How dentists bill insurance
Hi- I'm really hoping someone with experience in dentistry billing can help me with this. Bear with me as I try to explain it.
My husband and I have a pretax flex account that pays us back for qualified medical expenses, including dental. In order to be reimbursed, I have to provide the flex account people with an Explanation of Benefits from my insurance company. This document shows how much my health care provider billed the insurance company for, how much the insurance company paid the provider, and the difference- which is what I pay and the flex account people reimburse me.
I'm looking back over my health care paperwork for the last year, trying to find expenses I haven't submitted and been reimbursed for. I noticed a dental expense I had submitted was denied because I had only sent the flex account people a copy of my credit card receipt, not an Explanantion of Benefits. So I went back to the Explanantion of Benefits documents I have on file and they all say that for every claim my dentist made to my dental insurance, they were paid the full amount. So the paperwork shows that I never owed/paid my dentist any money. Yet I have receipts showing that I paid my dentist over $400 this year.
I THINK what happened (but I don't KNOW) is that the dentist asked me to just pay outright the portion they expected the insurance to deny, and only submitted to the insurance what they knew would be paid. Do you think that is the case? Why do you think they did it that way?
How this affects me is that I don't have an Explanation of Benefits that indicates that I paid anything to my dentist. And only that document will be accepted by the flex account people in order to prove there was an expense they can reimburse me for.
I know I need to go talk to my dentist's office and ask them why they billed as they did. Unfortunately, I am not on good terms with that dentist. Despite the fact that I am a generally agreeable person, I walked out of my last appointment because I wasn't comfortable with the way he was handling my appointment. My husband did offer to pay as I was waiting in the car, so we did not stiff them.
If I go into that dentist's office now, I am not convinced that they will be clear or honest with me. So I feel like I need to understand as much as I can about this situation before I go in so that it is more likely I will have good results from the conversation I have with them.
Can anyone with experience in the dental field help me understand why my dentist's office did the billing as they did?
Thank you very much,