Orthodontists change total fee

[DaisyDoesDallas]

Long story short halfway through braces we changed insurance policies and the new policy covers more of the cost. Originally the total fee for braces was $5k now that insurance is covering more they have changed what the original total fee is to over $6k. I for one am not buying it. We have in writing what the total original fee was, so I don't see how they can now change it because insurance is covering more? Has anyone ever had this occur?

[Snatch Napkin]

The medical profession has been adjusting prices for insurance and cash prices for quite a while. It helps to offset the costs of free healthcare to those who refuse to pay.

[STRONGNUFF]

Different insurance companies have different "in network" fee's for the Doctor. Some insurance companies pay the Doctor more than other's.

[DaisyDoesDallas]

I guess what makes no sense to me is regardless of who the insurance company is or what amount they are paying, if you say a procedure costs $5k then no matter what insurance covers the total amount should stay $5k. So now that insurance is paying more you can go back and change $5k to be greater even though I have in writting the total procedure costs $5k? To me this doesn't seem legal.

[dsrtuckteezy]

middle aged women in braces are hot

[DaisyDoesDallas]

middle aged women in braces are hot

I am not middle aged, I am a senior AARP welcomed me a decade ago and the braces aren't for me! LOL

[Geor!]

The medical profession has been adjusting prices for insurance and cash prices for quite a while. It helps to offset the costs of free healthcare to those who refuse to pay.

How does that apply to dental though? Dental is an at-will service. Medical is an at-need service.

[onemeangixxer7502]

I guess what makes no sense to me is regardless of who the insurance company is or what amount they are paying, if you say a procedure costs $5k then no matter what insurance covers the total amount should stay $5k. So now that insurance is paying more you can go back and change $5k to be greater even though I have in writting the total procedure costs $5k? To me this doesn't seem legal.

Its very legal, basically said practice has agrement with insurances companies. They bill insurance and they get EOB back and it will say billed 6xxx but they have the caregiver write off the extra 1000. They dont pay any extra $. the Dentist could bill then 20,000 for said procedure and dentist will still only be paid 5k ....

[Snatch Napkin]

How does that apply to dental though? Dental is an at-will service. Medical is an at-need service.

I didn't quite think it that way.

I could offer some miniscule, anecdotal evidence to prove myself and stretch this thread, but I'm good on attention today.


They're being greedy and trying to get all the money they can.

[DaisyDoesDallas]

Its very legal, basically said practice has agrement with insurances companies. They bill insurance and they get EOB back and it will say billed 6xxx but they have the caregiver write off the extra 1000. They dont pay any extra $. the Dentist could bill then 20,000 for said procedure and dentist will still only be paid 5k ....

I get that part, I understand that the dentist can charge $50k for the procedure but insurance is only going to pay $1k. Totally understand that. Maybe this will help explain what I am not understanding.


In the original contract, which I am going to look to see if it says they can change the fee at anytime:

5,750 total procedure fee
350 insurance pays
5,400 out of pocket expense

11 months later, insurance policy is changed
6,835 total procedure fee
3,200 insurance pays
3,635 out of pocket

How can they go back and change the total procedure fee in the contract now that insurance is paying them more? They billed insurance the same $5,750 as they did in the very begining?

[STRONGNUFF]

I get that part, I understand that the dentist can charge $50k for the procedure but insurance is only going to pay $1k. Totally understand that. Maybe this will help explain what I am not understanding.


In the original contract, which I am going to look to see if it says they can change the fee at anytime:

5,750 total procedure fee
350 insurance pays
5,400 out of pocket expense

11 months later, insurance policy is changed
6,835 total procedure fee
3,200 insurance pays
3,635 out of pocket

How can they go back and change the total procedure fee in the contract now that insurance is paying them more?

Good point, I would talk to someone at that office and ask for an explanation.

[juiceweezl]

I get that part, I understand that the dentist can charge $50k for the procedure but insurance is only going to pay $1k. Totally understand that. Maybe this will help explain what I am not understanding.


In the original contract, which I am going to look to see if it says they can change the fee at anytime:

5,750 total procedure fee
350 insurance pays
5,400 out of pocket expense

11 months later, insurance policy is changed
6,835 total procedure fee
3,200 insurance pays
3,635 out of pocket

How can they go back and change the total procedure fee in the contract now that insurance is paying them more? They billed insurance the same $5,750 as they did in the very begining?

It's been explained above. Different insurance companies will pay the doc a certain amount. They may have only charged $5750 because that's what they were charging per your insurance and their cash price that you're paying. With the new insurance (which would make a "contract" as you called it null and void), they may be able to charge more for certain aspects, so they are going to do it. They're making up money elsewhere. It happens all the time.

[Baron Von Crowder]

wait, you are complaing because it is costing you less?

[DaisyDoesDallas]

It's been explained above. Different insurance companies will pay the doc a certain amount. They may have only charged $5750 because that's what they were charging per your insurance and their cash price that you're paying. With the new insurance (which would make a "contract" as you called it null and void), they may be able to charge more for certain aspects, so they are going to do it. They're making up money elsewhere. It happens all the time.

I have to disagree with you, the $5750 was the price quoted before they even made contact with the original insurance company to see how much insurance would cover.

[onemeangixxer7502]

It's been explained above. Different insurance companies will pay the doc a certain amount. They may have only charged $5750 because that's what they were charging per your insurance and their cash price that you're paying. With the new insurance (which would make a "contract" as you called it null and void), they may be able to charge more for certain aspects, so they are going to do it. They're making up money elsewhere. It happens all the time.

They aren't really making MORE money per say. Just the reimbursement is different from one company to another. Basically the care givers have their negotiated rate. So they may have had to bill more to be reimbursed for what they needed to do procedure. Its so goofy the will they're contracted with these insurance companies. If the braces were done on old insurance nothing should have changed, unless you were quoted price then did it.