April 17, 2014 -- Dear ABC News Fixer: I had an appointment for a dental cleaning in December. I filled out the form, paid a $25 co-payment and they put me in the chair, ready to take an x-ray. I told them I didn't want the x-ray.
The dentist took a look at my teeth, and he said I have good teeth, but they couldn’t clean them unless I took an x-ray there or transferred one from another office.
So I asked for my co-payment back and went home.
Later, the dentist’s office called and said I have to re-pay the co-payment because the dentist saw me. When I protested, they threatened to send this to a collection agency.
A month later, I got the explanation of benefits letter from my insurance company showing that the dentist office claimed and received payment of $145 for the appointment. According to the letter, I'm responsible for the co-payment of $25.
- Raymond Chao, Daly City, Calif.
Dear Raymond: You told us that your biggest gripe about this whole fiasco was that if they had just told you ahead of time about the need for x-rays, you would’ve brought along the ones from your previous dentist.
When you saw that the dentist had made an insurance claim for what you thought was a cleaning, you contacted the ABC News Fixer. You were concerned that you’d have to wait another six months for your insurance to cover a dental visit somewhere else.
We looked into it, and they did indeed make a claim, for which they received $145. However, the claim was coded as an examination, not a cleaning.
We called the manager of the dental group and relayed your complaints. It seems -- to twist an old proverb -- that the examination was in the eye of the beholder: to you, as the person in the chair not getting your teeth cleaned, the dentist’s peek around your mouth seemed like nothing. To the dentist, it was an examination. And so the dental group billed it that way.
The good news is the manager told us they’re not going to seek the $25 co-pay any more. And in another month, your insurance will cover another six-month preventative care visit (presumably with a different dentist!), so that part of your problem will be fixed soon.
For everyone else – here are some tips to avoid a situation like this:
When choosing a dentist, pick one who provides info about specific fees and payment plans before treatment is scheduled.
Check user reviews online and stop by the office before you commit to an appointment.
If you have a problem with a bill or treatment, try discussing it directly with the dentist. If that doesn’t work, consider using a “peer review” dispute resolution process through your state’s dental society. For links to state programs, CLICK HERE.
- The ABC News Fixer
Got a consumer problem? The ABC News Fixer may be able to help. Click here to submit your problem online. Letters are edited for length and clarity.