Hi all,
First of all, forgive me because I am very new to all of this. I am looking for advice on whether there is any course of action I have here or if things simply are what they are.

I recently got my wisdom teeth extracted. After receiving my EOB from insurance, the amount that they have me responsible for is only $520.56, however the dentist is charging me $1,164.56. This prompted me to ask for an itemized bill. Looking between the EOB and the bill, it is clear that my insurance massively downgraded the codes to pay out less money, hence the large difference in responsibility.

Now the part the I don't understand is if that simply then makes me liable for the difference. I know nothing about dentistry so I really can't speak to who has the more accurate codes, but there are a couple of things I would want to know:

Does the dentist have to abide by the patient responsibility amount on the EOB, or since the codes were downgraded is that not their problem and the difference is shifted to me? If the dentist is accurate in their codes is there any process for me to appeal to the dental consultant that my insurance used to justify downgrading the codes?

As an extra note, I talked to my insurance and all I get from them is that my dentist must abide by the EOB. I have also talked to my dental office and they simply tell me that they are charging me the difference because the codes were downgraded and there is nothing they can do about it.

See also  prior authorization on expensive drugs

Any advice here would be appreciated 🙂

Explanation of benefits + Itemized bill: https://imgur.com/a/FB1PQnw

submitted by /u/TheBoredness
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