Insurance Billing Errors or are they?

A few weeks ago, I went to the dentist for a routine cleaning and check-up. I try to take care of my teeth as much as possible to avoid pain and anguish at the dentist. No problems were found at my visit. I was in and out the door in under 30 minutes! Not too bad. My insurance pays the entire dentist bill, so I didn’t even need to worry about paying anything.

Last week, I received the billing statement from the insurance company. It had on there the following: Periodic oral evaluation, prophylaxis – adult, topical application of fluoride – adult, and bitewings – two films. What? I didn’t have any x-rays done.

I e-mailed the insurance company and explained the problem to them. Their response was less than enthusiastic about looking into the problem. I gave them all of the information I thought they needed, but, of course, they requested more information, which I sent to them in a second e-mail stating that I did want them to look into the problem.

Here is their response I received from them yesterday.

“Please be advised that Dr. ******’s office did submit a claim for the below referenced x-rays and have been paid for them. This does affect your account as it has reduced your available benefit by $28. We advise that you contact Dr. ******'s office and request that they return the $28 to **** [us] or allow you to have the x-rays done.”

Again I say, What? I have to call and complain to the dentist that my insurance company was overcharged! Don’t forget this is the dentist, you know, the guy who shoves sharp objects into your mouth, gives you shots in the mouth, and has a wide variety of other torturous tools that can be used. Or I could just go and have the x-rays done to avoid the overcharge! I only pay $3.51 per month for my dental coverage. Why would I want to complain over $28 that I don’t even have to pay for! But someone has to pay, right?

As I reviewed the information more thoroughly, I found out that our insurance company is simply a billing company. They charge my employer about $2000 per month to handle all of the billing claims. The insurance company pays the bills to the dentists and then bills my employer for those claims that were paid. Confused yet? Essentially, my employer pays for all dental costs plus a large fee to the “insurance” company. Therefore, the “insurance” company has no incentive to look into billing errors.

No wonder it is estimated that 85% of medical bills have errors on them. No one is held accountable for the contents. So who is really paying for these errors? In my case, the state and local taxpayers. In the case of corporations, the consumer will be paying the bill in the form of higher costs on the product or service the corporation is selling.

So the moral of the story is to pay attention to your medical bills!