Can you trust a good dentist when they are a part of a bad business practicing unscrupulous billing? Read more to find out.
MetLife Dental Insurance partners with in-network providers that agree to - rate for services. When a provider is in-network, you should be able to rely on MetLife's negotiated rate.
With that said, District Dental is considered in-network for MetLife members and therefore rate for services is already negotiated. Members should feel at peace knowing they can rely on a negotiated rate unless something unscrupulous happens.
It might help to explain that I experienced severe tooth pain and decided to see an in-network dentist (District Dental). Getting straight to the point. My dentist provided options for treatment. Nothing unscrupulous about that. In fact, I was impressed with the care I received and ready to move forward with one of the treatment plans. That is until I met with billing.
Billing reviewed my insurance and coverage, for billing code 2950 - core buildup. Cost for procedure: $120. But I found that strange, because I had this exact treatment done twice in 2022, but it was significantly less. How? A discussion on cost ensued and we figured the out-of-pocket cost is actually $60, after MetLife pays its portion. So, why am I being charged $120?
Here's the unscrupulous part - according to District Dental, there's no guarantee MetLife covers this procedure and therefore payment for full price (non-negotiated rate) upfront is required. You get reimbursed after MetLife approves the claim. That was a Red Flag for me, so I called MetLife to find out. There have been some problems with getting reimbursed by MetLife for this bill code according to District Dental. Sounds like a trust issue between MetLife and provider. Pay attention to the word I used "Trust".
MetLife reviewed my coverage details with me and concluded the procedure was covered under my policy for the negotiated rate of $60. I asked, why is my bill $120? MetLife explained to bill full price (that means non-negotiated rate) for a member in-network was not a best practice and goes against MetLife's guidelines for their providers, furthermore MetLife told me this is not a common practice they hear about and to file a grievance against the provider with MetLife.
The representative ended our conversation with an important point. They said, if this provider had trouble getting reimbursed by MetLife, then it sounds like there's a trust issue and the provider should contact MetLife to discuss their concerns. I thought about what she said and possibly what she was alluding to. Does that mean District Dental can't trust MetLife, or MetLife can't trust District Dental's billing?
What did I learn from my experience here? Frist, I'll never be back. Second, check your bill against your coverage. Then check your bill again against your coverage. And then check your bill against your coverage again.
PROS:
Booking Appointment, excellent;
Customer Service, excellent;
Dentist, excellent;
Facility, excellent;
CONS:
Payment/Billing, unscrupulous. read more