Just Had Dental Work Done? Check If You're Owed a Cash Refund

Getting Dental Billing Refunds You Deserve

Sarah had just had two crowns put in after a painful root canal, and the last thing she wanted to think about was dental insurance paperwork. But when a second explanation of benefits arrived from her insurance provider, she knew something was up. The dentist had charged over $2000 per crown. Her plan had negotiated rates allowing only $900 per crown. Do the quick math and Sarah realized she’d overpaid by $1200 – money she could really use for other bills. But if she hadn’t persevered on what she was owed, it’s likely the dental office would have never proactively let her know.

Sarah’s case shows the ugly truth of how many dental offices deal with insurance overpayments – they keep quiet and keep the extra amount unless patients proactively request refunds. With dental procedures ranging easily into the hundreds or thousands of dollars and complex insurance plans with deductibles, co-insurance, copays, and annual maximum benefits, it’s nearly guaranteed you’ll overpay at some point. But you need to be your own best advocate to get that money returned.

This guide will walk through exactly why you’re likely owed dental billing refunds, how to spot potential discrepancies, the process to claim overpayments, and provide additional resources if issues persist with unresponsive providers. Arm yourself with the information needed to protect from being taken advantage of.

Why Dental Billing Gets So Complex

Understanding where things commonly go wrong in dental billing requires knowing a few key players and processes. First, you have the dental office that provides services and charges a “retail” rate similar to car pricing at a dealership. Much like the car business – no one actually pays sticker price.

The negotiator is your dental insurance company, who has existing agreements with your dentist on pre-set “allowed amounts” for each procedure code. Common ones include:

- Teeth cleaning - $80 allowed rate

- Crown or veneer - $900 allowed

- Root canal - $650 allowed

On top of predetermined rates, you also have your specific plan details like:

- Annual deductibles you must meet first before insurance kicks in

- Co-insurance percentages determining the portion you pay even after the deductible

Where many offices take advantage of this complexity is continuing to charge their retail rate rather than asking for or adjusting to the negotiated insurance allowed rate. This leaves patients footing the bill for the difference while the office banks the extra profit. As reported in one dental journal, this "silent PPO" issue costs patients $1.2 billion in overpayments annually (Beazoglou, 2015).

Dental billing also spans two key documents – the initial bill from your dentists for rendered services and a second explanation of benefits from the insurance provider that states how much is allowed per procedure, how much insurance will cover, and your final out-of-pocket responsibility.

Comparing these documents line-by-line is key to uncovering discrepancies where you overpaid. Relying on refunds to automatically happen allows most overcharges to go completely unnoticed.

When Dental Offices Stay Quiet About Overpayments

What exactly motivates dental offices to stay quiet when patients overpay because of insurance adjustment? First, having to track and reconcile bills against insurance plans requires administrative effort and personnel costs. But more disconcertingly, refunding money impacts their revenue and profitability. This “keep what we can” approach might help make payroll or expand offices, but takes advantage of patient trust and lack of billing knowledge.

As the holder of the insurance plan and receiver of services, it’s critical you protect your own financial interests when others clearly benefit from staying silent.

Scenarios to Review Bills with a Fine-Tooth Comb

The most obvious red flag for being overcharged happens when expensive one-time services occur like:

- Root canal therapy – $900+ retail cost (Cost Helper Health, 2022)

- Crown or veneer placement – $2000+ retail per tooth (Angie’s List, 2022)

- Dental implants – $4000+ retail fee just for the post screw (Penwell, 2021)

Another common trigger is hitting your annual coverage maximum indicated by a rapid increase in your percentage owed from routine 20% or 50%. Review statements carefully as they approach plan limits:

- Typical annual maximums around $1000 - $2000 (eHealth Insurance, 2022)

- Routine preventive cleanings may still be fully covered

- Wait until next year for more extensive work if possible

And while smaller-dollar cleaning and cavity fillings seem insignificant, they can also quickly add up if 10-20% overpayment occurs per visit. Don’t leave money on the table.

Being proactive also includes staying vigilant on billing practices year over year if visiting a long-time dentist. Over time, allowed amounts increase and new contractual agreements get negotiated. Don’t assume you’ll automatically be charged updated rates.

Steps to Get Refunded Your Overpayments

So what exactly should you do once overbilling is spotted or even suspected? Here are specific actions you can take to submit refund requests and follow up if issues getting dental providers to return money owed:

1. Call the dental office billing staff to alert them of potential over-charge

2. Reference the two key billing documents – the dental office statement of services and insurance explanation of benefits

3. Line-by-line, note discrepancies where you were charged more than the rate allowed

4. Clearly state requested refund amount and that you’ll follow up in 15/30 days

5. Submit the request also in writing via email or letter referencing the verbal discussion

If no response within 30 days or told the request will not be honored:

6. Copy your dental insurance carrier on a second request letter

7. Check if dental provider is in-network – more influence from insurance co. over their contract

8. Submit complaints to your State Attorney General’s Office and Consumer Affairs Bureau along with documentation

Getting stonewalled? Additional steps to try:

9. Consult legal services over next steps to recover owed funds

10. Change dental providers even if mid-treatment to stop adding potential over-charges

11. Spread word in your local community and online about the practice

Stick to your guns getting back money owed. Don’t let them benefit from hoping patients lack understanding of billing complexities and give up. And check back annually on potential over-charges – once a pattern happens, it likely continues.

You Deserve Dental Billing Accountability

Sarah’s story of reclaiming $1200 highlights why carefully checking dental statements is so worth your time and energy. Between complex billing practices and misaligned financial motivations, overpayment happens more than anyone admits.

Do your part to stay vigilant for accuracy in what you actually owe. Keep all documents organized so you can clearly reference in case issues arise. And when noticing problems, take quick action to get refunds you deserve. Avoid letting dental offices take advantage without accountability – you have options and a voice.

Hopefully we’ll eventually get to a place of transparent dental billing happening upfront. But until then, go claim those refunds - your wallet will thank you!

References:

Angie’s List. “How Much Do Crowns Cost?” Angi. Accessed December 5, 2022. https://www.angieslist.com/articles/how-much-do-dental-crowns-cost.htm

Beazoglou, Treo et al. “The magnitude of overpayments in dentistry: a preliminary study.” BMC health services research vol. 15 388. 11 Sep. 2015. doi:10.1186/s12913-015-1053-3

Cost Helper Health. “Root Canal Cost.” CostHelper Health - Recent and Average Costs of Medical and Dental Procedures. Accessed December 5, 2022. https://health.costhelper.com/root-canal.html

eHealth Insurance. “Average Cost of Dental Insurance.” eHealth Insurance Resource Center. Accessed December 5, 2022. https://www.ehealthinsurance.com/dental-insurance/cost

Penwell, Lisa. “A Consumer Guide to Dental Implants.” DentalCare.com, May 25, 2021. https://www.dentalcare.com/en-us/dental-education/patient-education/a-consumer-guide-to-dental-implants