Originally Posted by
3GreenKSNA
I had a major problem with an unscrupulous provider so be very careful. When asked if they took our insurance they said yes. What I failed to ask is if they were in or out of network. They ended up being out of network. Found this out the hard way later on.
If they had been in network I would have paid a lot less, Regardless of their shady actions I describe below. They had no intention of filing a claim for the cavity filings despite their paperwork saying they were being paid out from the insurance. When I called met life they explained they had only received a claim for the preventive work. The office presented me with a document showing my portion and the insurance companies portion. My portion alone was more than what the total amount authorized by MetLife. The dentist was perfectly happy over charging me even as an out of network provider keeping my money and not filing a claim with MetLife as their total income would have been vastly reduced. The dentist office hoped I would not have done my homework. I ended up getting my money back.
MetLife was great, franchised dental office, not so much.
-Keep the dirty side down
yes, unfortunately, this is legal in almost all states.
Ensuring the doctor is in network is the patient's responsibility. Keep in mind that a doctor can be in network at one office and out of network at another.
Also the doctor doesn't have to submit a claim. nearly all reputable dentist offices will, but they don't "have to". they can force it on you.
if you are having any work done that may be expensive, or you need to be certain that it will be covered beforehand, have the dentist office submit a "predetermination" its basically a sample claim they submit to see how it gets covered, before you do the work. the two drawbacks is you probably need to get an exam, and xrays done before they can even submit a predetermination so they know what kind of work they will be doing, plus predeterminations usually take a while to process. up to 6 weeks at certain insurance companies.