Dentist quoting 4 times above my Delta Dental HMO’s listed prices — normal or shady?
Checking to see if this is normal practice. I have DeltaCare HMO (DeltaCare USA). My in network dental office gave me a couple of estimates, and I decided to look into why everything was so expensive. I pulled up my Evidence of Coverage document for the first time ever, and surprisingly, every code listed in my estimates had a much lower price in the document than what I was quoted.
I called Delta directly and they confirmed the office shouldn’t be charging me more than the rate listed in my Evidence of Coverage. When I brought this up with the dental office, they said lab fees aren’t included in that price, so the extra is lab fees. That’s rubbing me the wrong way — the document lists an onlay made from a specific material, so why wouldn’t lab fees be baked into that price already? The office first suggested maybe the document was referring to a different material, then switched to saying it was lab fees.
But I also have an estimate for a filling, which should have zero lab component, and it’s also about 3x the listed price for the same code. If “extra fees” can apply to literally any line item without being disclosed separately, then technically every price in the document is meaningless.
The office got hostile when I pushed on this: if lab fees are really a separate, legitimate charge, why are they billing it under the same procedure code listed in my benefits packet, at one lump price — instead of showing my actual Schedule A rate for that code plus a clearly itemized “lab fee” line on top? Quoting one combined number under a code that’s supposed to have a fixed, contracted price feels like it’s designed to obscure what’s actually the copay versus what’s an add-on, rather than disclose it. They treated me like I was asking a stupid question and handed me a list of community clinics.
I also read in this same document that Delta pays offices a monthly capitation fee based on number of enrolled patients, and that additional office revenue comes from patients paying out of pocket for services. So offices do have a financial incentive to overcharge patients who probably don’t check their benefits package.
Is this an issue with DeltaCare HMO generally, or is it specific to this office?