How to Dispute a Dental Bill and Win
Navigate the complexities of dental billing to successfully resolve disputes and save money.
Dental bills can contain errors or unexpected charges. Reviewing statements and communicating concerns helps resolve discrepancies. This guide outlines how to dispute a dental bill, from initial review to seeking external resolution, to ensure accurate billing.
Understanding Your Dental Bill and Preparing Your Case
Reviewing your dental bill and supporting documents is the first step. Dental bills list Current Dental Terminology (CDT) codes for services, dates, provider names, and billed amounts. Compare each item on the statement against any treatment plans or estimates received.
The Explanation of Benefits (EOB) from your dental insurance company should also be examined. An EOB details how your insurance applied charges, showing the total billed amount, covered portion, deductibles, co-payments, and your patient responsibility. Discrepancies arise when dental bill services do not match the EOB, or if the EOB indicates a different patient responsibility. For example, a service might be denied as “not medically necessary” on the EOB, but still appear as a charge on your bill.
Gathering supporting documentation is essential. This includes appointment confirmations, signed treatment plans, written communication with the dental office regarding costs or procedures, and your personal notes. Identifying the specific nature of the dispute, such as charges for services not received, incorrect service codes, or billing for unapproved procedures, provides clarity. This preparation ensures you understand the alleged error and have evidence to support your claim.
Initiating Your Dispute with the Dental Office
After reviewing your bill and gathering documentation, communicate directly with the dental office. Start with a phone call to their billing department, as many discrepancies resolve quickly this way. Have your dental bill, EOB, and notes ready to reference dates, service codes, and amounts. Clearly explain your concern, referencing specific disputed items and why they are incorrect.
If a phone call is unsatisfactory or the issue is complex, draft a formal written dispute letter. The letter should be concise, professional, and include your full name, patient account number, and service dates. State the specific charges you dispute, explaining your reasoning and referencing contradictory documents. Attach copies of relevant documents, such as the dental bill, EOB, and treatment plans, keeping originals for your records.
Send your written dispute via certified mail with a return receipt for proof of delivery and to establish a timeline. This provides a verifiable record if further action is needed. Most dental offices review billing disputes and respond within a reasonable timeframe, often 30 days. Maintain a detailed log of all communications, including dates, times, and names.
Engaging Your Dental Insurance Company
If the dispute involves coverage issues, EOB accuracy, or if the dental office directs you to your insurer, contact your dental insurance company. Contact their customer service or appeals department. Provide your policy number, patient’s name, and details of disputed services, including dates and billed amounts.
Provide copies of the dental bill, EOB, relevant treatment plans, and the dispute letter sent to the dental office. Clearly state if your dispute concerns an incorrect coverage denial, an error in benefit application, or a discrepancy between the dental office’s bill and the EOB.
Dental insurance companies have a formal appeals process for denied claims or disputed benefit applications. This process involves an initial internal review, where the insurer re-evaluates the claim based on provided information. If the internal appeal is unsuccessful, many states offer an external review by an independent third party. Insurers must respond to appeals within a specified timeframe, often 30 to 60 days, depending on claim type and state regulations.
Seeking External Assistance
If disputes cannot be resolved directly with the dental office or insurance company, external assistance is available. File a complaint with your state’s dental board. These boards regulate dental professionals and practices, investigating complaints related to professional conduct and billing. Provide detailed documentation of your attempts to resolve the issue, along with copies of all relevant bills, EOBs, and correspondence.
Another resource is your state’s consumer protection agency or the Attorney General’s office. These agencies handle complaints related to unfair business practices and can mediate disputes. While they may not directly resolve billing discrepancies, they can facilitate communication or investigate problematic billing patterns. The complaint process varies by state, but generally involves submitting a written form with supporting documentation.
For complex disputes, especially those involving significant amounts, mediation services offer an alternative resolution. These services use neutral third parties to facilitate discussion between you and the dental office or insurance company, aiming for a mutually agreeable solution without legal action. These external options require effort and time, but provide resolution avenues when direct negotiations fail.