I had gum surgery last year. The periodontist advised the total cost would be $30,000, of which $20,000 would be borne by the insurance company, and I would have to pay $10,000. The procedure was split into several visits. After the 1st visit, I got a notice from my insurance company that the claim would be denied due to insufficient measurements. The periodontist advised this always happened, and that the measurements were being sent. I indicated I didn't want to go through with any further treatments until the insurance company gave me an indication they would pay the bill. The periodontist said (orally, over the phone) that in the rare event the insurance company denied the claim, the periodontist would bill me only what my out-of-pocket ($10,000) portion would be. So I went ahead with the treatments.
Well, throughout last year the insurance company continued to deny the claim based on insufficient measurements. Finally, towards the end of last year, my insurance company dropped that periodontist from their network altogether.
I didn't hear any thing further from either – until today, when I got a vague bill from the perio for "treatment" in the amount of some several hundred dollars. No invoice number, no itemization, no CDT codes, no date of treatment.
What is my next move?
Ask my perio for an itemized bill, of course, but then I'm somewhat nervous they'll go back and say that I owe them $20,000 due to the insurance company denying the claim. Any advice?
Surprise bill from Periodontist
byu/Weak_Papaya1056 inpersonalfinance
Posted by Weak_Papaya1056
3 Comments
This isn’t really personal finance. It’s more contract law.
Did you sign anything that:
* Said you’d pay if insurance didn’t? If so, you’re fucked.
* Said all you’d pay is the 10k? If so, you’re good
* Wildcard: did you sign nothing and this guy is a bully? If so, tell him to pound sand and run his business better.
Either way never go back.
I am not a lawyer.
Edit: also id call the insurance company and find out why they dropped this perio, if they’ll tell you. Also, I’m not 100% sure dropping him matters as the process was started before that happened but that’s insurance policy. Something I know even less about. But hey, Mario’s brother was a creative problem solver, so
You’re reading a lot into him not being in network anymore. Usually it’s providers who leave because of shit like this where they’re not getting paid.
Regardless. If he was in network on the date of service, that’s all that matters. However, there is a time limit to file a claim and to file appeals.
Just call the provider and be polite and ask for more details. You might be amping yourself up to the point you lose it on them out of nowhere, and that isn’t a recipe for getting what you want.
I don’t see anywhere that you have paid anything out of your pocket. Can you clarify what you’ve paid thus far?