What are my options against what may be greedy billing?

[shane]

I recently had two of my teeth extracted. My dentist billed my credit card $560 for two bone grafts and $360 for nitrous oxide & conscious oral sedation, in addition to charges for the extraction. The dentist also filed an insurance claim for these services without including a narrative on why the bone grafts and sedation procedures are required.

My dental insurer says if the dentist resubmits the claim with a narrative on the need for bone grafts and sedation procedures, I will pay contracted prices instead of dental office list prices since the provider is in the network. The contracted prices are roughly 50% of the dental office's list prices.

My dentist refuses to resubmit the claim with a narrative saying these are non-covered items in the dental insurance plan and that they charge dental office list prices for such services.

Although my dental plan excludes bone grafts and sedation procedures, I cannot get contracted prices since the dentist refuses to resubmit the claim with a narrative.

I have this experience of the dentist refusing to resubmit the claim with a narrative for the first time.

I am clueless if this is the standard industry practice or if I am getting taken for a ride.

Is this common dental practice in Texas?

Is there any way to get the contract prices on these non-covered items and save approximately $500?

Shane

 

[MattKW]

I don't know the US system, much less so Texas.

1. Perhaps you should seek out a Consumer Protection-type agency for help.
2. Do you have some sort of Dental or Health Board that deals with disgruntled patients?
3. You should make a formal request for your full records from the dentist as these may have detailed notes about the information you seek. In Australia, we have 30 days to comply.
4. You could do a negative review on social media.
5. If you really want to stir up shit, then raise the issue with your credit card company and ask for them to reverse the charges. However, since the dentist has actually done the service, they may not be willing. Also, even if they did reverse the charges, this may aggravate the situation and the dentist may send debt collectors after you.

Whatever you choose, start keeping a detailed set of notes with dates, actions, persons you spoke to, ....