tduby1
Pearl Clutcher
Posts: 2,979 
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Post by tduby1 on Oct 19, 2016 22:33:07 GMT
Wrong, it's ultimately YOUR insurance and YOUR policy and therefore, YOUR responsibility. They do it because they want to get paid by your insurance, not because they have to. Use a calendar, you'll be able to keep track. I go to a dentist within my network. He advertises himself as a Delta dentist....in doing so I expect him to be informed on what Delta does/doesn't cover. I had to fight with my dentist recently because Delta only covers one exam a year. I can barely remember what I ate for breakfast this morning, so I have no clue if I saw the dentist 6 months ago. He turned over his practice to a new associate who likes to do exams every 6 months. When I got billed for $69 because it was a second exam in a 12 month period I fought the charge, and they removed it. I've since switched dentists....I'm pretty sure it's industry standard that insurance only covers one exam a year. Actually, "Delta" doesn't only cover one exam per year across the board. Your policy does. There are literally thousands of delta policies, all with different frequencies, copays, deductibles, maximums and covered procedures. Thousands. I have never seen a delta plan that only covers one exam a year, that tells me your plan is a rare one. Also, the industry standard is TWO exams not one per year. Like I said, in our practice we don't even see policies stipulating one per year. There was some talk a few years ago of making that the standard but dentists balked. So much can go wrong in a year. You expect your office to keep track of hundreds, maybe thousands of plans, but you are unable to keep track of only one? |
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tduby1
Pearl Clutcher
Posts: 2,979
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Post by tduby1 on Oct 19, 2016 22:41:40 GMT
I go to a dentist within my network. He advertises himself as a Delta dentist....in doing so I expect him to be informed on what Delta does/doesn't cover. I had to fight with my dentist recently because Delta only covers one exam a year. I can barely remember what I ate for breakfast this morning, so I have no clue if I saw the dentist 6 months ago. He turned over his practice to a new associate who likes to do exams every 6 months. When I got billed for $69 because it was a second exam in a 12 month period I fought the charge, and they removed it. I've since switched dentists....I'm pretty sure it's industry standard that insurance only covers one exam a year. Mine covers two, which I know because I read my policy as use a calendar and don't expect anyone to keep track of things but me. There isn't just one policy per company. I think a lot of people on this thread really don't get the concept that it's THEIR policy and THEIR responsibility to know what's covered and how often. Anything else is just a courtesy of the office, because getting paid by the insurance company is a lot easier than dealing with multiple patients who haven't the first clue what their coverage is. Yeah, there is a lot of misinformation on this thread. (Industry standard is NOT one exam per year, that is a sub par policy). Offices DO NOT only take a few insurances- all with the same policies company wide and all policies are not the same within any company. In fact, not all insurance companies even break procedures up the same. What may be basic for one could be considered major for another and the patient is the one supplied with that info. It is frustrating when they throw their info packet away and then get mad at us because we don't magically know what their coverage is. They expect us to tediously track the down that was provided to them and they couldn't be bothered to keep, let alone read. The majority of our patients don't even know WHO their provider is! Take responsibility people! |
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scorpeao
Pearl Clutcher
Posts: 4,521
Location: NorCal USA
Jun 25, 2014 21:04:54 GMT
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Post by scorpeao on Oct 20, 2016 1:13:59 GMT
I go to a dentist within my network. He advertises himself as a Delta dentist....in doing so I expect him to be informed on what Delta does/doesn't cover. I had to fight with my dentist recently because Delta only covers one exam a year. I can barely remember what I ate for breakfast this morning, so I have no clue if I saw the dentist 6 months ago. He turned over his practice to a new associate who likes to do exams every 6 months. When I got billed for $69 because it was a second exam in a 12 month period I fought the charge, and they removed it. I've since switched dentists....I'm pretty sure it's industry standard that insurance only covers one exam a year. Actually, "Delta" doesn't only cover one exam per year across the board. Your policy does. There are literally thousands of delta policies, all with different frequencies, copays, deductibles, maximums and covered procedures. Thousands. I have never seen a delta plan that only covers one exam a year, that tells me your plan is a rare one. Also, the industry standard is TWO exams not one per year. Like I said, in our practice we don't even see policies stipulating one per year. There was some talk a few years ago of making that the standard but dentists balked. So much can go wrong in a year. You expect your office to keep track of hundreds, maybe thousands of plans, but you are unable to keep track of only one? Two exams or cleanings? I get two cleanings and one dental exam from the dentist...when I got billed I asked my friends who have different plans and they get the same: one exam, two cleanings per calendar year. |
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tduby1
Pearl Clutcher
Posts: 2,979
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Post by tduby1 on Oct 20, 2016 1:42:44 GMT
Actually, "Delta" doesn't only cover one exam per year across the board. Your policy does. There are literally thousands of delta policies, all with different frequencies, copays, deductibles, maximums and covered procedures. Thousands. I have never seen a delta plan that only covers one exam a year, that tells me your plan is a rare one. Also, the industry standard is TWO exams not one per year. Like I said, in our practice we don't even see policies stipulating one per year. There was some talk a few years ago of making that the standard but dentists balked. So much can go wrong in a year. You expect your office to keep track of hundreds, maybe thousands of plans, but you are unable to keep track of only one? Two exams or cleanings? I get two cleanings and one dental exam from the dentist...when I got billed I asked my friends who have different plans and they get the same: one exam, two cleanings per calendar year. Two exams and two cleanings are definitely the industry standard and like I said I can not think of any policies that our patients have that only allow only one and we see policies for Delta Dental from about 15-20 different states along with many other companies. X-rays are kinda of all over the place. Some policies allow for bite wings twice a year (rare), some for once a year (most common) and some every two years. Full mouth ranges from 3-5 years. PAs are always as needed. |
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theshyone
Pearl Clutcher
Posts: 3,411
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Post by theshyone on Oct 20, 2016 6:27:23 GMT
I needed one of those full panoramic shots for some major work being done. I was six days prior to five full years and they would not cover.
then something went horribly wrong coincidental to the work I had done and I needed another. They still haven't reimbursed me for it.... Note to self call later today.
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Post by anxiousmom on Oct 20, 2016 12:07:22 GMT
My father is a dentist.
He would have likely directed that you would have been reimbursed because above all else, he doesn't want to lose patients. He believes in what he does, and he knows how much the general public hates the dentist and everything to do with dental care. To him, it is more important to make the process as least painless as he possibly can, even if that means that he has to eat the cost of a cleaning.
But at the same time, what isn't known is that when he writes off those costs, he isn't just absorbing the cost of the insurance payment, but is still paying the hygienist who cleaned your teeth, the overhead costs of running the business, the front desk staff, the supplies, etc. Add that to the cost of the person who called at the last minute to cancel or simply didn't show up (still gotta pay all the costs) or...whatever.
The person who does the billing is a smart woman and the sweetest person in the world. She will do her best to try to keep up with the needs of the insurance companies, but she is one person and relies on people to help keep track of their own specific policy requirements.
I have seen my dad agonize over these kinds of things. He doesn't want to turn people off to dental care in a world where there is already a deep theme of people hating the dentist. He is a small town dentist, in a single dentist practice in the town he was born, raised and returned to. He does a lot of free dental care in the community that a lot of people don't even know about because he cares-a lot. But he is still a man who runs a business where he has a staff to pay (including their insurance) over head costs, and hopefully, at the end of the month have some left over to pay himself.
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julieb
Pearl Clutcher
Posts: 2,845
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Post by julieb on Oct 20, 2016 13:12:12 GMT
My father is a dentist. He would have likely directed that you would have been reimbursed because above all else, he doesn't want to lose patients. He believes in what he does, and he knows how much the general public hates the dentist and everything to do with dental care. To him, it is more important to make the process as least painless as he possibly can, even if that means that he has to eat the cost of a cleaning. But at the same time, what isn't known is that when he writes off those costs, he isn't just absorbing the cost of the insurance payment, but is still paying the hygienist who cleaned your teeth, the overhead costs of running the business, the front desk staff, the supplies, etc. Add that to the cost of the person who called at the last minute to cancel or simply didn't show up (still gotta pay all the costs) or...whatever. The person who does the billing is a smart woman and the sweetest person in the world. She will do her best to try to keep up with the needs of the insurance companies, but she is one person and relies on people to help keep track of their own specific policy requirements. I have seen my dad agonize over these kinds of things. He doesn't want to turn people off to dental care in a world where there is already a deep theme of people hating the dentist. He is a small town dentist, in a single dentist practice in the town he was born, raised and returned to. He does a lot of free dental care in the community that a lot of people don't even know about because he cares-a lot. But he is still a man who runs a business where he has a staff to pay (including their insurance) over head costs, and hopefully, at the end of the month have some left over to pay himself. It sounds like your dad is a lovely man, who genuinely became a dentist to help people. Wish there were more people in the medical field like him. |
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