Hoping one of you guys can explain this better than my dental office has been able to do. I had some extensive work done back in May and June. Part of the work entailed getting two temporary implants, I was charged just over $1,200 for each of these two plus other associated costs. When it was filed with Cigna my EOB states my expense for these should only have been $600 each. The codes for the procedure matchup with what the dentist office has and what my EOB is so there doesn't seem to be an issue other than I paid more than twice what I should have. Went to the office and brought my EOB with me to talk about the discrepancy. I was told that there are different options for material used for the work (resin, acrylic, etc.) and I might have chosen the more expensive option which is why the charge is so much more. To be completely honest, I don't remember any discussion about options, it was basically "this is what you can do". The office manager asked me to give them a week to talk with the dentist who did the work and find out why the charges are what they are. My question here is, the code they used to bill me and the insurance shows the expense on my end to only be $600. There are no options for different charges or materials according to the billing code. Cigna is very clear, what I owe is $600 each. Am I missing something here? If what they billed to Cigna shows my end of the expense to be A, I should only pay A, and not B, C, etc., correct? The difference is substantial in my option, over $1,200. Thanks for any and all input.
Your EOB should match the bill. Can you not get a copy of the bill and see if there are additional line items? The material cost would be different, but that would still show on the EOB whatever they billed the insurance company for. Sounds like they didn't send the entire invoice to the insurer, didn't record the discount, or didn't record the insurance payment.
Thanks for the response. I have my itemized bill. The only discrepancies are the two implants at the moment, everything else matches. They at first gave me their charge bill, not what the patient fee charge was. So I saw a ton of discrepancies at first, but that hopefully is remediated. I just don't understand how I can get something done that is coded by the dentist office, Cigna has the same code and what my part of the expense should be given that code and I'm being told there's a chance I have to pay 2X+ more than the coded cost. Since Cigna has everything accounted for that's also on the itemized dental bill I'm assuming the issue is the dentist not recording the right discount? I'd have thought this would be a simple fix, but when I'm told they need to figure it out and that I "likely" won't see much of a refund as a result of the fix that has me a bit confused.
I would assume they didn't record the discount from the insurer. Nothing in medical billing is as easy a fix as it should be. If they don't fix it or provide a good explanation, consider filing a BBB complaint. I've had that work with multiple companies over the years.
There are no implants for $600. Implants run 1200 and up. You may have a 50/50 deductible on major work. Thus your portion should be 600 and theirs 600. I’m assuming this is what it is.
Thank you for the response. Yes, the total cost is north of $1,500, my portion according to Cigna's patient expense schedule is $600.
It's a write-off in any case. Remember, if you go at the dentist's favorite time, 2:30, you'll get a discount.
