Learn From Our Experience: Avoid Out-of-Pocket Costs Ballooning Nearly 400%
In my experience, we ended up paying $1,605 for a procedure that would have cost around $401.50 if we'd had all the necessary details upfront. Apex assured us--both over the phone and in person--that they were a Delta Dental Preferred Provider, even taking our information to verify our Delta insurance coverage. However, after the procedure, I discovered that they were not part of the Delta network. When I called to clarify, I was told I must be mistaken, and further attempts to reach them went unanswered.
Unfortunately, the issues didn't end there. Apex required us to pay the full amount upfront, explaining they had "issues" with clients not paying bills and assuring us that Delta would reimburse the difference by check. Trusting this explanation, we paid upfront--a decision I later regretted. This approach resulted in us paying far above insurance's standard rates, which prevented us from realizing Apex was out-of-network until later.
What should have cost around $400, based on Delta's rates, escalated to over $1,600--a nearly 400% increase. Our insurance reimbursement was only about $78, leaving us with an unexpected $1,522 to cover out of pocket.
After contacting the Missouri Attorney General, the office reached out to me; however, the information provided did not clarify the details on pricing or address the information shared by their staff. Had we known Apex was out-of-network, we would have gladly chosen one of the many trusted in-network providers in the St. Louis area. Paying $1,600 for a service that typically costs $400 was a surprising and disappointing outcome.
Consider this a cautionary note about taking a provider's assurances at face value: out-of-network providers often lack pricing oversight, which can lead to fees far above the insurance's standard rates. In our case, Apex's charges were more than double Delta's accepted rate.
Learn from our experience and proceed with caution if you're considering Apex. I recommend verifying network status directly with your insurance and being cautious about any request for upfront payment. For us, this experience served as a costly reminder. Protect yourself by doing your due diligence to avoid a similar situation. read more