand it could work against me since it's one more player I have to deal with.

Anyway, he agreed in principle that something seems fishy and that he needs to call my insurance and figure out what's going on. So he said he'd do that, but he didn't call me back this afternoon. I left him a message, and I'll get back to him tomorrow.

Obviously, I fervently hope I'm right and that I've overpaid already. It would be a $1000 swing for my bank account (assuming I can extract money from the clinic), which would be cool!

When I wrote about this last month, I got mail from my friend Rob telling me that fighting the insurance companies can sometimes pay off. Well, it took me a while to get around to it (I'm no longer a world class procrastinator, but I can still do okay in the role), and it seems he might be right. I felt pretty good about myself after making the phone calls. It's one of those positive experiences that makes me think I can accomplish more than I usually think I can!

(Uh, that would be wrapped up in my self-esteem issues, obviously.)

Wish me luck as I continue to slog through this stuff.

This brings up an interesting question, though: If I'm right, how many other patients are overpaying the clinic?