Multi-dr firm changed my Dentist from PPO to Premier and didn’t tell me. Quoted me PPO and didn’t tell me until after the procedure leaving me with 2x my estimate.
On my last crown (I have a lot) a few months ago, I received my estimate weeks prior. My patient portion estimate was ~$300. I asked for a pre-authorization as I’ve had a surprise fee in years past and that’s just what I do now to see if I need to push to the next year or what not. The desk really didn’t want to do it and said it would take weeks and ASSSURED me that even if insurance didn’t pay anything, the MAX they would charge would be this, pointing to <$900 on the estimate, representing the contracted rate of my PPO plan with Delta Dental. Knowing where I was on my yearly max, I agreed.
The procedure was done and immediately after was presented with a statement summary indicating a ~$600 balance which they said they will submit to insurance.
Months later, insurance paid more than $600 for my procedures and I receive another $300 bill. The contracted rates were way more than I was given and my max benefit was immediately hit for me to pay %100 of a good portion of the difference. After months of trying to get an explanation, the dental billing department explains to me that the particular Dr. who I saw was not PPO but is now a Premier dentist, the only Premier dentist at the firm, who gets paid more with the delta dental contract. They said he became a Premier dentist but I don’t know when.
On the phone and in writing, they take complete responsibility for the mistake. I told them I understand an estimate is just an estimate and that I know I am responsible for any charges insurance does not pay however in this case, I was given a stated price for a different provider and was never informed of the dentist becoming Premier.
They say their hands are completely tied and even though they admit it was their fault, I am “unfortunately responsible” for the new balance as it would be insurance fraud for them to write off my portion (which I do understand they fraud part but I also know they can make other concessions including redacting a claim).
I do not believe what they did was right and have never felt this taken advantage of, even if just over a few hundred $.
Do I have any recourse or any recommendations?
Thanks in advance.
