In Part One, I wrote how I saw a dentist with some sketchy billing practices who included on the receipt an x-ray he did not perform. At that time, I decided to handle it by keeping a close eye on my EOB to see what insurance would pay.
Then I received a bill.
The bill included charges for the x-ray not performed. The bill also showed they submitted the claim to my insurance company, but I saw no evidence of this. No pending dental claims, no EOB.
So now what?
I think it’s important to demonstrate how these things work because it can take months or years to resolve these kinds of issues. When you think you’ve seen the last of it, you haven’t always. Sometimes it’s just nice to have examples for how to handle billing problems as they arise. How do I follow my own advice when it comes to handling billing issues? Here is what I did.
First, I called my insurance company. I wanted to ask if I missed something with a submitted claim. I knew he did not perform an x-ray, but perhaps I was simply missing the explanation of benefits. Second, as an out-of-network dentist, I wanted to know the process for claims submission and resolution. Did it matter if he submitted a claim? If insurance would pay $0 for this claim on my particular dental plan, it wouldn’t really matter if they submitted it or not.
Next, I called the dental office. The first thing they told me was that I received the bill in error. She said they submitted it twice to my insurance, but it didn’t go through. I am a little skeptical over this explanation, particularly since I had just called the insurance company and they had no record of any submissions at all. However, the important thing is that the bill did not apply. Good.
I then brought up my concern about the x-ray. “You got an x-ray,” she said.
Well, that was unexpected. I paused. “One at your office or one at the dentist who referred me? Because when I walked in the room, I saw my regular dentist’s up there on the screen.”
“No, I am looking at it. And typically, we do perform our own x-rays.”
I started wondering if I had gone completely crazy. Because I didn’t owe them any money at the time, I decided not to argue any further. “Okay, I must have forgot,” I laughed. She laughed too, telling me it’s okay, and we ended the conversation.
I tell people when they go to the doctor or hospital to write down all the services they received. This is why. Sometimes you don’t receive a bill for months or even a year or two later. By that point, it’s easy for them to try to convince you that you had services performed that you didn’t. I truly thought I had gone mad and forgotten about an x-ray. Two things made me realize I wasn’t crazy. One, I noticed it immediately when she handed me the receipt after my visit. I wouldn’t have forgotten an x-ray that quickly. Two, I wrote down the services I received shortly after the appointment. An x-ray was not on there. The only thing I could think of is if the x-ray was built into the CT machine, but there is no medical reason to get an x-ray after you have a CT; the CT gives the clearer picture. And x-ray/CT machines don’t work like that. I am not sure what happened there. There could be some kind of gnarly misunderstanding because the person helping me has no incentive to lie. Maybe when she said she was looking at it, she meant she was looking at the bill and saw that x-rays were billed? I don’t know.
Stay tuned! I am sure there will be more to this story!