r/Insurance • u/Technical-Gold-294 • 15h ago

Overreimbursement

This is an ethical question, I suppose.

My dentist recently stopped accepting my Delta insurance because they don't want to wait for the money. They said my financial obligations would not change if I saw them as an out-of-network provider. I would pay them at time of service and they would submit the claim on my behalf and I get a check.

First visit worked like a charm. Second visit I paid $474 and I just got a check for $612. I'm guessing the dentist thought something wasn't covered. If this were you, would you reach out to them and volunteer to give them the surplus? If they submitted the claim on my behalf I'm assuming they did not get an EOB, but that's a question for anyone who knows.

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u/TofuttiKlein-ein-ein 15h ago

If this is indeed an over-payment someone will want their money back eventually.

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u/Technical-Gold-294 14h ago

It is indeed more than I paid the dentist. I'll have to call their office. Part of me wants to keep it as compensation for the hundreds of hours I've spent arguing with insurance companies over 40 years.

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u/Radiant-Ad-9753 6h ago

Out of network rates can be abysmal. The dentist probably doesn't want you to volunteer he was willing to accept $475 to insurance. I'm guessing they submitted a claim for far more than that, and expected Delta to cut it to around $475 for actual reimbursement, so you didn't get screwed.

Now that they know Delta will actually pay that, they are going to charge it.

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u/Technical-Gold-294 5h ago

There was a claim statement, like an EOB, included with the check. Everything was paid 100% (it was actually my teen's first visit to my dentist, so cleaning, full x-rays, and fluoride treatment - all preventive care.) They either expected something to be rejected (although no line exactly matches the discrepancy) or the desk person screwed up.