red flags?

[margarets]

Background: My brace day is booked for March 13, next week. That would also be the day I sign the contract and begin payments.

New development: I'm in a union that is currently negotiating a new contract. Things are getting tense, and it's possible there will be a lockout. That means benefits would be suspended during that period. IF a lockout happens, it won't start until after my brace day.

I called the ortho's office to explain the situation and see if they could accommodate my situation. I.e. instead of setting me up on an automatic payment plan that bills monthly, just bill me for each visit, and I'll make sure the visits are for when my benefits are "on". (It's doubtful the lockout would go on for long. And it's likely that this ortho has other patients in my situation, as it is a very large union in this city.)

No dice. In fact the treatment coordinator had a pretty lousy attitude. She wants me to just come in, sign the contract and start payments, and figure out the insurance stuff myself.

I found her attitude quite off-putting. I'm no longer sure I want to commit to a $3000+ contract with a business that doesn't even attempt to address my concerns. They certainly wanted to know all about my insurance coverage during the consultation, and now they couldn't care less as long as they get their end.

I'm thinking of backing out, getting another ortho. To be on the safest side, I should postpone all the treatment until the new labour contract has been settled and my benefits are no longer in jeopardy. And if I'm going to postpone... why not just choose another ortho?

My alarm bells are going off and so is my gut.

Thoughts?

[sirwired]

Orthodontists generally don't charge by the visit, which is why you can't get them to bill you that way. Much of the work, time, and effort for the whole treatment is in place by the time you walk out the door on bracing day. And they don't charge extra if the treatment takes longer than expected (nor do you get a discount if it takes less time.)

[klobird]

Ya, you should call your dental plan--the number should be either on your card or online. Ask how they pay out on your ortho treatment. Mine paid a huge chunk for the bracing date, and then another chunk 6 months later. For the first chunk of money, I just had to make sure my current dental plan was in effect on bracing day. I also had an amount that I paid on bracing day. Then I had a monthly budget plan for payments to be automatically withdrawn from my bank account. At 6 months, with my dental plan still in place, and my braces still on, the insurance sent another smaller chunk of money. And now at 10 months I'm all paid up!!

My ortho's admin/biller was pretty cranky in the beginning also. She was even condescending at times.
I, too, wondered if it was a wise choice to go to this ortho. The thing is--I was looking for an ortho with a reputation for doing amazing work--not for a nice office manager/biller. The first several months I really struggled with this person, but found out she's actually pretty cool.

[margarets]

Yes, but were your dental benefits suspended at any time due to a labour disruption during your treatment? *That* is the issue here.

I've contacted my insurance company and I haven't gotten a straight answer from them about how they will handle this situation. E.g. what if the billing date falls on a labour disruption day? Or it doesn't, but one of my ortho appointments does? I'm going to keep pressing them for an answer, but I am certain that the situation can be avoided by not having auto-billing while the labour issue gets resolved. I don't think it is a lot to ask.

[BracedInNOLA]

My alarm bells are going off and so is my gut.

Thoughts?

In general, I say to trust your spidey-senses! But you are presenting a very unusual situation, so this may just be the reaction to 'I have no idea how to deal with this' from the office manager. If your communications directly with the orthodontist have been effective, I'd think harder about switching.

If you think the labor dispute will be resolved in a timely fashion, then I'd go ahead and just 'assume it will all work out' (provided they don't change your ortho coverage in the negotiations!) As long as your covered on the date the service is provided, it should be ok.

How it impacts the monthly payments, really depends on how your orthodontic benefits are paid. Mine will pay a chunk for treatment 'on bracing day' and then quarterly after that, even if it's based on monthly bills, up to the maximum benefit, after deductible, with 'co pay' taken into account.

So I had ortho coverage on brace day and the office manager there (I lucked out on that one, she's got a GREAT manner) sent the 'bill' to the insurance company, but I was expected to pay the full bill on that day. So let's say that was $1000, which I paid upfront. The insurance company sent $475 to the ortho ([1000-50(deductible)] *50% (copay)), so I had a credit in my account, that will cover the next few monthly payments, and then they'll start charging my credit card again. All that mattered for that first initial payment is that I had coverage on the date the service was provided - NOT if I had coverage on the date they submitted the bill.

I honestly don't know what would happen for the payment requests made during the next quarter if there was some time in the middle that my benefits were suspended. For me, though, it wouldn't really matter, since my total cost is well below the maximum benefit I can receive from the insurance coverage, so it would just shift some of my 'all me' payments earlier and have some 'insurance too' payments later.

[margarets]

Well, the labour dispute just gets worse and worse, so there's no telling what will happen. Eventually it will be resolved, but it could be a bumpy ride till we get there.

So, I got confirmation from the insurance company of exactly how they would handle the worst-case scenario (lockout and suspension of benefits). I went back to the ortho's office and asked whether they could adjust the payment schedule if the worst-case scenario comes to pass. This time I talked directly to the finance person in the ortho's office.

It was a BIZARRE conversation. Her answers were ALL OVER THE PLACE. She said she can do stuff like start treatment now but not bill me anything for 3 or 4 months until this whole thing blows over (which seems a little insurance-fraud-y to me), or skip the bill one month and then double-bill me for two. But the one thing she cannot do is simply move the date of one monthly payment. Apparently "once it's in the system" the date can't be changed, which is a contradiction of other things she said (e.g. the skipping and billing later thing). In any event she refused to give me any written confirmation of any of these options.

Her whole attitude indicated she didn't care if I took my business elsewhere as a result of this inflexibility. Actually I don't think she considered that possibility; I think she believed that she was calling the shots.

The treatment coordinator was apologetic but useless.

Argh!

After all that, I just really don't have a good feeling about working with this office. I liked the ortho, and she probably doesn't know anything about this, but I know I'm going to have an attitude the whole time, half-wondering what other nasty surprises are in store.

[trisportgirl]

I'll tell you about my experience with paying, and maybe that will help you decide. I think what she was getting at is that they can't change anything once you've agreed to it - so they can put it in the system that you delay payment, or they can put in the system that you pay monthly, but you have to follow through on whatever you choose.

I am paying for my braces on my own because they're not covered, so I don't have any insurance issues. My total cost is $6780, total treatment length 18-24 months.

Their first offer was $3000 up front, then equal monthly payments for 18 months. I said I would have to delay starting until I could save up $3000, which would probably be about a year. The maximum monthly payment I could afford would be $300.

Their second offer was $1000 up front, then equal payments for 22 months. I said I would still have to wait several months to save up the $1000 up front.

We ended up doing $385 (diagnostic/records fee) up front, 3 months of $300 per month, then $264 per month until it was paid off (about 22 months I think). I was also informed that if I would have to pay anything remaining as a lump sum if I finished early (so if I finished with 2 months payments outstanding I would have to pay $528 as a lump sum before they would remove the braces).

So mine was good about adjusting the payment plan so I could start earlier. If you have doubts about your insurance coverage, why don't you just delay payments for a few months, until you're sure the labour dispute will be resolved?

[margarets]

Now it's gone beyond the insurance coverage. I'm turned off by the staff's attitude and don't want to deal with them. For whatever reason it REALLY irks me that they wanted to know all about my insurance coverage but won't even attempt to address one minor billing issue. Their attitude was rubbish; they could only offer solutions that worked out great for *them* but were absolutely no help to me at all. I want better customer service than that.

And anyway I doubt it's that difficult to change one billing date. Whatever software they're using, somebody somewhere has the authority to make changes like that. I think the billing clerk doesn't know how to do it and therefore assumes it's impossible, when it may be a matter of merely consulting the manual or calling customer support.

If the labour dispute goes as far as a lockout/suspension of benefits, I'm certain they'll be getting calls from others in my situation - as will many orthos in this city, as it's a big union.

[trisportgirl]

Good luck sorting it out! The sooner you start, the sooner you get to enjoy your awesome new smile!