How to review and negotiate your bill at the dentist’s office

Dental Insurance, Insurance, Provider Networks

Learn how to navigate the process of dental claims and billing

Have you ever been confused by dental claims or had a dispute with your bill at the dental office? It can be a frustrating process to deal with all the insurance information, claims data, and the provider bill from the dentist. Sometimes you may be unsure if you’re being billed correctly, or you may even feel like you’re being over charged for unnecessary expenses. We’ll give you some helpful information and tips about how to best negotiate your bill at the dental office.

Make sure your dental claim is filed
Review your EOB
Make sure In Network discounts are applied
Make sure provider bill matches the EOB
Ask the dentist to “write off” some charges
Continually monitor your provider bills

Make sure your dental claim has been filed with the insurance carrier

If you have a dental plan, the first step is for a claim to be filed with the insurance company. In most cases, the dental office will file claims to the insurance company. In Network dentists are required to file dental claims, but many Out of Network dentists will also file claims as a courtesy to their patients.

Once the claim has been received and processed, the insurance company sends an Explanation of Benefits or EOB to the member and a remittance statement with any payment due to the provider’s office. Normally, dental offices will then send a bill to the member for any outstanding charges that were not covered in full by the dental plan.

However this is where some confusion can enter the process. Now we’ll explain how to review your EOBs and provider bills with a few things to look for.

Review your EOB to make sure the claim was processed correctly

Once you receive your Explanation of Benefits in the mail from your dental carrier, it’s best to check a few things to make sure the claim was processed correctly. Although it doesn’t happen all the time, it’s possible that a claim may not include all the procedures a dentist performed or it may list an incorrect procedure code.

The main thing is to make sure that you’re getting credit and coverage for all the work that was done in the dental office. If an item is missing, you can request that the dentist resubmit the claim with the corrected procedure codes and info. Most dental carriers also have an appeal process if you feel that an item is not processed correctly according to your plan benefits.

Be sure that In Network allowed amounts are being applied

If you saw an In Network dentist, then you’ll want to make sure the claim is processed according to the In Network discounts. This will often appear on most EOBs as the “allowed charges” and should be a lesser amount than the total charge for each procedure.

For example, let’s say the total charge listed on the EOB for an x-ray is $100, but then it shows an allowed charge of $75 for the procedure. This would indicate that the claim is giving an In Network discount of $25 for this procedure since the dentist is In Network. If the total charge is the same amount as the allowed charge, then it could indicate that a discount was not applied.

Make sure the billed amount matches the patient responsibility on the EOB

After you’ve reviewed your Explanation of Benefits from the dental carrier and believe that it was processed correctly, then you will want to make sure the provider bill from the dentist is charging the correct amount. The easiest way to determine this is to see if the patient responsibility shown at the bottom of the EOB matches the billed amount on the provider bill. This will usually indicate the information is matching up and that you’re paying the correct amount.

If an In Network dentist is trying to bill for a larger amount than the EOB indicates, you may want to find out what these charges are for and show them your Explanation of Benefit’s to make sure they’re using the same information.

If you’ve seen an Out of Network dentist, they may sometimes charge you for additional charges beyond the allowed amounts listed on the EOB. This is often called balance billing, where Out of Network providers can charge additional amounts beyond what an insurance carrier has paid. You may want to negotiate with these dentists to reduce your bill.

Ask the dentist to write off any disputed amounts or charges

If you’ve identified some charges that are not matching up to those listed on your Explanation of Benefits, then you should ask In Network dentists to honor the charges from the EOB. For Out of Network dentists, you could ask them if they could write off the additional charges and accept the amounts shown by the insurance plan. It never hurts to ask providers to reduce charges as you’ll never know unless you ask.

Always review your EOBs and provider bills as errors can happen

As we’ve discussed, it’s always a good idea to thoroughly review your Explanation of Benefits and provider bills to make sure everything is correct. Hopefully these tips for reviewing dental claims, EOBs, and provider bills can help make sure you’re getting the most out of your dental benefits. If there’s a discrepancy, then it’s always good to discuss these with your dental provider. With some knowledge and a little negotiation, you can be sure to pay the correct amounts for your dental services or even less.

Tags Dental InsuranceIn NetworkInsuranceOut of Network