Tooth Talk: Insurance trouble? Inform yourself first

Q: I’m really mad. I just had a bunch of work done at my dentist. I paid my portion and now he sent me a bill because the insurance company didn’t pay the rest. I don’t think I should have to pay it. I think they made a mistake and was probably overcharged. Before I call the Better Business Bureau I thought I would ask you what you think. Can you help?

A: This is an all too common problem. I can help but you are probably not going to like my answer.

Since you have not told me what type of work you had performed, I can only offer assistance based upon my own experience with many, many, many similar situations.

Normally, when you are seen for dental work the fee is given to the patient. If dental insurance is involved, most offices will “estimate” the patients portion. The word estimate is key because there may be many factors unknown to your dentist that will affect the amount of money that the insurance company may or may not pay towards dental treatment.

To go further, each dental insurance plan is different and may include or exclude any number of procedures, waiting periods and time limits. When a claim is submitted, it is processed by a person who doesn’t know you, doesn’t know your needs, doesn’t know your dentist and knows nothing about teeth or dentistry in general. They do know they have a claim to process which involves determining if you have benefits left for the year, if you have paid your deductible and what amount of money does the insurance company allow towards the treatment you had done.

In every circumstance that I have ever come across, the benefit paid will be less than your dentist’s fee. See? I told you that you wouldn’t like my answer.

This does not mean that you have been overcharged or a mistake has been made. Remember the person at the insurance company processing your claim? If they haven’t lost it (which is a real possibility) they may have determined that your plan doesn’t cover that service, your deductible wasn’t paid, your plan has a waiting period or any number of things.

We always try to encourage our patients to familiarize themselves with their insurance plans. I understand they can be complicated but I would urge you to make a phone call so you can be better informed and prepared.

You may need to call your human resources person or the insurance company directly and ask them to explain exactly your deductible, what is included and what is not. Also, ask if there is a waiting period for certain procedure and what those procedures are.

Get the name, number and extension of the person with whom you spoke. This can be very important if you feel you may have been misinformed. If there has been a mistake made, both you and your dentist can work as a team to get the insurance company to rectify the error.


Questions can be sent to Fred Eck, D.D.S. at Marco Dental Care, 950 N. Collier Blvd., Suite 305, Marco Island, or call 389-9400. Web site: He received his Doctor of Dental Surgery at the University of Detroit Mercy and is licensed by the Florida State Board of Dentistry.

© 2008 All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

  • Discuss
  • Print

Comments » 0

Be the first to post a comment!

Share your thoughts

Comments are the sole responsibility of the person posting them. You agree not to post comments that are off topic, defamatory, obscene, abusive, threatening or an invasion of privacy. Violators may be banned. Click here for our full user agreement.

Comments can be shared on Facebook and Yahoo!. Add both options by connecting your profiles.