You Got a Bill From the Dentist. What should you do


Understanding your dental bill and your explanation of benefits from your insurance company.

We have all been there before.  We need dental work and the dental office provides a treatment plan with an estimate of what will be covered by insurance and how much we need to pay.  You pay for your estimated portion, the dental work gets done, and then a month later you get a bill saying that you still owe money.   How could that happen?

Well first of all, yes it can and believe it or not there is just no avoiding it.  Let me explain why first.  Dental offices confirm your insurance and confirm many details.  However, it is 100% impossible to verify every single detail within your plan.  It sounds absurd, but yes it is the truth.  Each plan has different caveats.  The plan itself differs by employer and you may have different clauses that may apply based upon tenure with the employer, dental insurance, and even your dental history.

So next question, what can you do.  First thing, call the office and have them explain why.  We will need to pull the explanation of benefits so it may take a day or so for the office to research, but we can figure it out.  Also, you should pull the explanation of benefits and review.  But its key to know these components of the explanation of benefits from your insurance company.  They are;

  1. Allowed amount: How much the dental office can bill you for the procedure per their contract between the dental office and insurance company.
  2. Patient Portion (Patient Payment): The amount you should pay
  3. Insurance Portion: The amount insurance should pay

Make sure that you read the footnotes.  This is why you usually have a balance. 

Assuming that the bill is correct, what can you do next?  If the amount owed is not within your budget talk to the office.  They will most likely be willing to split your payments and give you some time to pay.  We would rather get the money from your insurance company but sometimes this happens.  There is no avoiding it and nobody is being deceptive.  It is just part of the world of insurance.

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