<p>Hi,</p>
<p>I have a cavity and I should go to the dentist. The problem is that I'm absolutely clueless about insurance stuff. Usually one of my parents would just come with me and fill out the insurance forms/pay at the end, but right now they are on vacation and I can only e-mail them (which I did).</p>
<p>Our family plan covers 90% of the bill so I guess I need to pay 10%. Do you need to pay the whole thing and then the insurance pays me back or do I just pay my 10%? Do I need to bring a form or something? Can the dentist refuse to have the insurance pay and tell me to pay the whole thing?</p>
<p>My freshman year, I went once to a hand specialist for a small hand fracture, she told me to just pay her now because she didn't take insurance plans, which seemed sketchy to me (especially since I have my school's insurance, my school's supplemental plan and my parents insurance) but I didn't understand anything that was going on so I just payed and left.</p>
<p>So what should I do? How does health insurance work?
Thanks! (By the way, I think it would be cool if parents told us that stuff before we go to college)</p>
<p>^^LOL.</p>
<p>I assume you are home now? You have a dentist you normally go to? If so, then he/she should have a record of your health insurance policy. Tell them to file the insurance and bill you the balance. </p>
<p>If you have to go to a new dentist then you would need to have a proof of insurance (insurance card). If a doctor is part of your insurance network then they will take your insurance card. You will either pay the co-pay on your way out or you would get billed for what your insurance doesn’t pay. It is good to go to a doctor in your network, it would be a lot cheaper. If a doctor is not in your network, you would pay your doctor full price, then file with insurance later.</p>
<p>The way to find a doctor in your network is to go on the insurance company’s website.</p>
<p>The first question is do you have DENTAL insurance? (Dental care isn’t covered under health insurance. It’s a separate insurance plan in most cases.)</p>
<p>The next question is does the dentist accept your dental insurance plan? This you will need to ask straight out to the dentist’s receptionist/bookkeeper/office staff BEFORE you have any services provided. You will need to know the name of your insurance carrier and your ID number. (Usually you will have a small plastic ID card with the name of the insurance company, your name and ID#. You will need to bring this with you to the dentist’s office so the staff can verify you’re actually insured.)</p>
<p>If the dentist does accept your insurance plan, then you need to ask the receptionist/bookkeeper/office staff another question: Will you fill my claim for me?</p>
<p>If the answer is yes, then you will make a payment based upon the estimated balance of your procedure.</p>
<p>If the answer is no or if the dentist doesn’t accept your dental insurance plan, then you will have make full payment for the procedure. </p>
<p>If your dentist doesn’t accept your insurance plan or if the dentist won’t file the claim for you, then after you pay the full cost, you will take your itemized receipt and file your own claim with your insurance company. (Ask you parents for a blank dental insurance claim form.) If you complete the paperwork accurately and document what needs to be documented, you will get a partial repayment of your bill from the insurance company–in the form a check mailed to legal HOME address.</p>
<p>Thanks oldfort. I found somebody on the website so I will just go there with my insurance card and wait for the bill to come.</p>
<p>Thanks WayOutWestMom. If the dentist is in the insurance network, does that mean that he will fill the claim for me?</p>
<p>^The answer is yes. They should, it is part of being in the network.</p>
<p>Make sure the dentist is in network for your insurance and he’ll file the claim, and more importantly has agreed to accept the rate set by the insurance company rather than his rate for services. However the amount due could be more than 10%, for example if you have a deductible that must be met before they pay the 90%. If you’ve exceeded the annual limit, again, y may have more out of pocket expenses. Also there may be some services that are not covered and you have to pay out of pocket.</p>
<p>Your question was really about using a doctor that is “out of your plan/network”, like the hand specialist. It’s up to you to file those insurance bills, but usually the insurance will accept them. They may not pay the full amount you’re billed for, but they’ll generally pay some portion. </p>
<p>If you still have that bill, or it hasn’t been 18 months, you can still file insurance for that. (The doctor may also have a copy of the bill.)</p>
<p>Your question is also: what’s the difference between IN my network and OUT. Generally, the small individual doctors don’t take insurance and are called “out of network”. There are just too much details for individual doctors to handle that kind of paperwork. Some also don’t like insurance companies because insurance companies often negotiate lower, acceptable fees and specialists don’t like to be so controlled. </p>
<p>Large hospitals and large doctor practices will often file the insurance for you and you won’t pay for anything except the co-pay until you hear back from the insurance. Once the insurance culls what you had done, based on the diagnosis, and determined coverage, you’ll be “told” how much balance you are responsible to pay. If there is a discrepancy between what the doctor’s office tells you you owe and what the insurance tells you are responsible for, only pay what the insurance tells you. That’s what the doctor’s office & insurance company agreed to.</p>
<p>ETA: I was thinking this was mostly about general medical office visits. Dental is different and I forgot the question was about that. Dah!</p>
<p>I see. Thanks a lot. The website says that my plan covers medical, dental, nursing home, and a bunch of other stuff. They say the maximum for dental fees is 7k/year, so I think it should be ok. I should ask for that hand doctor bill and get some of my money back.</p>
<p>Thanks. I can’t believe I didn’t know about all that.</p>
<p>If your appointment with the hand doctor was within the current calendar year, then you can still file a claim. If the appointment was during 2010, it’s too late. </p>
<p>To file, you’ll need your original bill. (If you no longer have it, you can call the doctor’s office and request a copy.)</p>
<p>I just filed a claim for D1 form 12/2010, they paid.</p>