Does this sound right to you? Dentist Office Says Cleanings While In Braces Not Covered By Insurance

[candle1112]

I have regular dental insurance in the US through work. We have coverage for 2 free dental cleanings a year. I just found out that my dentist office hasn't been submitting any of my cleanings to my insurance since I've been in braces for the last 2 years. They have been charging my account each time for every "ortho" cleaning as they call it. I understood that I would have to pay them for any cleanings more frequently than twice a year because insurance wouldn't cover it, but shouldn't two of those cleanings per year be covered as my two free cleanings?
When I questioned it, the girl at the front desk said "it takes more time and the dental hygienists have to get paid somehow for the extra time."
Does this sound right to you.
Are you guys being charged differently for cleanings now that your in braces?

[iob]

No, I do not get charged extra or differently for my twice-yearly cleanings. That's ridiculous, IMO...never even heard of that being done. In fact, if my dentist had tried to make that argument and charge me 100% for those two cleanings, I would have switched dentists, even though he's been my dentist for ten years and is the one who told me that I needed to see an orthodontist. Are you just now being told that you're responsible for two years' expense? If so, even more shameful.

[iob]

BTW, you might need to get your insurer involved. For example, if you're covered by Delta or Aetna or one of the larger insurers and your dentist is in their network, then they have signed an agreement with the insurer that spells out what's covered, what they're allowed to charge/bill (the Maximum Plan Allowance), etc. If your dentist is providing a standard evaluation, cleaning/polishing, etc. they need to bill it through as such. They are not permitted to balance bill or charge you an amount above what they've agreed to with the insurer. In this case, the insurer can probably advocate on your behalf.

[EWUgal15]

It takes more time for a cleaning with braces? That's the most ridiculous thing I've ever heard. I was told when I got my braces put on that I would need to schedule time to have my wires taken out before a cleaning to make things easier for the hygienist. I've never been charged differently because I have braces and my insurance has covered them as they should. Something isn't right about your dentist.

[Candyland]

I agree, this is very wrong. My dentist has never charged me for my cleanings. My insurance has been billed as usual for the past 3 years I've had braces. I would not allow them to do that to you, it is just wrong!

[metalliKa]

You need to call your dental insurance and confirm that your regular dental office has been submitting claims for the two free cleanings since you've been braced. If they have, they are overcharging you and that's in violation of your right as a dental patient. Whether it takes the hygienist more time to clean your teeth, the cleaning is paid for by your dental insurance. And I would also ask for a statement of service for the two years you're in braces and compare the charges against what was submitted to the insurance. You have to do your due diligence if you don't want to be a victim of unfair treatment.

[candle1112]

Thanks for everybody's feedback. I'm going in person tomorrow and asking to talk to the office manager and going to request that she call Cigna right there with me there too to get this straightened out. You've all been very helpful confirming my suspicions.

[djspeece]

Thanks for everybody's feedback. I'm going in person tomorrow and asking to talk to the office manager and going to request that she call Cigna right there with me there too to get this straightened out. You've all been very helpful confirming my suspicions.

Excellent plan. Take no prisoners .

[metalliKa]

Thanks for everybody's feedback. I'm going in person tomorrow and asking to talk to the office manager and going to request that she call Cigna right there with me there too to get this straightened out. You've all been very helpful confirming my suspicions.

Actually, that isn't a good plan you going in and demanding the officer manager to call your insurer. They could just tell you what they've been telling you all along. They know you're easy picking. You need to contact your insurer and dental office separately and compare notes! Part of not becoming a dental fraud victim is you sometimes have to be Sherlock (or more so Watson) yourself.

[sirwired]

If the receptionist is kind of new, it might be a coding error. I could certainly see a braces cleaning taking longer, and insurance not covering the additional cost. But there should be a way to code it so insurance pays what they always do, and you pay the leftover.

Insurance coding is involved enough that there are entire community college programs dedicated to learning it.

[candle1112]

Went in early this morning the the dental office and found out that they currently have no office manager. She left 3 weeks ago.
I was able to get a printout of all my charges and payments for the last 2 years (since I've been in braces) and got the name of the Regional Manager for the offices in the area (it happens to be a national dental chain, not a private one-dentist office).
The Regional Manager said she will research it and get back to me. I'm following it up with a letter or email so I have something in writing to the Regional Manager asking for credit for the payments for 2 dental cleanings per year for the last 2 years.

[Snowglobe32]

Sounds to me like you also should call your dental insurance company. If you haven't received a statement that usually says something similar to "This is not a bill" from your dental insurance company, then more than likely they have not been submitting the claim to the insurance. Probably because they can charge more than what the insurance company will pay... You may have been "taken" on this one. Just call the 1 800 number on the back of your card and ask when the last claim for a cleaning was submitted.

Does your insurance pay a portion of your ortho work? You may want to make sure that was paid also. When I wore braces, my insurance paid $1500, they issued two checks for $750 to me and I paid the ortho.

For my cleanings, I was lucky that my ortho was a few blocks away from my dentist so I would stop by the ortho to get my wires removed, then go get my cleaning, then back to ortho for new wires. It was fairly simple.

Good luck. Please keep us posted!

[metalliKa]

Don't forget to contact your insurer also to make sure the dental office didn't bill you and the insurer.

[fifi6504]

I've gone in for 3 cleanings with braces now (had them for a year and a half) and they schedule the same time as I would without braces. They still do x-rays and check out my teeth for cavities, etc. My insurance covers the cleanings/check ups as usual. The only thing different is the hygienist gave some extra super floss and talked with me about areas I need to pay more attention to clean better.

[infusionaire]

Wait because you got braces they are saying you can't use your insurance? That is ridiculous lol. That is literally saying you getting braces voids insurance. People would be up in arms over that if that was the case.