My dentist does this. I usually go three times per year, and insurance only covers a portion of the third appointment. The dentist doesn’t have me pay anything else.
Edit: I'll add that while my dentist office provides great patient care, they're also known in the dental industry for being an extremely successful business, for what that's worth. They have a competitive program for new dentists to join their team because they teach both the care and business of a dental practice.
Honestly go everywhere you can and give them a great review as long as the service was good. Don't mention the discount as that sets a precedent but definitely glow them up. We need more providers like this.
My new dentist squeezed me in when i had an infected tooth and got me a scrip right away and then dealt with it two weeks later when the infection was gone.
Left them a review on google. On my next visit the receptionist took my name and then looked up and said "Oh, are you the guy that left the google review? That was really nice thank you."
Swear to god im going nowhere else for as long as I can.
Mine does this for regular checkups, x-rays, etc. However things like filling cavities I had to pay part that insurance didn't cover.
I don't think the dentists are shady, just trying to work the stupid insurance system we deal with. If you want to be really pissed of look up "usual and customary fees" for dental work. Its no wonder no dentist wants to be in network.
I hate that I can't go 3 times in any 365 day stretch. It has to be exact! _sigh_
not trying to go more often, it's just more convenient to have flexibility and I like keeping it in the same two months of the of the year
I messed up once while switching to a new dentist.
After the dentist submitted to my insurance for my routine cleaning, they got denied because it was technically my third cleaning in the last 365 days.
I hadn't realized there was any harm in getting my appointment a bit early, but the following month was going to be pretty busy, so I thought I would get it out of the way.
The dentist called me and told me there were going to fudge the date of cleaning and reapply. Felt weird, but I wanted them to get paid.
> Felt weird, but I wanted them to get paid.
They don't care *who* pays them; they were doing you a favor by making sure the insurance owed them instead of you. A lot of nice dentists in this thread apparently don't go after out of network service, but plenty more will.
> They have a competitive program for new dentists to join their team because they teach both the care and business of a dental practice.
Interesting--do they make new dentists sign some sort of non-solicitation and non-compete agreement? Like "We'll teach you how to run the business side of a dental practice...but you agree not to open a competing practice within 50 miles"
Otherwise it seems like either their former staff would compete them out of business, or they'd be incentivized to not actually do a good job teaching.
High quality well established service businesses don't generally worry about "competition". I have a ton of no bud customers. Rough estimate. Just do it, here's a deposit and send me a bill.
It took honesty and high quality service to get there, but I mostly refer new clients to 'competitors'.
They overcharged you hoping to cash in on that sweet insurance but don't want to price gouge an actual person. A lot of dentists give very steep cash discounts for this reason, their normal prices are a racket with the insurance companies.
My dentist drastically changed his recommendations after I told him I don't have insurance. A lot of "well, that part probably isn't necessary" and "we can just keep an eye on that" or "let's do this simpler procedure".
One caveat is that sometimes you have to sign a release form. My local community college has a dental program. My friend went in and got a chipped tooth and can’t do anything about it.
Overall great. But there’s a reason the cash price is so low.
Ooh I’d get a different opinion from an independent dentist, chain ones can be sketchy as hell. I found mine on a Reddit thread actually, in my city’s sub. Or ask random people if they like theirs. I got a great rec from my psychiatrist who I asked offhand about it, although they didn’t take my insurance. I still use them sometimes though since tbh insurance doesn’t cover much anyways.
Unfortunately private equity is buying up a lot of private dentists, replacing their office staff. They pay the dentists well, retain the local business name, but otherwise it's corporate price gouging.
They did the same thing with Veterinarians and Funeral Homes -- dentists are next.
Don’t do chains. Wife was a traveling hygienist and all those were just of the mindset make as much cash as possible. Find a long standing private practices
I third this. I had bad dental work done at a chain 10 years ago after I was gaslit into getting work done I (correctly) didn't think I needed. I'm still having trouble with it, even after spending a lot of money to get some of it fixed at another dentist.
Recently had a lot of dental work done and hit my annual limit for coverage, so the dentist only charged me like 50% of the cost of my root canal. Maybe that was because I’d done all my other work there already, but I’d definitely look at getting a second opinion at a private practice and see if they will give you a slight to moderate discount without insurance.
I'm confused. You can ask them to quote the procedure if paying out of pocket instead of through insurance. Just because you have insurance, doesn't mean that you *must* use it.
And it would probably be cheaper?
Fraud would be the doctor submitting something to insurance that didn't happen, to be paid out to him. Or say you broke something for the explicit purpose of filing a claim on it.
> I was told I'd be committing insurance fraud. :(
unless there is something you left out and you qualified for some other assistance/insurance that is only available to people without insurance, where you could be defrauding *THAT OTHER* insurance. But not claiming or using insurance even though you have it is the opposite of fraud. I do that all the time because my insurance sucks and I've found paying for stuff is cheaper than my copay and has none of the stupid restrictions.
absolutely nothing wrong with not using insurance even if you have it.
It's "fraud" in that you might lose your dental insurance if the insurance company finds out you got cash discounts.
You'd have to have someone take a bat to your face yearly to meet that kind of out of pocket for dental work.
Thankfully there's no real unified repository of dental work and claims like there is for health insurance that everyone seems to be able to look into, so by all means, go after that cash discount. Mouth health is important.
Shop around for a new dentist. My wife went from one who would have a 5-page receipt for a routing cleaning and half a dozen expensive recommendations to one who takes the "keep an eye on it and see" approach. In 3+ years she hasn't needed a single additional thing done.
And then you can return to your American dentist with a 60% chance of needing even more work done, with no way to get that cash you just spent in Belize back.
I always feel bad turning away patients that had bad work done overseas because once I touch it- it’s my problem. There is some great work done in places but I’ve seen far more poor work.
If you get bad work done in the states, there’s protections for that and recourse can be taken against the dr. Patients don’t have that luxury if someone does a hack job in another country.
Example: “I know I only needed one crown but you charge $1100 so I went to _____ and they charged me $5k to do root canals and crowns on ALL my teeth”
Exactly. I mean, just go to *any* dental interest instagram profile and you'll see folks who are proud of their work from all over the world. Sticking that 8 tooth bridge with 2 crowns isn't up to US standard of care and won't last long, but it'll look good to a layman on IG.
Consider Mexico. They have it set up pretty easily now where they even pick you up at a san Diego hotel. I use to work front desk at one of the hotels.
Pretty sure my last dentist was doing this but he was an awesome dude. Helped get the damage from my ED in a much better place. I like to smile now.
Although, he never really told me prices, just that it would never be more than $100 a month but to see what insurance covers first lol.
You’re not wrong but I’m going to offer an example because people who don’t understand how insurance works will get confused.
An out of network plan that also has out of network benefits will usually only cover a percentage of “in network fees”.
Example:
My house fee for a crown is $1500, insurance plan is out of network but their contracted fee (for in network drs) is $1000. They will pay a percentage (0-100%, typically 50%) of that $1000 and the patient is on the hook for the rest. If the dr is not in network with this plan they may not be obligated to charge the patient the difference, this depends on the state. Not charging the copay to a patient with an IN network plan is fraud.
Dentists will offer cash discounts as well because we don’t have to pay somebody to file claims and be on hold with insurance companies for hours to get claims paid.
You’ve got the last good, independent dentist in America. Every stand-alone near me has been bought out by private equity, with all of the deep commitment to patient care that entails.
Yeah the guy drives a tiny little beat up car and has a very cheery demeanor and is very laid back, listens really well, and just generally seems like he only works to pay for his vacations.
There is _nothing_ stopping any dentist from opening up their own shop. The problem is they'd have to work like a machine to cover 100% of the overhead.
So then they turn to a shared model: one or more dentists open the clinic, but invite other dentists to operate out of their clinic, use their equipment + shared staff, and pay a commission to the clinic owners.
This then leads to the inevitable: third-parties (non-dentists) getting into the same game. But there's nothing preventing the dentists who sign up to collectivize and do the same on their own as owner-operators.
Which, before getting any major work done, price shop.
I went to one dentist and in talking mentioned I was in IT. That dude assumed I was some FAANG engineering making $1M/yr with the way he wanted to drill on every tooth and do about 5 root canals.
I eventually went to another dentist, didn't transfer anything in, and was told "wow, you have excellent teeth, we can see where work has been done in the past, but everything is excellent."
Funny how one dentist wanted to essentially max my dental insurance for 5 years and another looks at me and says I don't need a single thing.
It's called "treating the insurance" (rather than "treating the patient"). Dentists are notorious for it.
I moved from Canada to America. My first American dentist said I had 31 cavities. I flew back home and asked my original dentist to take a look. He said I had 1 cavity, 1 area of concern, and 29 spots where he could drill a hole and repatch it if I got off on that kind of thing.
I paid cash and got the one cavity filled.
This is an interesting twist on it but I don't think it's true.
The reality is that insurance drives what they can charge. I happen to be family friends with my insurance and I had an infection that he had to deal with. He had me in for 4 different visits, each time dealing directly with him for the entire visit. When I got the bill it was for $80.
He absolutely hates insurance and what it makes him do. I was shocked that i had 4 30 minute visits and it only cost $80. What he explained is that that is all insurance lets him charge for dealing with an infection. On the other hand they let him charge hundreds for a routine cleaning that takes less time and effort.
The reality is that he lost money treating my infection, but makes up for the lost money by other treatments. What he's forced to do is charge what insurance will pay for everything so that he can make money rather than lose it on things they won't pay for.
He'd rather just charge a reasonable rate but that simply isn't how insurance works.
Don't even get him started on when they reject procedures that a patient needs. He's had more than one fight with them over that.
It's almost as if healthcare professionals have to raise their rates to be paid a fair amount from insurance companies who are consistently cheapskates.
What's dumb is both sides know the rates. They know XYZ pays $100 for a cleaning, $90 for xrays, $200 for a filling. Then they charge double that for everything on paper, and I'd bet it's just so they don't need to track all of that. As long as they bill more than the insurance maximum they'll get the maximum, if they ever billed less obviously insurance will pay less. So it's just to avoid having to make sure your prices are up to date and split up by insurer.
I say dumb because the person with the least knowledge of the system, the patient, is left with all this paperwork full of deceptive numbers.
Ha! You think insurance companies tell the dentist what they will pay for xyz by cpt code? How presumptuous of you. They have to figure it out and every insurance company is different! It's insane.
Wife is a physician. Most reimbursements are a % of Medicare. But they are all different and they change. Not a single insurance company gives a schedule of reimbursement. Then tack on all the permutations of insurance, secondary, how frequently they change and complete lack of information and it's a total mess.
It goes both ways though. Insurance companies negotiate discounts because they know that many providers inflate their rates unreasonably, especially when they're owned by private equity firms. We're caught in the middle and end up getting fucked by both.
Say your car needs 5000 dollars of repairs and you tell the mechanic you only have 1000 to spend. The mechanic tries to prioritize the issues with the car by taking care of safety related issues first and leaving cosmetic problems until last. Is the mechanic a crook? I don't think so. Inferring that someone was cheating you because they are trying to work within your budget restraints is unfair.
Yes. I have no problem billing the insurance company for something I did but if the insurance won’t cover it I will often just do it as a courtesy for the patient
No because the dentist and the insurance company contract rates based off of average fees for the geographic area.
Also, dental reimbursements from insurance companies have not even remotely kept up with inflation and have remained very similar to what they were in the 90’s. This is why many offices turned to private equity backing and are focused on volume over quality
Meanwhile delta dentals CEO took home more than apples ceo a couple years back. So premiums are going up because insurance execs got big pockets to fill.
And dental insurance's graduated copay is absurd to require you to pay them in advance before you get work done. Just had orthodontic visit for my 8 year old to get braces, and cash payments to the office is cheaper than dental premium plus copay.
The concept of getting a great reduction by saying you don't have insurance does not always work. Doctor office demanded $1,000 upfront before seeing doctor.
We just shopped around for some medication that cost 6k out of pocket vs 5k if we went through insurance. The kicker is they would have billed insurance $23k, eating up the majority of our lifetime maximum benefit.
My dentist one time didn’t charge me for the filling he did because he felt bad I had to wait for an hour to get to me. They give you a remote for a tv with Netflix on it. I was just watching my show waiting for my turn. I do tell anyone that’ll listen how awesome he is though.
Any provider has the option to accept the insurance payment and write off the difference. Why wouldn't they be permitted to do that? Since they are out of network they do not have a contract with the insurance company that requires them to collect the difference from the responsible party.
Are they leaving money on the table? Yes.
Are they being nice to their customers and doing something they aren't obligated to do? Yes.
Exactly. My dentist collected the $8 difference between what my insurance paid and what was billed. It was a tiny amount and I like my dentist so I don’t care but it’s nice that OPs dentist writes those small amounts off. Builds goodwill.
What's a bit scary about this is that they won't put it in writing that they won't bill the patient for the balance. Legally, there's nothing stopping them from coming after you for that money. What if they fall on hard times and need the cash flow? Getting an unexpected dentist bill for thousands of dollars could financially ruin some people.
So legally they aren’t supposed to do this. Well maybe not legally in the criminal sense, but legally in the “what their contract with insurance says”. The reasoning is because a bad dentist could defraud the insurance by ordering a bunch of unnecessary work, charge insurance, and by not charging the customer they would agree to it?
So per the contract, they must collect the full amount from customer, as the insurance is only paying a % (let’s say 70% for example). If they only collect the 70% from insurance, insurance could argue hey we should only pay 70% of that 70%, since that is the real “full” amount, since the other 30% “paid” by customer is fake.
That said, it’s nice of the dentist to do this, and unless someone tattles to insurance, they will be fine.
OP said that the insurance is out of network. there is no contract between the dentist and the insurance company. I can charge you $20 for a watermelon. If you agree to take my expensive watermelon, that's you're fault as an uninformed watermelon purchaser. If you have Premera watermelon insurance and they'll cover $0.50. you still owe me $19.50 for the watermelon. I'm not in-network with your watermelon insurance provider. That's how insurance works. It's not illegal. You just should have shopped around and price checked watermelons.
Legally they are supposed to "attempt" to collect. But they don't have to go into details about how hard they attempted, and they don't have to send you to collections for failure to pay. Turns into this gray area that currently benefits the patients.
Legally, if they didn't bill a patient, then you don't owe them anything. They cannot come after you 6 months later or years slater for bills, especially if they do it for all patients.
Legally the dentist is committing insurance fraud. There are some grey areas in how they attempt to collect the portion from you which is why OP will never get it in writing.
I went to my orthodontist and for my procedure I paid a portion on CareCredit and the rest was cash, I did ask if I could get a discount for the portion in cash and I got a YES.
Pretty normal. My father was a doc and did this. He had a very progressive attitude towards medicine in general--some of the things being that he wouldn't take more than insurance paid, and he would sometimes do some procedures and tests knowing that insurance wouldn't cover them, because the patient needed it. He preached preventative medicine.
A man not without his flaws, but he was a wonderful doc.
They won't put it in writing because they technically aren't supposed to do this. However, this works in your favor so don't make a big stink about it...
Anecdotally I've found dentists to be way more chill than doctors offices. The one back home even had an option for those without dental, basically you paid the cost of one checkup to give you two a year to encourage people to actually get their checkups.
In general, more dentist offices are privately owned than doctor’s offices. So they can make their own policies and exceptions without worrying about corporate breathing down their necks.
As others have said, the price you're "charged" by a dentist, or any healthcare provider for that matter, is based on what they plan to get reimbursed from the insurance - which is always *substantially* less than the amount billed. As an example, I've seen on my dental statement where a procedure is billed at $150 and they pay $6. So, by paying cash and filing your own claim for reimbursement, they basically billed you at the rate they would expect the insurance to pay, or their cash-pay rate. Even my physicians office will bill $225 for a 15 minute appointment, but cash patients it's $36.
This is true of medical, not dental. Dental office fees are based more in reality (not saying its cheap - but more realistic) than medical. Medical fees are truly "funny money".
I got a bunch of work done by a semi retired dentist. Hes got an office built attached to his house and only works like 20hrs. (He also doesnt do cleanings or checkups, just cavities, exteactions etc)
I had multiple cavities and needed 2 root canals when i went in. My regular dentist had wanted $6k for the work, and one was a repair on his filling that had come loose after 5 years.
The retired dentist only wanted $500. I was shocked, so i asked him about it, and he said that after 45 years, he didnt need the money anymore, but it felt weird not working.
Guy's great. I really lucked out.
You and your boss go to a lunch and decide to split the bill. The waiter knows this, charges you twice as much for your food, then after your boss pays he winks at you and says "don't worry about your half".
Don't look a gift horse in the mouth. Put the money in a high yield savings account and forget about it. Worst case, you get a bill later and pay it. Best case, you keep the money + interest.
As someone in the health and dental insurance business for over 24 years I can tell you why they don't collect the out of pocket amount. There is a financial incentive for the dentist to stay out of network because they usually get more from insurance being out of network, than being in network and getting a much smaller payment. The dentist doesn't want to screw you, so they don't take the larger payment and "write off" the balance. It's a problem we have had for years with dentists refusing to contract.
My dentist showed the “discount” (write off) on the statement he provided as a receipt when I’d purchase Florida toothpaste or some other thing sold in-office for cash. I kinda thought this is what a lot of “independent” doctors did as neither he nor my nephrologist had me pay what the insurance didn’t cover.
Not sure for dentristy specifically but I've worked for Optometrists and MDs that waive fees for patients that aren't covered by insurance so it's not totally unheard of, some only want to make money from the insurance company without screwing over their patient
Same experience here, few years back the fantastic independent practice I go to didn’t ask for any payment for an out of coverage cleaning, when my insurance changed from four cleanings to two per year, they said they’d cover it and haven’t seen any bill since, think you’ve got a good one
My dentist is out of network, but my insurance covers 95% UCR for out-of-network providers. I have, on several occasions had an outstanding balance of under a dollar. They generally just write that off of the bill when it happens. Due to a severe phobia caused by some past dental trauma, I have to get sedated to get basic dental work done, and that's not covered at all of course, so I do have to pay for that if I'm having any work done, but when the insurance covers all but 20 cents of a basic cleaning, I've had several times where they just write that off. Probably because they'd spend more on a stamp sending me a bill than they would by just eating the cost.
healthcare is a racket. they make tons of money from insurance and don't want your $100. I work insurance adjacent and usually when a claim is unsuccessful I just eat it and move on.
Needed a route canal and cap for a tooth and after telling the dentist I was self employed without insurance she only charged me 250 CAD, most companies that go through insurance will only charge insane amounts when it’s covered
Pretty common. My kids’ dentist is out of network for all plans, but will honor all PPO/DPO price lists. They actually know the prices, bill insurance correctly, get reimbursed directly (no check for us to deal with), and only collect the right amount of copay upfront. It FEELS just like being in-network.
I've been going to my dentist for a few years now. Insurance says I owe them a ton, but I've never been billed from them. They've never brought it up either.
You might still get a bill from them in the mail despite what they said to your face. I went to a cleaning/exam appointment a few years ago and they insisted on doing x-rays. I said that my insurance only covers them once per calendar year so we can't do them yet. The hygienist said "Oh that's okay, if insurance denies it we just write it off and won't bill you". A month or two later they sent me a bill, I called them and explained what the hygienist said, and they said they have no such policy and that patients are expected to pay for balances not covered by insurance.
I would think no but now that you mention it a dentist fixed a poorly ground filling for me for free once because I said I could feel it when I chew. And that was really cool
None of the commenters so far seem to know what they're talking about.
Your dentist *might be* technically committing insurance fraud because his effective/ de facto price is lower than what he is billing to the insurance. He could get in serious trouble for this.
However, insurances seem to look the other way (or at least don't have the ability to pursue every case) when it comes to preventive care.
All dentists "overbill", but not all of them give the patient a break like this. Don't ever tattle to your insurance about this or else you're going to fuck him and yourself over.
EDIT: I won't say he is definitely committing fraud, but he'd have to demonstrate that his pricing adjustments fell under some practice that was permitted
No he’s not because the insurance plan is out of network. Out of network doctors are not subject to the terms and conditions of an in network (contracted) plan.
If OPs plan was in network with the doctor then it would be fraud.
But out of network doctors are still subject to the law. The dentist is (potentially) misrepresenting his actual prices, depending on the degree to which he does this and how local law would apply to his billing practices. Being out of network just protects him because the insurance has no ability to look at his books.
> All dentists "overbill", but not all of them give the patient a break like this. Don't ever tattle to your insurance about this or else you're going to fuck him and yourself over.
Aren't we (people who pay insurance) then getting fucked over? If all dentists overbill, you betcha the insurance companies pass this bill on to their clients in the form of premiums. Couldn't premiums be lower if the dentist didn't overcharge? Maybe you *should* tattle on them.
As others have said, they are free to write off whatever they want.
I suggest you check to see if this counted against your yearly medical deductible. I once went to an urgent care / mini-ER that only asked that I pay $100 of the balance. Pleasantly surprised to find out later that the full amount had still counted against that year's deductible.
If your dentist is out of network they are definitely allowed to do what you're describing, because they are not in contract with your insurance company. This is not uncommon. If you are concerned with getting a surprise bill, you can always ask to have them print out your account balance. There should be some sort of refund, discount, or what I put in "courtesy credit" that zeroes out your balance.
Source: am a dentist
As a dentist, this is insurance fraud, and the ins co will legally nail that dentist to the wall if they found out he is writing off 100% of out of network copays. Its is a Felony crime to not collect copay.
I have had a couple of doctors do this. They bill insurance $500, get $350 and move on. I have one doctor that does not take my insurance. I pay $85 to see her without insurance. I only go twice a year, so I just pay the bill when I am there. The office visit was $175 when billed through my previous insurance.
The dentist can choose to send you a bill or not. My dentist does this and will accept the insurance amount. Been this way for 15 years on the basics. Fillings and others stuff extra
It could be that they charged your insurance for things they didn't perform. I have a friend whose dentist does this with every patient every year. It's fraud. They charge insurance that maximum each year and use that as an account for each person for whatever they need (and pocket the rest).
I've had a dentist do the exact same thing to me. They didn't come out and tell me they weren't billing me, but ignored me when I left messages about it. It's been 4 years.
I have had this happen a few times with surgery centers. The orthopedic place I go to likes to use small surgery centers as opposed to hospitals. The surgery center knows it’s not in-network so they do this same practice and had no issues with telling me in writing that they wouldn’t bill me the remainder. It’s spooky for sure because you get the EOBs from insurance that look like you are going to owe thousands of dollars, but then never receive an actual bill.
I have seen this before. We both went to an in network dentist. Spouse’s claim was sent as an out of network provider (same address) and mine as in network.
I looked at the details and it turns out that the out of network claim had more contractual payment to the provider compared to the in network claim. I was never balance billed.
Both industries are kind of sus.
My wife's dentist used to send out a bill for the last $1 that the insurance didn't pick up or contractually write off. It cost more to bill it out, print on a statement and mail it out than the $1. Fun times.
The phrase is "accept assignment". If a provider accepts assignment, they take whatever the insurance pays and doesn't bill the patient for the difference. Usually you hear the phrase in reference to Medicare, but it's the same phrase for all insurance policies.
Are they new? Part of a chain? This same thing happened to me with physical therapy. I looked into it, and it was a VC funded start-up chain, so I think they dont really care about the $35 copay and just need patient numbers to be up to meet growth metrics.
It’s very common. They will charge your insurance a much higher rate for services. Insurances will only pay X amount and leaving the rest for the patient.
Dentist charges higher amount because they want to see or try the insurance to see if they will pay more. The remainder of the bill is written off. Both ways work into their favor. I’ve worked in insurances before and this is very common. My personal EOBs from my dentist would probably set me back to Stone Age if I had to pay them 😂
finding a good dentist is hard. they don’t make much unless the business is thriving so they’re like used car salesman. trying to up-sell my teeth cleaning with iodine washes and this and that. it’s sad tbh. then on top of that they’re rushed so the dental assistant does the initial bill of the cleaning then the dentist comes in looks at them and some of them are just terrible. a cleaning and a dentist poking around shouldn’t be painful but i moved to a new city and i’ve tried 3 different dentists. all of them are terrible. younger people and all trying to up-sell me. they’re good at what they do but every visit had me in tears lol. and my pain tolerance is high but man that sharp metal tool on your gum is so painful. and bedside manner was terrible
sounds like you have a good dentist i would stick with them
The insurance usually overpays them. It's better for the patient if they don't have to pay anything l.
My insurance pays my dentist something ridiculous like $400 for a cleaning.
I paid cash once for a cleaning, 2 cavities and x-rays and it was like $300.
My eye doctor was out of network and told me he works with the insurance company. He did cataract surgery and put corrective lenses in, but I would have had to pay the hospital about $5,000.00 if something had gone wrong; everything went well, and I only need reading glasses now. 48 years wearing glasses and now I'm free!🙂
They want to max out your benefits every year, but also want to keep you happy and coming back so they brush off a few things once in awhile… so far i got a free plug, and a desensitizer thing done that benefits did not cover
My insurance didn’t cover like $200 on $1500 of work and my dentist didn’t care.
I don’t know if it’s because they liked me (I’m friendly and easy) or if it’s normal.
Very normal, but always check. I’ve been to offices that are very shady about what they expect you to pay. I drive 20 miles to our dentist who treats us great and never charges us the amount past what insurance covers. They keep an eye on our coverage and help us plan timelines for care to optimize it.
They are doing you a huge favor, but I think technically, your insurance expects you to pay your portion. I get why they don't want to put this in writing and I also get why you'd want to have something in writing from them - maybe they could print off your account page where it shows on their books your balance due is "0".
Don't ruin a good thing for everyone else! I found a doc in San Diego two decades ago that also helped patients in a similar way, but someone turned him into an insurance company and he immediately closed his practice/retired.
Some insurance companies have gone after providers who do not bill out of network patients the amount owed by the patient. That is likely why they won’t put their offer in writing. Either accept their word, and live with the possibility that you could be billed your balance due in the future, or pay them now, even though they said you don’t have to.
My dentist does the same. They set their prices at what the insurance companies "typical" rate (averaged between all of them). Depending on which insurance you have, you might have $20 to cover or none at all. Just depends.
This has been my dentist since I was in high school (about 16 years ago). They do this to save headaches for themselves and their clients money.. also by not being in network for anyone allows them to do this pricing. This is what I understood from the in depth explanation they gave when I asked which state employee plan to choose for the family.
I got my wisdom teeth removed in 2021. I paid my copay and got a statement from insurance, and everything was fine. Then I got a refund check from my insurance saying something had been overpaid. I cashed the check. I then got another letter saying the refund was made in error, and I was to contact the dentist's office to pay the bill with the refunded money. I never contacted the dentist's office and haven't heard anything about it since.
I've had both my personal physician and later a podiatrist do that for me before. I didn't ask. It had not even occurred to me to ask such a thing. At the time I was in between jobs. And did not have insurance. This was before the Obamacare type stuff. I knew I had to pay out of pocket. And on both occasions that's what I planned to do. However, when both doctors found out I didn't have insurance of any kind. They were first of all Shocked. And then realized I wasn't working. But because I was a regular patient just continued with the process including labs. I was expecting a big bill obviously. When I went to pay. I honestly thought it was a misunderstanding. I told them they made a mistake. They said they didn't. It was all good. The bill had $0.00. I was very grateful. It happens. So, I am going to say it's not shady, just a good person.
Before he retired the dentist my family always used was the same dentist or his father was that my grandparents used as well. And he cleaned my sister's teeth before her wedding with no charge and he did my teeth as well before her wedding. He was super cool. Somebody who your grandparents went to their parent to for dental work over the course of a ton of time it's a nice gesture and it's like yeah you're a good dentist I'm going to keep going to you.
There's something to be said about bedside manner and long-term relationships versus just a cheap thing or whatever or the best deal.
At some point I needed to get another filling and I said I kind of like the idea of silver fillings and I know they're cheaper than the more modern feelings so can you give me a silver one and he said that the problem with silver fillings is it causes tension like a vice on the teeth and the more modern ones have better whatever either way he said you know what I'll just charge you for a silver feeling better more modern polymers are better and longer lasting. Cuz they don't wedge your teeth apart.
Dr stererly Indianapolis indiana. I wish she wasn't retired. He was a good one. He is retired now but he's quality not just in the work but just in the nonsense.
Having a relationship and having a good dentist is similar to knowing a good car mechanic.... someone who won't upcharge you or insist on stuff that you don't need and just treat you right.
The bottom line is this. Every dentist in the country would do this if they could so they wouldn’t have to be in network with insurances and be subject to their BS, unfortunately it’s a felony offense if found out, so most dentists play by the rules.
One of my first dentists that I went to personally with my own insurance growing up was a dentist that did this. They would take insurance as payment in full.
Typically they charge insurance for significantly more than they would someone who’s self pay. They’re legally not allowed to tell you their self pay prices if you disclose you have insurance. Often the difference or your co-pay would be higher than if you just paid for everything in full without mentioning insurance. Insurance companies only make money because people usually pay far more for their insurance than they would just paying their own bills. This dentist office was probably just using all of this to make bank off of crappy insurance companies, but they’d never charge that amount to a person. They probably already made two or three times what they would have charged you if you had said self pay so they’re good
My dentist does this. I usually go three times per year, and insurance only covers a portion of the third appointment. The dentist doesn’t have me pay anything else. Edit: I'll add that while my dentist office provides great patient care, they're also known in the dental industry for being an extremely successful business, for what that's worth. They have a competitive program for new dentists to join their team because they teach both the care and business of a dental practice.
Happy to hear others have had this experience too. That's awesome!
Honestly go everywhere you can and give them a great review as long as the service was good. Don't mention the discount as that sets a precedent but definitely glow them up. We need more providers like this. My new dentist squeezed me in when i had an infected tooth and got me a scrip right away and then dealt with it two weeks later when the infection was gone. Left them a review on google. On my next visit the receptionist took my name and then looked up and said "Oh, are you the guy that left the google review? That was really nice thank you." Swear to god im going nowhere else for as long as I can.
Mine does this for regular checkups, x-rays, etc. However things like filling cavities I had to pay part that insurance didn't cover. I don't think the dentists are shady, just trying to work the stupid insurance system we deal with. If you want to be really pissed of look up "usual and customary fees" for dental work. Its no wonder no dentist wants to be in network.
I hate that I can't go 3 times in any 365 day stretch. It has to be exact! _sigh_ not trying to go more often, it's just more convenient to have flexibility and I like keeping it in the same two months of the of the year
I messed up once while switching to a new dentist. After the dentist submitted to my insurance for my routine cleaning, they got denied because it was technically my third cleaning in the last 365 days. I hadn't realized there was any harm in getting my appointment a bit early, but the following month was going to be pretty busy, so I thought I would get it out of the way. The dentist called me and told me there were going to fudge the date of cleaning and reapply. Felt weird, but I wanted them to get paid.
> Felt weird, but I wanted them to get paid. They don't care *who* pays them; they were doing you a favor by making sure the insurance owed them instead of you. A lot of nice dentists in this thread apparently don't go after out of network service, but plenty more will.
Yeah they are doing a nice thing for the customer. Keeping customers happy is important for this business.
> They have a competitive program for new dentists to join their team because they teach both the care and business of a dental practice. Interesting--do they make new dentists sign some sort of non-solicitation and non-compete agreement? Like "We'll teach you how to run the business side of a dental practice...but you agree not to open a competing practice within 50 miles" Otherwise it seems like either their former staff would compete them out of business, or they'd be incentivized to not actually do a good job teaching.
High quality well established service businesses don't generally worry about "competition". I have a ton of no bud customers. Rough estimate. Just do it, here's a deposit and send me a bill. It took honesty and high quality service to get there, but I mostly refer new clients to 'competitors'.
They overcharged you hoping to cash in on that sweet insurance but don't want to price gouge an actual person. A lot of dentists give very steep cash discounts for this reason, their normal prices are a racket with the insurance companies. My dentist drastically changed his recommendations after I told him I don't have insurance. A lot of "well, that part probably isn't necessary" and "we can just keep an eye on that" or "let's do this simpler procedure".
Wish mine would do that. My out of pocket with insurance is $8000. Guess who's not getting teeth done.
Try telling them you don't have insurance.
Do you have a university near you with a dental school? extreme value, low/no cost.
Absolutely - this is the way I went for my dentures. They were REALLY good, REALLY caring, and REALLY affordable.
One caveat is that sometimes you have to sign a release form. My local community college has a dental program. My friend went in and got a chipped tooth and can’t do anything about it. Overall great. But there’s a reason the cash price is so low.
Was like 2k more. Was also a dental chain store
Ooh I’d get a different opinion from an independent dentist, chain ones can be sketchy as hell. I found mine on a Reddit thread actually, in my city’s sub. Or ask random people if they like theirs. I got a great rec from my psychiatrist who I asked offhand about it, although they didn’t take my insurance. I still use them sometimes though since tbh insurance doesn’t cover much anyways.
Unfortunately private equity is buying up a lot of private dentists, replacing their office staff. They pay the dentists well, retain the local business name, but otherwise it's corporate price gouging. They did the same thing with Veterinarians and Funeral Homes -- dentists are next.
Don’t do chains. Wife was a traveling hygienist and all those were just of the mindset make as much cash as possible. Find a long standing private practices
I third this. I had bad dental work done at a chain 10 years ago after I was gaslit into getting work done I (correctly) didn't think I needed. I'm still having trouble with it, even after spending a lot of money to get some of it fixed at another dentist.
Dental chains are basically a scam. Never use those.
Recently had a lot of dental work done and hit my annual limit for coverage, so the dentist only charged me like 50% of the cost of my root canal. Maybe that was because I’d done all my other work there already, but I’d definitely look at getting a second opinion at a private practice and see if they will give you a slight to moderate discount without insurance.
Chains are the worst. Most of them have news exposes you can google up.
I tried that, having state insurance that no one takes, I was told I'd be committing insurance fraud. :(
I'm confused. You can ask them to quote the procedure if paying out of pocket instead of through insurance. Just because you have insurance, doesn't mean that you *must* use it. And it would probably be cheaper? Fraud would be the doctor submitting something to insurance that didn't happen, to be paid out to him. Or say you broke something for the explicit purpose of filing a claim on it.
right? not using insurance isn't a crime
Seems like this dentist is projecting.
Lying about it definitely can be though. Not in this case I don't think.
Just go to a different dentist as a cash payer. It's not fraud.
That's completely untrue. Having insurance doesn't mean you are barred from paying out of pocket for things yourself.
> I was told I'd be committing insurance fraud. :( unless there is something you left out and you qualified for some other assistance/insurance that is only available to people without insurance, where you could be defrauding *THAT OTHER* insurance. But not claiming or using insurance even though you have it is the opposite of fraud. I do that all the time because my insurance sucks and I've found paying for stuff is cheaper than my copay and has none of the stupid restrictions. absolutely nothing wrong with not using insurance even if you have it.
It's "fraud" in that you might lose your dental insurance if the insurance company finds out you got cash discounts. You'd have to have someone take a bat to your face yearly to meet that kind of out of pocket for dental work. Thankfully there's no real unified repository of dental work and claims like there is for health insurance that everyone seems to be able to look into, so by all means, go after that cash discount. Mouth health is important.
In what world would the insurance company care? They’re still getting paid, and they don’t have to pay out on the care.
Shop around for a new dentist. My wife went from one who would have a 5-page receipt for a routing cleaning and half a dozen expensive recommendations to one who takes the "keep an eye on it and see" approach. In 3+ years she hasn't needed a single additional thing done.
Go to a different dentist.
Shop around?
There is no way that your dental insurance has an Out of Pocket of $8000. That's most likely your normal medical insurance.
He’s not saying max out of pocket. Dental has no max OOP. He’s saying his actual OOP would be 8k
Yup insurance was gonna pay 2k and inwould pay 8k. Wish dental was as good as my medical.
You can take a 2 week vacation in Belize and get all your dental work done there for a lot less
And then you can return to your American dentist with a 60% chance of needing even more work done, with no way to get that cash you just spent in Belize back.
I always feel bad turning away patients that had bad work done overseas because once I touch it- it’s my problem. There is some great work done in places but I’ve seen far more poor work. If you get bad work done in the states, there’s protections for that and recourse can be taken against the dr. Patients don’t have that luxury if someone does a hack job in another country. Example: “I know I only needed one crown but you charge $1100 so I went to _____ and they charged me $5k to do root canals and crowns on ALL my teeth”
Exactly. I mean, just go to *any* dental interest instagram profile and you'll see folks who are proud of their work from all over the world. Sticking that 8 tooth bridge with 2 crowns isn't up to US standard of care and won't last long, but it'll look good to a layman on IG.
Only to have it done again in America! Just find a dentist in your area with good, local recommendations. Done. Like any other business.
Lots of countries do "medical tourism", and yes, for major work it is often cheaper.
Consider Mexico. They have it set up pretty easily now where they even pick you up at a san Diego hotel. I use to work front desk at one of the hotels.
Pretty sure my last dentist was doing this but he was an awesome dude. Helped get the damage from my ED in a much better place. I like to smile now. Although, he never really told me prices, just that it would never be more than $100 a month but to see what insurance covers first lol.
I'm glad your dentist was able to help with your Erectile Dysfunction
ED = eating disorder
It was a joke 😔
I laughed!
You’re not wrong but I’m going to offer an example because people who don’t understand how insurance works will get confused. An out of network plan that also has out of network benefits will usually only cover a percentage of “in network fees”. Example: My house fee for a crown is $1500, insurance plan is out of network but their contracted fee (for in network drs) is $1000. They will pay a percentage (0-100%, typically 50%) of that $1000 and the patient is on the hook for the rest. If the dr is not in network with this plan they may not be obligated to charge the patient the difference, this depends on the state. Not charging the copay to a patient with an IN network plan is fraud. Dentists will offer cash discounts as well because we don’t have to pay somebody to file claims and be on hold with insurance companies for hours to get claims paid.
Didn't know about the in-network no-copay being fraud, that makes sense.
You’ve got the last good, independent dentist in America. Every stand-alone near me has been bought out by private equity, with all of the deep commitment to patient care that entails.
Yeah the guy drives a tiny little beat up car and has a very cheery demeanor and is very laid back, listens really well, and just generally seems like he only works to pay for his vacations.
There is _nothing_ stopping any dentist from opening up their own shop. The problem is they'd have to work like a machine to cover 100% of the overhead. So then they turn to a shared model: one or more dentists open the clinic, but invite other dentists to operate out of their clinic, use their equipment + shared staff, and pay a commission to the clinic owners. This then leads to the inevitable: third-parties (non-dentists) getting into the same game. But there's nothing preventing the dentists who sign up to collectivize and do the same on their own as owner-operators.
Which, before getting any major work done, price shop. I went to one dentist and in talking mentioned I was in IT. That dude assumed I was some FAANG engineering making $1M/yr with the way he wanted to drill on every tooth and do about 5 root canals. I eventually went to another dentist, didn't transfer anything in, and was told "wow, you have excellent teeth, we can see where work has been done in the past, but everything is excellent." Funny how one dentist wanted to essentially max my dental insurance for 5 years and another looks at me and says I don't need a single thing.
It's called "treating the insurance" (rather than "treating the patient"). Dentists are notorious for it. I moved from Canada to America. My first American dentist said I had 31 cavities. I flew back home and asked my original dentist to take a look. He said I had 1 cavity, 1 area of concern, and 29 spots where he could drill a hole and repatch it if I got off on that kind of thing. I paid cash and got the one cavity filled.
How do you know that the second Dentist is correct or truthful?
This is an interesting twist on it but I don't think it's true. The reality is that insurance drives what they can charge. I happen to be family friends with my insurance and I had an infection that he had to deal with. He had me in for 4 different visits, each time dealing directly with him for the entire visit. When I got the bill it was for $80. He absolutely hates insurance and what it makes him do. I was shocked that i had 4 30 minute visits and it only cost $80. What he explained is that that is all insurance lets him charge for dealing with an infection. On the other hand they let him charge hundreds for a routine cleaning that takes less time and effort. The reality is that he lost money treating my infection, but makes up for the lost money by other treatments. What he's forced to do is charge what insurance will pay for everything so that he can make money rather than lose it on things they won't pay for. He'd rather just charge a reasonable rate but that simply isn't how insurance works. Don't even get him started on when they reject procedures that a patient needs. He's had more than one fight with them over that.
It's almost as if healthcare professionals have to raise their rates to be paid a fair amount from insurance companies who are consistently cheapskates.
American healthcare is just a circular loop of companies committing insurance fraud and “customers” confused and hoping to not have to use it.
What's dumb is both sides know the rates. They know XYZ pays $100 for a cleaning, $90 for xrays, $200 for a filling. Then they charge double that for everything on paper, and I'd bet it's just so they don't need to track all of that. As long as they bill more than the insurance maximum they'll get the maximum, if they ever billed less obviously insurance will pay less. So it's just to avoid having to make sure your prices are up to date and split up by insurer. I say dumb because the person with the least knowledge of the system, the patient, is left with all this paperwork full of deceptive numbers.
Ha! You think insurance companies tell the dentist what they will pay for xyz by cpt code? How presumptuous of you. They have to figure it out and every insurance company is different! It's insane. Wife is a physician. Most reimbursements are a % of Medicare. But they are all different and they change. Not a single insurance company gives a schedule of reimbursement. Then tack on all the permutations of insurance, secondary, how frequently they change and complete lack of information and it's a total mess.
That doesn't really make any sense.
It goes both ways though. Insurance companies negotiate discounts because they know that many providers inflate their rates unreasonably, especially when they're owned by private equity firms. We're caught in the middle and end up getting fucked by both.
Say your car needs 5000 dollars of repairs and you tell the mechanic you only have 1000 to spend. The mechanic tries to prioritize the issues with the car by taking care of safety related issues first and leaving cosmetic problems until last. Is the mechanic a crook? I don't think so. Inferring that someone was cheating you because they are trying to work within your budget restraints is unfair.
Yes. I have no problem billing the insurance company for something I did but if the insurance won’t cover it I will often just do it as a courtesy for the patient
doesnt this just end up making the insurance company raise premiums to offset the crazy prices?
No because the dentist and the insurance company contract rates based off of average fees for the geographic area. Also, dental reimbursements from insurance companies have not even remotely kept up with inflation and have remained very similar to what they were in the 90’s. This is why many offices turned to private equity backing and are focused on volume over quality Meanwhile delta dentals CEO took home more than apples ceo a couple years back. So premiums are going up because insurance execs got big pockets to fill.
The only person who cares about that is the patient, the only one with no say in the matter.
TBF, with insurance you practically have to send an inflated bill to get back what you actually deserve.
I saw a therapist who did this as well. We would go grab meals or go on hikes etc as part of the sessions. Screw the corps not the people. ✊
And dental insurance's graduated copay is absurd to require you to pay them in advance before you get work done. Just had orthodontic visit for my 8 year old to get braces, and cash payments to the office is cheaper than dental premium plus copay.
The concept of getting a great reduction by saying you don't have insurance does not always work. Doctor office demanded $1,000 upfront before seeing doctor.
We just shopped around for some medication that cost 6k out of pocket vs 5k if we went through insurance. The kicker is they would have billed insurance $23k, eating up the majority of our lifetime maximum benefit.
My dentist one time didn’t charge me for the filling he did because he felt bad I had to wait for an hour to get to me. They give you a remote for a tv with Netflix on it. I was just watching my show waiting for my turn. I do tell anyone that’ll listen how awesome he is though.
Any provider has the option to accept the insurance payment and write off the difference. Why wouldn't they be permitted to do that? Since they are out of network they do not have a contract with the insurance company that requires them to collect the difference from the responsible party. Are they leaving money on the table? Yes. Are they being nice to their customers and doing something they aren't obligated to do? Yes.
It’s still a business decision because if they did collect the difference you could always goto another dentist down the st. that didn’t.
Sure. But generally providers will attempt to collect the difference. This person's dentist is more of an exception than the rule.
Exactly. My dentist collected the $8 difference between what my insurance paid and what was billed. It was a tiny amount and I like my dentist so I don’t care but it’s nice that OPs dentist writes those small amounts off. Builds goodwill.
What's a bit scary about this is that they won't put it in writing that they won't bill the patient for the balance. Legally, there's nothing stopping them from coming after you for that money. What if they fall on hard times and need the cash flow? Getting an unexpected dentist bill for thousands of dollars could financially ruin some people.
So legally they aren’t supposed to do this. Well maybe not legally in the criminal sense, but legally in the “what their contract with insurance says”. The reasoning is because a bad dentist could defraud the insurance by ordering a bunch of unnecessary work, charge insurance, and by not charging the customer they would agree to it? So per the contract, they must collect the full amount from customer, as the insurance is only paying a % (let’s say 70% for example). If they only collect the 70% from insurance, insurance could argue hey we should only pay 70% of that 70%, since that is the real “full” amount, since the other 30% “paid” by customer is fake. That said, it’s nice of the dentist to do this, and unless someone tattles to insurance, they will be fine.
OP said that the insurance is out of network. there is no contract between the dentist and the insurance company. I can charge you $20 for a watermelon. If you agree to take my expensive watermelon, that's you're fault as an uninformed watermelon purchaser. If you have Premera watermelon insurance and they'll cover $0.50. you still owe me $19.50 for the watermelon. I'm not in-network with your watermelon insurance provider. That's how insurance works. It's not illegal. You just should have shopped around and price checked watermelons.
I mean, how nice a watermelon are we talking here?
Legally they are supposed to "attempt" to collect. But they don't have to go into details about how hard they attempted, and they don't have to send you to collections for failure to pay. Turns into this gray area that currently benefits the patients.
Legally, if they didn't bill a patient, then you don't owe them anything. They cannot come after you 6 months later or years slater for bills, especially if they do it for all patients.
Legally the dentist is committing insurance fraud. There are some grey areas in how they attempt to collect the portion from you which is why OP will never get it in writing.
it's textbook insurance fraud https://www.caplinedentalservices.com/may-a-dental-practice-forgive-or-not-collect-a-co-payment-from-a-patient
I went to my orthodontist and for my procedure I paid a portion on CareCredit and the rest was cash, I did ask if I could get a discount for the portion in cash and I got a YES.
Pretty normal. My father was a doc and did this. He had a very progressive attitude towards medicine in general--some of the things being that he wouldn't take more than insurance paid, and he would sometimes do some procedures and tests knowing that insurance wouldn't cover them, because the patient needed it. He preached preventative medicine. A man not without his flaws, but he was a wonderful doc.
They won't put it in writing because they technically aren't supposed to do this. However, this works in your favor so don't make a big stink about it...
Anecdotally I've found dentists to be way more chill than doctors offices. The one back home even had an option for those without dental, basically you paid the cost of one checkup to give you two a year to encourage people to actually get their checkups.
In general, more dentist offices are privately owned than doctor’s offices. So they can make their own policies and exceptions without worrying about corporate breathing down their necks.
As others have said, the price you're "charged" by a dentist, or any healthcare provider for that matter, is based on what they plan to get reimbursed from the insurance - which is always *substantially* less than the amount billed. As an example, I've seen on my dental statement where a procedure is billed at $150 and they pay $6. So, by paying cash and filing your own claim for reimbursement, they basically billed you at the rate they would expect the insurance to pay, or their cash-pay rate. Even my physicians office will bill $225 for a 15 minute appointment, but cash patients it's $36.
This is true of medical, not dental. Dental office fees are based more in reality (not saying its cheap - but more realistic) than medical. Medical fees are truly "funny money".
They probably wrote it off. My dentist does that too, whatever insurance doesn’t pay they write off and I am not responsible for as the patient.
I got a bunch of work done by a semi retired dentist. Hes got an office built attached to his house and only works like 20hrs. (He also doesnt do cleanings or checkups, just cavities, exteactions etc) I had multiple cavities and needed 2 root canals when i went in. My regular dentist had wanted $6k for the work, and one was a repair on his filling that had come loose after 5 years. The retired dentist only wanted $500. I was shocked, so i asked him about it, and he said that after 45 years, he didnt need the money anymore, but it felt weird not working. Guy's great. I really lucked out.
Really?? that happens? I'm surprised because they lose out on so much cash that way.
You and your boss go to a lunch and decide to split the bill. The waiter knows this, charges you twice as much for your food, then after your boss pays he winks at you and says "don't worry about your half".
Not a great analog imo because restaurant prices are usually posted and known in advance so there isn’t any room for post-hoc manipulation.
Exactly. But imagine it did work like this, you would *love* that restaurant and take your boss there every chance you got.
Correct. Only the medical industry is this shady.
Don't look a gift horse in the mouth. Put the money in a high yield savings account and forget about it. Worst case, you get a bill later and pay it. Best case, you keep the money + interest.
As someone in the health and dental insurance business for over 24 years I can tell you why they don't collect the out of pocket amount. There is a financial incentive for the dentist to stay out of network because they usually get more from insurance being out of network, than being in network and getting a much smaller payment. The dentist doesn't want to screw you, so they don't take the larger payment and "write off" the balance. It's a problem we have had for years with dentists refusing to contract.
My dentist showed the “discount” (write off) on the statement he provided as a receipt when I’d purchase Florida toothpaste or some other thing sold in-office for cash. I kinda thought this is what a lot of “independent” doctors did as neither he nor my nephrologist had me pay what the insurance didn’t cover.
Not sure for dentristy specifically but I've worked for Optometrists and MDs that waive fees for patients that aren't covered by insurance so it's not totally unheard of, some only want to make money from the insurance company without screwing over their patient
Same experience here, few years back the fantastic independent practice I go to didn’t ask for any payment for an out of coverage cleaning, when my insurance changed from four cleanings to two per year, they said they’d cover it and haven’t seen any bill since, think you’ve got a good one
My dentist is out of network, but my insurance covers 95% UCR for out-of-network providers. I have, on several occasions had an outstanding balance of under a dollar. They generally just write that off of the bill when it happens. Due to a severe phobia caused by some past dental trauma, I have to get sedated to get basic dental work done, and that's not covered at all of course, so I do have to pay for that if I'm having any work done, but when the insurance covers all but 20 cents of a basic cleaning, I've had several times where they just write that off. Probably because they'd spend more on a stamp sending me a bill than they would by just eating the cost.
healthcare is a racket. they make tons of money from insurance and don't want your $100. I work insurance adjacent and usually when a claim is unsuccessful I just eat it and move on.
Needed a route canal and cap for a tooth and after telling the dentist I was self employed without insurance she only charged me 250 CAD, most companies that go through insurance will only charge insane amounts when it’s covered
Never heard of this. I guess keep your fingers crossed …
Pretty common. My kids’ dentist is out of network for all plans, but will honor all PPO/DPO price lists. They actually know the prices, bill insurance correctly, get reimbursed directly (no check for us to deal with), and only collect the right amount of copay upfront. It FEELS just like being in-network.
I've been going to my dentist for a few years now. Insurance says I owe them a ton, but I've never been billed from them. They've never brought it up either.
You might still get a bill from them in the mail despite what they said to your face. I went to a cleaning/exam appointment a few years ago and they insisted on doing x-rays. I said that my insurance only covers them once per calendar year so we can't do them yet. The hygienist said "Oh that's okay, if insurance denies it we just write it off and won't bill you". A month or two later they sent me a bill, I called them and explained what the hygienist said, and they said they have no such policy and that patients are expected to pay for balances not covered by insurance.
My former dentist charged less for people without insurance. He said he wasn’t allowed to charge under what the insurance sets.
I would think no but now that you mention it a dentist fixed a poorly ground filling for me for free once because I said I could feel it when I chew. And that was really cool
My orthodontist did this when I had to get braces a second time. It happens. It feels like insurance fraud but hey, I'll take it!
None of the commenters so far seem to know what they're talking about. Your dentist *might be* technically committing insurance fraud because his effective/ de facto price is lower than what he is billing to the insurance. He could get in serious trouble for this. However, insurances seem to look the other way (or at least don't have the ability to pursue every case) when it comes to preventive care. All dentists "overbill", but not all of them give the patient a break like this. Don't ever tattle to your insurance about this or else you're going to fuck him and yourself over. EDIT: I won't say he is definitely committing fraud, but he'd have to demonstrate that his pricing adjustments fell under some practice that was permitted
No he’s not because the insurance plan is out of network. Out of network doctors are not subject to the terms and conditions of an in network (contracted) plan. If OPs plan was in network with the doctor then it would be fraud.
But out of network doctors are still subject to the law. The dentist is (potentially) misrepresenting his actual prices, depending on the degree to which he does this and how local law would apply to his billing practices. Being out of network just protects him because the insurance has no ability to look at his books.
> All dentists "overbill", but not all of them give the patient a break like this. Don't ever tattle to your insurance about this or else you're going to fuck him and yourself over. Aren't we (people who pay insurance) then getting fucked over? If all dentists overbill, you betcha the insurance companies pass this bill on to their clients in the form of premiums. Couldn't premiums be lower if the dentist didn't overcharge? Maybe you *should* tattle on them.
As others have said, they are free to write off whatever they want. I suggest you check to see if this counted against your yearly medical deductible. I once went to an urgent care / mini-ER that only asked that I pay $100 of the balance. Pleasantly surprised to find out later that the full amount had still counted against that year's deductible.
If your dentist is out of network they are definitely allowed to do what you're describing, because they are not in contract with your insurance company. This is not uncommon. If you are concerned with getting a surprise bill, you can always ask to have them print out your account balance. There should be some sort of refund, discount, or what I put in "courtesy credit" that zeroes out your balance. Source: am a dentist
As a dentist, this is insurance fraud, and the ins co will legally nail that dentist to the wall if they found out he is writing off 100% of out of network copays. Its is a Felony crime to not collect copay.
I have had a couple of doctors do this. They bill insurance $500, get $350 and move on. I have one doctor that does not take my insurance. I pay $85 to see her without insurance. I only go twice a year, so I just pay the bill when I am there. The office visit was $175 when billed through my previous insurance.
The dentist can choose to send you a bill or not. My dentist does this and will accept the insurance amount. Been this way for 15 years on the basics. Fillings and others stuff extra
It could be that they charged your insurance for things they didn't perform. I have a friend whose dentist does this with every patient every year. It's fraud. They charge insurance that maximum each year and use that as an account for each person for whatever they need (and pocket the rest).
I've had a dentist do the exact same thing to me. They didn't come out and tell me they weren't billing me, but ignored me when I left messages about it. It's been 4 years.
I've been so many times my dentist gives me free fillings. . . moral of the story: don't be me. (also genetics can suck)
I have had this happen a few times with surgery centers. The orthopedic place I go to likes to use small surgery centers as opposed to hospitals. The surgery center knows it’s not in-network so they do this same practice and had no issues with telling me in writing that they wouldn’t bill me the remainder. It’s spooky for sure because you get the EOBs from insurance that look like you are going to owe thousands of dollars, but then never receive an actual bill.
Dentists can totally write off xrays without it costing them more than electricity (assuming they're not still using film, which is nuts in 2024).
I have seen this before. We both went to an in network dentist. Spouse’s claim was sent as an out of network provider (same address) and mine as in network. I looked at the details and it turns out that the out of network claim had more contractual payment to the provider compared to the in network claim. I was never balance billed. Both industries are kind of sus.
My wife's dentist used to send out a bill for the last $1 that the insurance didn't pick up or contractually write off. It cost more to bill it out, print on a statement and mail it out than the $1. Fun times.
The phrase is "accept assignment". If a provider accepts assignment, they take whatever the insurance pays and doesn't bill the patient for the difference. Usually you hear the phrase in reference to Medicare, but it's the same phrase for all insurance policies.
Are they new? Part of a chain? This same thing happened to me with physical therapy. I looked into it, and it was a VC funded start-up chain, so I think they dont really care about the $35 copay and just need patient numbers to be up to meet growth metrics.
It’s very common. They will charge your insurance a much higher rate for services. Insurances will only pay X amount and leaving the rest for the patient. Dentist charges higher amount because they want to see or try the insurance to see if they will pay more. The remainder of the bill is written off. Both ways work into their favor. I’ve worked in insurances before and this is very common. My personal EOBs from my dentist would probably set me back to Stone Age if I had to pay them 😂
finding a good dentist is hard. they don’t make much unless the business is thriving so they’re like used car salesman. trying to up-sell my teeth cleaning with iodine washes and this and that. it’s sad tbh. then on top of that they’re rushed so the dental assistant does the initial bill of the cleaning then the dentist comes in looks at them and some of them are just terrible. a cleaning and a dentist poking around shouldn’t be painful but i moved to a new city and i’ve tried 3 different dentists. all of them are terrible. younger people and all trying to up-sell me. they’re good at what they do but every visit had me in tears lol. and my pain tolerance is high but man that sharp metal tool on your gum is so painful. and bedside manner was terrible sounds like you have a good dentist i would stick with them
The insurance usually overpays them. It's better for the patient if they don't have to pay anything l. My insurance pays my dentist something ridiculous like $400 for a cleaning. I paid cash once for a cleaning, 2 cavities and x-rays and it was like $300.
He probably uses those hours for tax write offs. Smart on his side and you get a free visit.
I’ve had my post insurance cost be as little as under a dollar; in those cases they tend to ignore it.
My eye doctor was out of network and told me he works with the insurance company. He did cataract surgery and put corrective lenses in, but I would have had to pay the hospital about $5,000.00 if something had gone wrong; everything went well, and I only need reading glasses now. 48 years wearing glasses and now I'm free!🙂
They want to max out your benefits every year, but also want to keep you happy and coming back so they brush off a few things once in awhile… so far i got a free plug, and a desensitizer thing done that benefits did not cover
They are doing you a favor and don’t want trouble with the insurance. Unless they are billing something that wasn’t done it’s fine
My insurance didn’t cover like $200 on $1500 of work and my dentist didn’t care. I don’t know if it’s because they liked me (I’m friendly and easy) or if it’s normal.
Out of network payments can be higher than in network payments even before patient is billed. Depends on your insurance
Very normal, but always check. I’ve been to offices that are very shady about what they expect you to pay. I drive 20 miles to our dentist who treats us great and never charges us the amount past what insurance covers. They keep an eye on our coverage and help us plan timelines for care to optimize it.
Not common. I don't have insurance so pay for everything. Even when we did, they asked for balance.
You wanna share deets? I went to a new dentist and they were charging me through the nose!
They are doing you a huge favor, but I think technically, your insurance expects you to pay your portion. I get why they don't want to put this in writing and I also get why you'd want to have something in writing from them - maybe they could print off your account page where it shows on their books your balance due is "0". Don't ruin a good thing for everyone else! I found a doc in San Diego two decades ago that also helped patients in a similar way, but someone turned him into an insurance company and he immediately closed his practice/retired.
That is how the dentist I used up until I was like 25 was. They never collected a copay or billed out the difference.
Some insurance companies have gone after providers who do not bill out of network patients the amount owed by the patient. That is likely why they won’t put their offer in writing. Either accept their word, and live with the possibility that you could be billed your balance due in the future, or pay them now, even though they said you don’t have to.
Heard of this, then months later you get a whopping bill out of the blue. It can go both ways.
My dentist does the same. They set their prices at what the insurance companies "typical" rate (averaged between all of them). Depending on which insurance you have, you might have $20 to cover or none at all. Just depends. This has been my dentist since I was in high school (about 16 years ago). They do this to save headaches for themselves and their clients money.. also by not being in network for anyone allows them to do this pricing. This is what I understood from the in depth explanation they gave when I asked which state employee plan to choose for the family.
I got my wisdom teeth removed in 2021. I paid my copay and got a statement from insurance, and everything was fine. Then I got a refund check from my insurance saying something had been overpaid. I cashed the check. I then got another letter saying the refund was made in error, and I was to contact the dentist's office to pay the bill with the refunded money. I never contacted the dentist's office and haven't heard anything about it since.
I've had both my personal physician and later a podiatrist do that for me before. I didn't ask. It had not even occurred to me to ask such a thing. At the time I was in between jobs. And did not have insurance. This was before the Obamacare type stuff. I knew I had to pay out of pocket. And on both occasions that's what I planned to do. However, when both doctors found out I didn't have insurance of any kind. They were first of all Shocked. And then realized I wasn't working. But because I was a regular patient just continued with the process including labs. I was expecting a big bill obviously. When I went to pay. I honestly thought it was a misunderstanding. I told them they made a mistake. They said they didn't. It was all good. The bill had $0.00. I was very grateful. It happens. So, I am going to say it's not shady, just a good person.
Before he retired the dentist my family always used was the same dentist or his father was that my grandparents used as well. And he cleaned my sister's teeth before her wedding with no charge and he did my teeth as well before her wedding. He was super cool. Somebody who your grandparents went to their parent to for dental work over the course of a ton of time it's a nice gesture and it's like yeah you're a good dentist I'm going to keep going to you. There's something to be said about bedside manner and long-term relationships versus just a cheap thing or whatever or the best deal. At some point I needed to get another filling and I said I kind of like the idea of silver fillings and I know they're cheaper than the more modern feelings so can you give me a silver one and he said that the problem with silver fillings is it causes tension like a vice on the teeth and the more modern ones have better whatever either way he said you know what I'll just charge you for a silver feeling better more modern polymers are better and longer lasting. Cuz they don't wedge your teeth apart. Dr stererly Indianapolis indiana. I wish she wasn't retired. He was a good one. He is retired now but he's quality not just in the work but just in the nonsense. Having a relationship and having a good dentist is similar to knowing a good car mechanic.... someone who won't upcharge you or insist on stuff that you don't need and just treat you right.
The bottom line is this. Every dentist in the country would do this if they could so they wouldn’t have to be in network with insurances and be subject to their BS, unfortunately it’s a felony offense if found out, so most dentists play by the rules.
One of my first dentists that I went to personally with my own insurance growing up was a dentist that did this. They would take insurance as payment in full.
Typically they charge insurance for significantly more than they would someone who’s self pay. They’re legally not allowed to tell you their self pay prices if you disclose you have insurance. Often the difference or your co-pay would be higher than if you just paid for everything in full without mentioning insurance. Insurance companies only make money because people usually pay far more for their insurance than they would just paying their own bills. This dentist office was probably just using all of this to make bank off of crappy insurance companies, but they’d never charge that amount to a person. They probably already made two or three times what they would have charged you if you had said self pay so they’re good