Health & Wellness

Dentist sent me bill for unethical charges

  • Last Updated:
  • Dec 24th, 2019 8:46 pm
[OP]
Deal Addict
Nov 22, 2009
2566 posts
475 upvotes
Toronto

Dentist sent me bill for unethical charges

I have had my wisdom teeth removed recently and my dentist told me on the phone that my insurance company will be able to pay for the whole amount. I have noticed that they have submitted two claims for the exact same thing (anesthesia).

They told me that my insurance company only paid for one of the claims, which seems logical considering I only took one pill.

They said they will send the bill to collections unless I pay the remainder.

What should my course of action be? Pay them even if its a fraudulent charge?

I spoke with them and they said based on the record, I still need to pay to clear my account, even after I asked the reason for charging me twice for one pill.
17 replies
Deal Addict
Oct 6, 2015
2463 posts
1361 upvotes
Don't worry about 'collections'.

Write them a brief letter in reply to the "balance owing" invoice stating that the anesthesia code was already billed and paid for on the invoice in full by the insurer, and that the item appearing a second time is not appropriate and will not be paid. And that you consider the matter closed, the balance settled in full.

If your Dentist wants to end the relationship with you because he/she can't bill properly, that's up to them. You're probably better off, as a patient, using the services of a different dentist.

Code: Select all

Dear Dentist,  I am in receipt of the balance due invoice of 01/01/2019.  On that notice, for a visit of 01/01/2019, the anesthesia code is billed for twice.  My insurance company remitted payment on 01/01/2019 for the invoice as presented, with the exception of the accidentally double-billed anesthesia code.  Therefore, the invoice for services rendered on 01/01/2019 has been paid in full, and I consider the matter closed.  If you have any comment on the discrepancy between billed services and services actually rendered, please contact me at (905) 123-4567
[OP]
Deal Addict
Nov 22, 2009
2566 posts
475 upvotes
Toronto
burnt69 wrote: Don't worry about 'collections'.

Write them a brief letter in reply to the "balance owing" invoice stating that the anesthesia code was already billed and paid for on the invoice in full by the insurer, and that the item appearing a second time is not appropriate and will not be paid. And that you consider the matter closed, the balance settled in full.

If your Dentist wants to end the relationship with you because he/she can't bill properly, that's up to them. You're probably better off, as a patient, using the services of a different dentist.

Code: Select all

Dear Dentist,  I am in receipt of the balance due invoice of 01/01/2019.  On that notice, for a visit of 01/01/2019, the anesthesia code is billed for twice.  My insurance company remitted payment on 01/01/2019 for the invoice as presented, with the exception of the accidentally double-billed anesthesia code.  Therefore, the invoice for services rendered on 01/01/2019 has been paid in full, and I consider the matter closed.  If you have any comment on the discrepancy between billed services and services actually rendered, please contact me at (905) 123-4567
The problem is that the two claim for anesthesia has a different code, but it just dont make a lot of sense. Why would I need to take anesthesia twice on the same day and at the same time.
Deal Fanatic
May 14, 2009
6400 posts
1211 upvotes
blitzforce wrote: The problem is that the two claim for anesthesia has a different code, but it just dont make a lot of sense. Why would I need to take anesthesia twice on the same day and at the same time.
Did they use another type of anesthesia during the procedure? Or just this pill you took beforehand?

Ask for a copy of your file/record relating to the procedure and see what they wrote.
[OP]
Deal Addict
Nov 22, 2009
2566 posts
475 upvotes
Toronto
amz155 wrote: Did they use another type of anesthesia during the procedure? Or just this pill you took beforehand?

Ask for a copy of your file/record relating to the procedure and see what they wrote.
I only took the pill which is oral sedation, and was what I agreed to.

When they initially submitted a preapproval claim to GWL, they literally submitted $3.3k (wisdom teeth extraction)for a huge bunch of stuff. I feel like they want to know their full limits and would later bill the insurance as much as they can give.

What can I do if they write on their file that I took more anesthesia than agreed upon?
Deal Addict
User avatar
May 19, 2003
4919 posts
388 upvotes
Ancaster
blitzforce wrote: I only took the pill which is oral sedation, and was what I agreed to.

When they initially submitted a preapproval claim to GWL, they literally submitted $3.3k (wisdom teeth extraction)for a huge bunch of stuff. I feel like they want to know their full limits and would later bill the insurance as much as they can give.

What can I do if they write on their file that I took more anesthesia than agreed upon?
Oral sedation is for you to be calm and not freak out during the procedure. That does not numb your mouth for the procedure itself. It's almost a given that wisdom teeth extraction will require pain control (freezing), which is another thing the anesthesia specialist does. It would be inconceivable for you to consent to sedation, but not to local freezing, so I think making the argument that you only agreed to sedation (without any additional anesthesia interventions) would not be a good position to take.

However, at the same time I think the same applies to the insurance as well -- it would be inconceivable for the insurance to expect you to have wisdom teeth removal under sedation, but without local freezing.

Without knowing what was done it's very hard to give advice. One thing i can think of is that the two billing codes both cover pain control, but one includes sedation, and one doesn't. What are the codes they billed? All the codes are published and you can look it up online to see whether the services covered by the code, are the services offered to you, and whether they overlap or not.
Deal Addict
Jun 21, 2008
2935 posts
383 upvotes
Toronto
blitzforce wrote: I only took the pill which is oral sedation, and was what I agreed to.

When they initially submitted a preapproval claim to GWL, they literally submitted $3.3k (wisdom teeth extraction)for a huge bunch of stuff. I feel like they want to know their full limits and would later bill the insurance as much as they can give.

What can I do if they write on their file that I took more anesthesia than agreed upon?
So all you took was a pill?

Did you take any nitrous (laughing gas) or have any tubes stuck into your wrists?
Sr. Member
User avatar
Jun 14, 2017
816 posts
797 upvotes
The charges seem legit to me. Tooth extraction rarely requires Sedation but as you've mentioned in your OP, you've AGREED to take oral Sedation. The charges is for local anesthesia(needle to numb your gums since it will be cut open) which is paid by your insurance and the 2nd charge is for Sedation(relaxer) that you've agreed to but not necessary which in this case is paid by yourself.

If you have further concerns, why don't you just straight up as your dentist to explain the difference in the two charges. You may be barking up the wrong tree as it is your insurance that's likely not covering the Sedation portion.
Deal Guru
User avatar
Sep 1, 2005
11193 posts
6184 upvotes
Markham
OP only took ONE pill !! to remove wisdom teeth? Did he get any pills to take home after the procedure - they usually give you one or two "to go".

I'd speak with the dentist directly (was the dentist part of "them") and just ask for a better explanation AND that you were advised BEFORE you had the procedure that it was going to be covered and hence you weren't prepared to pay out of pocket AND perhaps you wouldn't have done the procedure at all if you knew it was going to cost you out of pocket.

FYI Perhaps the dentist just miscoded the item and it should be re-coded and re-submitted and likely covered by his Insurance co.
We're all bozos on the bus until we find a way to express ourselves...

Failure is always an option...just not the preferred one!
Sr. Member
User avatar
Jun 14, 2017
816 posts
797 upvotes
gr8dlr wrote: OP only took ONE pill !! to remove wisdom teeth? Did he get any pills to take home after the procedure - they usually give you one or two "to go".

I'd speak with the dentist directly (was the dentist part of "them") and just ask for a better explanation AND that you were advised BEFORE you had the procedure that it was going to be covered and hence you weren't prepared to pay out of pocket AND perhaps you wouldn't have done the procedure at all if you knew it was going to cost you out of pocket.

FYI Perhaps the dentist just miscoded the item and it should be re-coded and re-submitted and likely covered by his Insurance co.
OP is likely confusing that Sedation and Local Anesthesia is the same. You need local anesthesia to numb your gums that are being cut open but Sedation is rarely needed, however, it is provided to relax the extra nervous and squirmish folks.
[OP]
Deal Addict
Nov 22, 2009
2566 posts
475 upvotes
Toronto
gr8dlr wrote: OP only took ONE pill !! to remove wisdom teeth? Did he get any pills to take home after the procedure - they usually give you one or two "to go".

I'd speak with the dentist directly (was the dentist part of "them") and just ask for a better explanation AND that you were advised BEFORE you had the procedure that it was going to be covered and hence you weren't prepared to pay out of pocket AND perhaps you wouldn't have done the procedure at all if you knew it was going to cost you out of pocket.

FYI Perhaps the dentist just miscoded the item and it should be re-coded and re-submitted and likely covered by his Insurance co.
They gave me pain killers to take home, but I dont think you can charge $300 for pain killers
Deal Addict
User avatar
Jul 19, 2010
1638 posts
515 upvotes
Alpha Centauri
I learned the hard way that in order to avoid surprise out-of-pocket expenses, is to always have your dental office submit an pre-estimate to the insurance company before you commence any dental work, including cleaning and polishing.
I hate surprise dental charges!
Deal Fanatic
May 14, 2009
6400 posts
1211 upvotes
Do you have a copy of an invoice that itemizes each code that you were charged for?
Deal Guru
User avatar
Jul 12, 2003
11252 posts
3502 upvotes
Toronto
I notice dentist always send a duplicate claim and the insurance of course only pay once.
My dentist never bother me about it.

They make good money with patients with dental plans, they wouldn't want to lose a regular routine customer.

Your dentist is just greedy, I would bad mouth him/her or leave feedbacks on the web.
Retired Forum Moderator February 2009 - June 2015
Deal Fanatic
User avatar
Nov 13, 2010
6864 posts
1295 upvotes
Scarborough
We dont pay anything, its all billed to insurance directly. Thats all i give em. I dont pay anything on top. They get whatever the insurance pays.

Top