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Post by sunnyd on Oct 18, 2016 17:28:30 GMT
I know this is ultimately my fault but I'm still irked! My dentist called me last month & said "It's time for your 6 month cleaning. When can you come in?" So I made an appointment and went in for the cleaning. They billed my insurance like always & insurance denied the claim because it was 2 weeks short of being 6 months from my last cleaning. They only pay for dental cleanings every 6 months. My previous cleaning was March 29th and this one was September 15. UGH!! Insurance co. said if it was just a couple of days early they would pay it but not 2 weeks. I pay for my dental insurance so I don't have to pay for my dental cleanings. Would you be pissed at the dental office? PSA: Check the calendar before you make a routine dental appointment. *UPDATE* I talked to the dentist office receptionist again & they are discounting the cost of the services, which is really nice. Like I said in the OP, I know it's ultimately my fault so I was very appreciative. She said she flagged my account to know in the future that it must in 6 months+ between cleanings. I think she already knew that because when I originally called her to see why insurance didn't pay she dodged the question and played dumb even though she said she was looking at the EOB. I got a copy of the EOB today & it clearly states the reason for the denial: frequency of service. She could have solved the mystery a few days ago. Oh well, lesson learned.
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julieb
Pearl Clutcher
Posts: 2,845
Jul 3, 2014 16:02:54 GMT
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Post by julieb on Oct 18, 2016 17:31:29 GMT
I 100% would call the dental office and tell them to write it off. My office always checks to make sure it is within the time frame. They called you and should have been aware - your previous cleaning was probably right in front of them.
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MorningPerson
Pearl Clutcher
Posts: 2,506
Location: Central Pennsylvania
Jul 4, 2014 21:35:44 GMT
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Post by MorningPerson on Oct 18, 2016 17:32:07 GMT
I've never been to a dentist office that didn't make sure to avoid this.
I'd be pissed, but ultimately at myself.
ETA: Oops, I missed the fact that they called you. Yes, I'd be pissed at them.
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Post by Basket1lady on Oct 18, 2016 17:37:52 GMT
Yes, the office knows darn well when your insurance pays for Appts. I ran into the same problem with our eye dr. Got a message that it was time for our annual exams, but it was too early. They called in May, when our exams are in June--those weeks before school gets out, but high schoolers do nothing because the AP exams are in May. When I questioned it, I found out that we had to wait a few more weeks before the actual exam would be covered.
I think they notify you a ways out because people put things off. But a good office will check dates when scheduling an appt. I'd call the office. They May have some sort of non-insured discount. Our eye dr does for glasses because they are not covered--just the exam.
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Post by melanell on Oct 18, 2016 17:43:42 GMT
I almost had this happen with an eye exam and glasses for my son. The optometrist's office sends out reminder cards and they sent it with a date of Oct. 20th forward. We made an appt., and the morning of the appt. I checked something online about our benefits and saw that he couldn't go until Nov. 11th. I was so relieved that I just happened to see that.
Now, like you, OP, will always check just in case a similar error is ever made again.
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~Lauren~
Pearl Clutcher
Posts: 3,876
Jun 26, 2014 3:33:18 GMT
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Post by ~Lauren~ on Oct 18, 2016 17:46:14 GMT
IMO, this falls within the "personal responsibility" arena. While it's a nice service if the office does it, it's not their obligation to insure that your insurance company will pay. IMO, the ultimately responsibility is yours.
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Post by mikklynn on Oct 18, 2016 17:53:09 GMT
I'd try appealing with the insurance company. What do you have to lose?
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Post by Really Red on Oct 18, 2016 18:06:26 GMT
My dentist won't schedule regular checkups for less than 6 months apart (barring a problem), even though my insurance says twice a year. There's a lot of stuff I put on personal respsonsibility, but when THEY are the ones to call you, I think they are responsible.
I'd call them up and ask them. If they say no, I'd call the insurance and ask them.
And I'd let my dentist know as well. This is pretty much a basic dental office task these days. I seriously cannot recall the last time I wasn't asked (3 kids and me - that amounts to a lot!)
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eastcoastpea
Prolific Pea
Posts: 9,252
Jun 27, 2014 13:05:28 GMT
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Post by eastcoastpea on Oct 18, 2016 18:17:35 GMT
That happened to me once. Since then I've been sure to confirm that it has indeed been more than six months. One time they tried to book me a few days early and I said there was no way I was willing to chance that insurance would be okay with it.
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Post by bigbundt on Oct 18, 2016 18:19:52 GMT
I've been burned by dental insurance before. I think my appointment was something like a few days before 6 months was up and they refused to pay. Now I make my next appointment AT the end of my current appointment and tell them to add a week. I'd call and ask but IME insurance isn't going to budge, any concessions would come from the dental office.
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Post by buddysmom on Oct 18, 2016 18:23:09 GMT
Our dentist always tells me to make the appointment after "x" date.
They said I insurance won't pay if it's one day early.
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Post by pierkiss on Oct 18, 2016 18:41:27 GMT
I would be livid over this. All of my doctors offices keep track of when our last well checks were specifically to avoid insurance refusing to pay because we go in too early. There is no reason dentists offices can't do the same.
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Post by crimsoncat05 on Oct 18, 2016 18:43:21 GMT
been there, done that! stupid insurance restrictions!
I'd probably be pissed at the dentist, too, even though it's not *really* their fault...
eta: I like the '6 months from this appointment PLUS a week' to make sure. I'll have to remember that one!
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momto4kiddos
Drama Llama
Posts: 5,152
Jun 26, 2014 11:45:15 GMT
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Post by momto4kiddos on Oct 18, 2016 18:47:28 GMT
Our dentist office definitely wouldn't schedule one less than 6 months and would be on top of the insurance.
Anytime I called the kids pediatrician they would always tell me the date of their last appt and told me it needed to be a year and a day.
So yeah i'd expect them to have some knowledge of it, especially where they called you and told you "it was time."
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Post by littlemama on Oct 18, 2016 18:48:54 GMT
The dentist's office shouldn't be making you an appointment that wouldn't be covered. You weren't "due" for your appointment until 6 months had elapsed. I would call them and nicely talk to them about it. They should write it off.
Our insurance changed to only cover x-rays every 2 years. Our dentist's office kept telling us we were due, and we kept saying, it's only covered every 2 years, so if it has been 2 years, then go ahead, otherwise we will wait. Dh said this one time, and the hygienist's response was "it's covered!" She read it from the incorrect information in his chart instead of listening to him. When we got the bill, I called the office and told the office manager what he had said and what her response was and asked What else should we have done to ensure this didn't happen? They wrote it off.
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quiltz
Drama Llama
Posts: 6,714
Location: CANADA
Jun 29, 2014 16:13:28 GMT
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Post by quiltz on Oct 18, 2016 18:54:14 GMT
I book the next appointment while still at the dentist office. That way a time is booked & if something comes up, I can rebook for after the original date.
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Post by mrsscrapdiva on Oct 18, 2016 18:57:26 GMT
I would 100% call the office manager and complain.
While they might not refund your money, you need it in your file that "cleanings MUST be 6 months apart". Dental offices, I am pretty sure, are in the know about this fact about all insurance companies. Your hygienist would probably know that too.
Dental office are a business just like anyone else, I would be pretty pissed too.
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Post by Zee on Oct 18, 2016 19:15:38 GMT
IMO, this falls within the "personal responsibility" arena. While it's a nice service if the office does it, it's not their obligation to insure that your insurance company will pay. IMO, the ultimately responsibility is yours. Gotta agree here. It's nice if they check that for you, and to avoid this, most offices WILL have the date in front of them if they're calling you to schedule, but it's ultimately your responsibility to keep track of these things.
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Post by littlemama on Oct 18, 2016 19:32:07 GMT
IMO, this falls within the "personal responsibility" arena. While it's a nice service if the office does it, it's not their obligation to insure that your insurance company will pay. IMO, the ultimately responsibility is yours. Gotta agree here. It's nice if they check that for you, and to avoid this, most offices WILL have the date in front of them if they're calling you to schedule, but it's ultimately your responsibility to keep track of these things. No, it's really not. The dentist's office has access to the last appointment date and they should have their scheduling software setup not to allow them to book less than 6 months apart without an override. It is their business and they cannot claim they don't know that ALL insurance companies require 6 months between cleanings - it is their job to know the basic rules. I couldn't tell you the date of my last appointment (precisely), but if I were to call my dentist's office right now, they wouldn't allow me to schedule less than 6 months out from whenever that date is.
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Post by myshelly on Oct 18, 2016 19:39:55 GMT
Gotta agree here. It's nice if they check that for you, and to avoid this, most offices WILL have the date in front of them if they're calling you to schedule, but it's ultimately your responsibility to keep track of these things. No, it's really not. The dentist's office has access to the last appointment date and they should have their scheduling software setup not to allow them to book less than 6 months apart without an override. It is their business and they cannot claim they don't know that ALL insurance companies require 6 months between cleanings - it is their job to know the basic rules. I couldn't tell you the date of my last appointment (precisely), but if I were to call my dentist's office right now, they wouldn't allow me to schedule less than 6 months out from whenever that date is.
I'm flabbergasted that someone could think it's not their responsibility. Adults can't be relied upon to keep a basic calendar? How do you function?
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Post by littlemama on Oct 18, 2016 19:58:39 GMT
No, it's really not. The dentist's office has access to the last appointment date and they should have their scheduling software setup not to allow them to book less than 6 months apart without an override. It is their business and they cannot claim they don't know that ALL insurance companies require 6 months between cleanings - it is their job to know the basic rules. I couldn't tell you the date of my last appointment (precisely), but if I were to call my dentist's office right now, they wouldn't allow me to schedule less than 6 months out from whenever that date is.
I'm flabbergasted that someone could think it's not their responsibility. Adults can't be relied upon to keep a basic calendar? How do you function? I function just fine, thank you, and I do have a calendar, but my dentist's office tells me when to schedule my next appointment, so I don't need to know when my last one was. I have never been to a dental office that did not keep track of when people were due for their next appointments - it's a pretty basic part of the scheduling job in my opinion - insurance only pays once every 6 months - ALL insurance. It is to the benefit of the dental office to ensure that their customers are scheduled correctly.
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dantemia
Full Member
Posts: 308
Jun 27, 2014 19:28:17 GMT
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Post by dantemia on Oct 18, 2016 20:06:48 GMT
Of course your providers know the last visit - but the patient also needs to ask, cleanings, annual, exams, etc.
My dentist always makes my next appointment while I'm there so I know , but other providers I always ask.
Some dental insurance pays for cleanings 3x a year
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Post by annabella on Oct 18, 2016 20:08:10 GMT
I would call the office manager and say it was their error, they did call you, so they should pay for the cleaning. Make them eat the charge. It sounds like a manual counting error on the person who called you.
My dentists always has me book my next apt during the last one and I see the person counting to be exactly 6 months. I've changed dentists twice recently and both times they demanded to know when my last apt was and I said look it doesn't matter it's new insurance.
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Post by myshelly on Oct 18, 2016 20:08:33 GMT
There is no justification for the mentality that an adult is not in charge of her own calendar.
Personal responsibility.
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Post by littlemama on Oct 18, 2016 20:10:09 GMT
I would call the office manager and say it was their error, they did call you, so they should pay for the cleaning. Make them eat the charge. It sounds like a manual counting error on the person who called you. My dentists always has me book my next apt during the last one and I see the person counting to be exactly 6 months. I've changed dentists twice recently and both times they demanded to know when my last apt was and I said look it doesn't matter it's new insurance. Interestingly enough, it matters if you change dentists. DS switched dentists, and we had to get his last xrays from the old dental office because our insurance wouldn't pay for him to have new xrays at the new office. It just so happened that the old dentist was upstairs from the new dentist, so he could run up and request them, but I was shocked that the insurance wouldn't cover them at a new dentist
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Post by padresfan619 on Oct 18, 2016 20:10:42 GMT
This is why I make my next appointment at the end of my current one. The receptionist just goes 6 months forward in the calendar and makes me an appointment. They send out a reminder card a week before so I don't forget.
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Post by littlemama on Oct 18, 2016 20:12:20 GMT
There is no justification for the mentality that an adult is not in charge of her own calendar. Personal responsibility. There is no justification for the mentality that leads one to be a judgmental jerk.
For the third time - My dental office takes care of the timing of my appointments. I do not need to know when my last appointment was. My dental office does its job correctly.
Reading is fundamental.
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Post by myshelly on Oct 18, 2016 20:13:29 GMT
There is no justification for the mentality that an adult is not in charge of her own calendar. Personal responsibility. There is no justification for the mentality that leads one to be a judgmental jerk.
For the third time - My dental office takes care of the timing of my appointments. I do not need to know when my last appointment was. My dental office does its job correctly.
Reading is fundamental.
Personal responsibility is fundamental. Clearly not all dental offices do this. So if you ever have to change or move, you might have to learn to read a calendar for yourself.
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Post by littlemama on Oct 18, 2016 20:15:07 GMT
There is no justification for the mentality that leads one to be a judgmental jerk.
For the third time - My dental office takes care of the timing of my appointments. I do not need to know when my last appointment was. My dental office does its job correctly.
Reading is fundamental.
Personal responsibility is fundamental. Clearly not all dental offices do this. So if you ever have to change or move, you might have to learn to read a calendar for yourself. Why exactly are you attacking me? Have we had some prior interaction that is causing you to come unglued over this?
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Post by myshelly on Oct 18, 2016 20:27:12 GMT
Personal responsibility is fundamental. Clearly not all dental offices do this. So if you ever have to change or move, you might have to learn to read a calendar for yourself. Why exactly are you attacking me? Have we had some prior interaction that is causing you to come unglued over this?
Why are you interpreting this as unglued?
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