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Over Charged - Billing Question

M

momma

Junior member
Joined
Feb 24, 2015
Messages
16
I had all 4 wisdom teeth removed at the oral surgeon's office on February 20th. They required payment before the surgery, which my husband paid for with a check. The check has cleared the bank. A week after surgery, we received the EOB from our insurance. The insurance adjusted the claims, based on their figures, we were overcharged $200. How long should I wait for the surgeon's office to reimburse us before calling to ask for our money back?
 
What is the indication on the EOB that you were overcharged? I don't think you can usually determine this from an EOB. Is this an in-network or out-of-network provider? If you have questions about the EOB, I would first call your insurance company so that they can explain it to you. I think it's then also totally reasonable to call the dental office to help you understand the difference.
 
What is the indication on the EOB that you were overcharged? I don't think you can usually determine this from an EOB. Is this an in-network or out-of-network provider? If you have questions about the EOB, I would first call your insurance company so that they can explain it to you. I think it's then also totally reasonable to call the dental office to help you understand the difference.

This is an in-service provider.
The receipt they gave my husband says that we paid an "estimated down payment - your insurance will determine your exact benefits upon receipt of our claim." The receipt shows the charges of $1430.00, our payment of $627.00, and an account balance of $803.00.
I received a statement on 2/24 from the surgeon that states all of the same information. It says ending balance $803, less pending insurance $803, and please pay this amount $0.00.

I received the EOB on 2/25. It looks really straight forward and easy to understand. Just going on the totals for all of the line items: submitted amount = $1430.00, amount allowed = $1250.00, contractual adjustments = $180.00. It says total amount plan pays is $823.00, and patient pays provider $427.00.

Maybe my surgery hit on the end of their billing cycle, so I got that first statement right away. And it's not quite time for the next cycle? Maybe I just haven't been patient enough. Thanks for your help. I don't want to keep a credit with them :o ! I'd much rather have my cash back!
 
I just checked with the insurance. They paid $823 on 2/26.
 
I work in insurance and, unfortunately these things are sometimes more complicated than they appear. This is not to say whether you are right or wrong. I do think that the first step is to call your insurance company and verify that your understanding is correct. If that turns out to be the case, I think a quick call to the dental office will clear everything up. It may just be that, like you said, they have a billing cycle that will mean your check will come at some point soon.
 
Thanks! I talked to both places today. I think this process is more painful than the dry socket I ended up with. Both are claiming their figures are right. Surgeon's office says they will review it if I bring them the EOB. But if there's a credit, the difference goes back to the insurance company . . .
 
Did they say anything about 'balance billing? Did the insurance company say you were overcharged or just that the EOB was correct? If, in fact, it is an in-network dentist and they have overcharged you, this would be a violation of their contract with the insurance company and you could have the insurance company get involved to recoup the money for you. When you cal the insurance company, you will have to get past the front-line customer service person to a manager or even that person's manager in order to get a good explanation and assistance. And, yes, this is never an easy process. I've had to do something similar with a medical bill and it took me nearly 6 months to get it sorted out -- and I work in insurance/managed care and know the system, terminology, and rules very well. I can't imagine what it's like for someone who is not as intimately familiar with these things as I am.
 
Thanks for your support! I took the EOB in today. The office manager wrote me a check right there on the spot! :jump: So happy to cross this part of my journey off.
 
1. Ask for the money back
after 10 days ask again
2. Go in person and ask
3. Send certified letter asking
4. Complain to your workplace benefits administrator
5. If member of ADA they might have a grievance board which will get your money back.
6.. Small claims court

But if there are bad reviews why would you go there???
 
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