Original post: https://www.reddit.com/r/HealthInsurance/s/ZMySZCDId2

The above conversation is with the receptionist at my dental practice.

Welp, I learned a lot from this experience. I almost got billed an additional $2000 for my Invisalign. Maybe it wasn’t intentional, but it’s still a major mistake that could have cost me 2k.

I’m sure everyone’s gonna tell me he’s shit out of luck but my brains in denial and foolishly hoping there’s some Hail Mary option to alleviate? He was just told the bill for the dental work he needs immediately is going to be $40,000. That doesn’t account for the ER trip, a shit ton of stitches and facial plastic surgery he’ll surely need for medical reasons… I know this is just reality for so many people, he’s not a new sob story but I’m gutted. He’s 24, he landed his first big boy job that he worked so hard to get TWO days ago. He struggles to make rent as is.

I got Invisalign. My dentist submitted the claim to insurance for $6000. The insurance negotiated the price to $3800. The dentist still wants me to pay $6000 with my insurance covering $2000. The statement from my insurance says I only owe $2000 but the dentist wants $4000 from me.

UPDATE: I just called Delta dental. They confirmed my dentist is an in-network provider. The office billed 6k and the contracted rate for Invisalign is $3879, of which I am responsible for half. I already made a 1.5k down payment prior to starting treatment. The office is trying to bill me $3500 instead of $1939. This is considered balance billing and is a violation of the contract my dentist has with delta dental. I can open a grievance with them if they do not comply.

Question.. if I signed an agreement prior to receiving a letter from my insurance, am I required to pay?

I don’t want to make things super awkward considering I just started my treatment. I’m going to send the following email (so I have documentation). I’m welcome to suggestions to make this less awkward.

Good morning,

I hope you’re doing well. I’m writing to clarify a billing issue I noticed regarding my Invisalign treatment which I attempted to clarify with you at my first appointment. I contacted Delta Dental for further clarification and they confirmed that the contracted rate for Invisalign with in-network providers is $3,879. Delta will cover 50% of that amount, and my responsibility as the patient is $1,938.

Delta also confirmed that Dr. G is an in-network provider. As such, billing me beyond the contracted rate would be considered balance billing and would not align with Delta Dental’s in-network billing guidelines.

I truly appreciate the care I’ve been receiving from your office and want to make sure we’re all on the same page. I’m bringing this to your attention in the spirit of transparency and to ensure that everything is handled in accordance with the insurance agreement.

After double checking my file, could you please confirm the balance I owe considering I already made a downpayment of $1500.

hello! I am really lost here.. I unfortunately need close to $20k worth of dental work done. that's what I was quoted at Aspen dental without insurance. I have Michigan Medicaid, but the work that I need done is not covered by my Medicaid. without going too much into detail, my teeth were not a priority of my parents. I did not see a dentist until I was in high school. even then with multiple dentist telling my mom the work that I need done she did the bare minimum. I need 6 teeth extracted, dental implants, a gum graft, 2 cavities filled those will need crowns, & a thorough deep cleaning. the dentist said I probably have 3-4 years left with those teeth. please, if you're gonna say anything mean- don't. I am extremely embarrassed by my smile & it's a very large insecurity of mine. I tried to apply for a payment plan, but I was only approved for $1600. I can get dental insurance through my work but from what my coworkers have told me when I asked, the dental plan, they offer is trash.

is there a dental insurance plan that would help me cover some of these costs? I was looking online to see what I could find but I honestly I don't entirely understand all of the terms nor could I really go that long for a waiting period.

i'm not sure if anybody wanted an update, but I'm gonna post one anyways. I was sent home from work today due to how uncomfortable I looked according to my boss? I took advantage of this- I called 28 different dentists. only 3 of them took Medicaid. only one of them had availability to see me today. it was an hour north of me.

ok so yes, I have to lose my teeth but only losing 5. the molar with the incomplete root canal does have an infection underneath the root- the dentist was surprised because he believes the root canal was done very well. he showed me the x-rays. there was a large black spot underneath the left side of the root, that is what's causing my pain. he said antibiotics would help the infection, but it would not resolve the infection. he told me that he did not feel comfortable redoing the root canal, but if that's what I wanted done I could be sent to an Endo-dentist. however, that is not covered through Medicaid. so that tooth will be extracted.

he doesn't think 5 of my front teeth need to go he said just 4. he took an x-ray of that area. he showed me the x-ray- I have severe gum recession obviously, but I do have a substantial amount of bone loss. I could see the shape of my bone.. looking at the mostly decent teeth next to those affected teeth.. there was such a difference. he messed around with him noticed, yes they are indeed wiggling & agreed that I don't have much time left with those teeth & with the gum disease being so severe/ localized in that area, there's not really anything we can do to get it back.

so we are going to evaluate me for a partial denture. Medicaid covers certain kinds. he said he would push insurance to cover it because it is medically necessary. Medicaid would cover a bridge if it was 3 teeth or less so that kinda sucks. he put me on antibiotics for now to help with the pain that I have with that 1 molar. I come back the first week of September to start the evaluation assessment for dentures. it's unfortunately going to be a lengthy process- maybe up to 2 months.. but at least I know I'm able to get that done. 

So I had my braces put on back in February, at that time my ortho said the total cost is around 6k and my insurance would be covering around 2k so I was put on a payment plan and started my treatment. Well a couple days ago I got letter saying my insurance will not be covering anything at all and my ortho also called said it was denied and I should either call my dental insurance or I guess HR that deals with it or enroll in the highest plan next year so that it’s covered. When I look at my dental policy it’s saying that they cover 50% of treatment So I’m confused and not really sure what questions to ask when I call them. Obviously I’m going to ask why it was denied and inquire about the part that said it would cover 50% of orthodontic treatment. Is there anything else that I should ask or question?

I need a root canal on a molar and saw an endodontist for a first visit.

They said they can do the procedure today but kept persuading me to go get expensive implants which I kept turning down over and over.

Last minute, they said they need to get an authorization (from my insurance) which will take weeks and sent me home.

I called my insurance and they said this procedure does NOT require pre-authorization and said they have no clue why the office would say that.

So what’s their motive? Why would they lie to me?

Hi everyone,

I’m in California and need some advice about a situation with my dental provider and insurance.

• Date of service: October 1, 2024 (tooth extraction at Irvine Oral Surgery)
• Insurance: Ameritas
• Filing rule: Ameritas requires claims to be submitted within 90 days
• What happened: The dental office didn’t submit my claim until May 2025 (over 7 months late). Ameritas denied it for untimely filing.
• Office response: They confirmed on August 27, 2025, that the claim was “submitted electronically” with the 90 days timeline, but refused to provide a clearinghouse report showing when it was actually filed.
• Problem: The office is demanding that I pay the full denied amount out of pocket. They have also stopped my ongoing treatment until I pay.

From what I understand, filing the claim on time is the provider’s responsibility, not mine. I gave them my insurance information on the day of service. I don’t think I should be forced to pay for their administrative error, but I also need to continue treatment.

My questions are:

1. If I pay now just to continue treatment, how can I recover the money later?
2. Can I mark my payment as “paid under protest”? What if they refuse to accept that wording?
3. Should I file complaints ? How can I do that?
   
4. Is there a best way to solve this ?

I’d appreciate any guidance or similar experiences. Thanks in advance!

My son recently had some dental work done, and the dental office gave me an itemized bill at the end that showed the procedure would cost $1300. This dental office was out of network, and we knew that going into this. The bill shows they expected dental insurance to pay $0. I paid the bill and they said I had no current balance.

The dental office then submitted a claim to my insurance for $2800, more than double what they billed me.

I called the dental office and asked what the remaining balance of my bill was, and they said zero dollars. I asked why they would send a claim to insurance then if the bill was paid. They couldn’t say why. I asked what the total prodedure cost, and they said “it depends”. I told them I found that hard to believe, and that they should known how much they wanted to be paid for the procedure. She kept saying the final amount “depends” on what insurance pays. I said their bill showed they expected insurance to pay nothing. I then asked what the difference in the balance was that I had already paid, and what they wanted to get from insurance. All she would say is “it depends”. I finally got her to say the procedure “could” cost $1700, but she still wasn’t sure.

I called my insurance, and they stated they would not be paying any portion of the bill, which I already knew.

I called the dental office back, and told them my insurance would not be paying any portion of the bill. She said in that case, your bill is final and the $1300 we already billed is what the balance is.

I asked why they would submit a bill to insurance for $2800, more than double what my bill showed and what I had paid. She said they had different rates with insurance, and if insurance was going to pay the rate would be different.

Does this seem fishy? Can the balance change based off of who’s paying? Seems like they were just trying to scam insurance for more money.

The doctor was in network. I double checked it. There is no way I am going to out of network doctor.

Hi everyone, I’d really appreciate any advice you can share.

I’m scheduled to have implant surgery for 2 front teeth in two weeks. One dentist quoted me $7,000, and another periodontist quoted $10,000, so total $17,000, which is killing my finance.

Unfortunately, I’ve already maxed out my Cigna dental insurance, which had a $2,000 annual limit. Now I’m looking at Spirit Dental insurance (underwritten by Ameritas Life Insurance), which says it has no waiting period, a $1,500 max benefit, and costs about $52/month.

It sounds too good to be true — no waiting period, no minimum enrollment period? Has anyone used Spirit Dental before for major procedures like implants? Would it even help in my case?

Any insight or personal experiences would be really helpful. Thank you in advance!

Edit: I’m in CA Edit2: Spirit Dental is underwritten by Ameritas Life Insurance

My company enrollment is open, I added vision this year thinking I might have my eye checked. It’s 14$ dollar a month.

So I happily called for an eye exam. Guess what, out of pocket is 59$ but if I do with insurance it’s “covered” with only 49$ co pay.

ORZ! what have I done.

Day of my appointment, they charge me $900 which I disputed because their estimate said $807. They end up changing it back to $807.

Couple months go by & their office tells me I have an outstanding balance of $807. I told them I already paid that. Several more months go by & they finally get back to me saying I do owe that much since my insurance didn’t pay. I discovered I’d messed up because I thought they were in-network since I found them through my insurance’s website. Turns out they’re not.

I get my estimate out & see that since insurance covered $514, I covered $807, & their fee said $1895, I’m not sure where the other $807 is coming from? I spoke with my uncle who worked in insurance for 25 years (albeit not health insurance) & he said paying them $573 is what would make the most sense if they honor their estimate.

Now they’re saying I owe $2,398 since my insurance didn’t cover. So my questions are:

1. Do they not have to honor their estimate at all?

2. Are they charging me the office fee because my insurance didn’t cover what they had estimated? If they had, would I just be getting the regular fee?

3. Do I owe $573 to make up what insurance didn’t cover? Or $1,591? Or $807?

4. Do providers usually charge what the insurance says & not what they estimate?

I was seen by an orthodontic office for invisalign treatment, and they told me multiple times (even in writing) that they were in network with Delta Dental. Even read me my in network benefits.

I would call them multiple times a week, and they basically told me I had to pay a down payment up front and start treatment before they’d send the claim to my insurance.

Alas, they sent the claim to my insurance a month after I paid and treatment started. I find out that they are NOT in network and now I’m on the hook for 4k, instead of 50% of the maximum allowable contract which would’ve been just 1.8k.

Do I have ANY leverage here? The insurance coordinator has been extremely unprofessional, dodging my calls since I started treatment, and I’m really frustrated.

There is nothing in my plan documents that state I need a pre authorization and the website says that even with one it’s not a guarantee of benefits.

I’m not rich, and this is really putting me out a lot of money. :(

EDIT: Thank you those who offered sound insights and advice! Unfortunately, myself, like many others, are not well informed with the nitty gritty details of dealing with health insurance in this country. I don’t come from a family who was well off enough to even consider dental work, and I just was not aware of how to properly go about it. Cheers.

Hi all! I am currently uninsured but need a LOT of work dental work done. Like tens of thousands of dollars worth that I've been putting off for years. It's bad and I'll need surgery of some sort. I finally screwed up the courage to schedule a dental consultation this Friday.

Is it possible to sign up for dental insurance right before needing a procedure done? Or is there a waiting period? Is there an issue with getting a consultation done before having insurance in place (other than paying out of pocket for the consult)? Should I wait to find out what insurance they take and choose my plan from there?

I haven't had health insurance in almost a decade, and before it was always through my employer. I work for a small business so I'll need to get an individual plan on the marketplace and am not sure how that works. Thanks in advance for any insight. I appreciate it.

For context, I live in California. I booked a dental cleaning near my house under the impression that they were in-network. I filled out the forms, gave them my dental insurance card and my ID. At this time, nothing is said about my insurance being out of network or out of pocket costs. I get X-rays, and afterwards they scan my teeth. I thought this was new tech and part of the X-ray process since they didn’t say anything and just proceeded to scan my teeth after X-rays. The dentist then comes in and shows me the scans, recommending braces and what not. I never mentioned I was unhappy with my smile; I came in for just a cleaning. I hear him out and then they proceed with the cleaning. After, they say I’ll receive a check from my insurance, and that I’ll have to bring it back to the dentist office. I thought it was weird, but nothing was mentioned about out of network or out of pocket costs during the entire experience.

Fast forward a few weeks, I get a letter in the mail from my insurance with the check. However, they will only cover partially because they are out of network - and this is how I found out! The dentist office wants me to pay $600+ for a scan I never asked for!

I tried to dispute this with my insurance, but there’s nothing they can do since the office is out of network and unaffiliated with my insurance.

Before I go to the office directly, any advice or suggestions on next steps?

EDIT - thanks to everyone who shared their insight and knowledge in the comments below. This was truly a learning experience for me!

Just putting this out there to see if others have had a similar experience—because I’m getting increasingly frustrated.

I have a very strong prescription and I’m legally blind without corrective vision. Glasses aren’t really an option since they make me feel dizzy and disoriented because of how extreme the magnification and distortion is. So I rely completely on specialty contact lenses.

I see my optometrist twice a year, not just for vision correction but for retina imaging and monitoring. My eyes are under a lot of strain, and my doctor keeps a close watch so that when (not if) my retina tears, it can be caught and repaired early. It’s not about managing hypothetical risk, it’s about actively monitoring a chronic condition.

Despite all this, my vision insurance (Superior Vision Plus, the highest plan offered through my employer) does almost nothing. I still pay about $200 out of pocket for exams and get a $150 annual allowance for contacts—while I spend $800+ per year on lenses alone. That’s over $1,000 a year out-of-pocket, with insurance.

My doctor believes my contacts should be considered medically necessary, but the insurer doesn’t. Apparently the standards for “medical necessity” vary wildly between providers, and people like me fall through the cracks.

It feels unfair, honestly. I don’t use many other health benefits, but this one area where I do need support, there just aren’t options. I feel overlooked—like the system wasn’t designed for people with high, complex needs.

Anyone else in the same boat? Have you found a plan or workaround that actually helps? I’d love to hear what others have done, or even just know I’m not alone in this.

TL;DR I’m legally blind without correction, can’t wear glasses due to distortion, rely on specialty contacts, and need frequent retina monitoring. My high-tier vision insurance still leaves me with over $1,000 out-of-pocket annually. My contacts should be considered medically necessary but aren’t. Feeling stuck and unsupported—anyone else dealing with this?

Hi, my wisdom tooth partially ruptured on Monday and I’ve been in extreme pain since. I went to my apt today and they said it has 2 infections and they could not extract it because it’s preventing my mouth to only be able to move partially open. My throat also hurts and I’m having trouble swallowing and half my face is swollen including my throat, it looks like I’ve been punched in the face. My dentist told me I will have to wait a week before they can take it out and “do at home stretches with popsicle sticks” to get my mouth open. I can’t even move my mouth open more than half way so idk how this is going to work. I’m already on antibiotics I got through urgent care because they told me over the phone I couldn’t go 24 hours. They also said the infection may spread in the next week causing my airways to be blocked and I may have to go to ER.

I have BCBS. With this anesthesia pill it’s looking like it will be $896 and my insurance only covers the 1 tooth and not the anesthesia so I’m paying $500. I paid that today but my question is did I get bamboozled? Should I call my insurance myself? My grandmother who works in a doctors office and has a lot of medical knowledge called me and said I could get the whole thing covered if it was deemed “medically necessary” since it’s infected but I would need a referral to an oral surgeon. I also don’t know how they expect me to go back to work like this for the next week, I can barely talk or open my mouth and I’m a lawyer. Please advise.

What am I missing? It does not make sense.

So I went to the dentist in may and they said I needed teeth extraction which I already knew all my teeth had to come out cause there just broken and in pieces. Well I needed a clearance cause I have a heart condition and copd. I didn’t get my clearance till July. But in June I had a bad infection in my mouth that sent me to the er and they told me to call my dentist and they didn’t care (really that should of been my first clue). Anyways I had appointment coming up to get my molds done for my dentures but they canceled it cause they said my insurance denied my dentures so I told them I would call my insurance (the nurse wasn’t happy when I said that) so I called my insurance on a Wednesday and they said they never got anything from my dentist to approve me for my dentures so I called my dentist back and tell them and they said they Weill look in to it. So I called my insurance back on Thursday,Friday and Monday and asked them about it and still nothing. I got proof that they haven’t sent anything to my insurance since may from my first appointment. So my friend gets the same insurance and I’m going to get dentist soon. But why would my old dentist now I guess lie to me.

I went for an in-network eye exam to a place I'd never been to before. When I checked in they asked me for my eye insurance and medical coverage cards, and when I said I was only there for an eye exam she said they like to have it on file. Afterwards I paid my $10 co-pay. Yesterday I got an EOB from MedMutual for $35, a copay for "eye exam with photos". Can I dispute this? I didn't ask for photos, they never mentioned photos. Thank you in advance!

I made my son his dental appointment in January, and then in July I called and made him his 6 month appointment. Insurance is saying the appointment was 10 days before the full 6 months and there is nothing they can do but charge me. What are my options? Would my dental office change the dates in the system? I don’t like that dentist and am planning on changing anyway. What are repercussions if I don’t pay.

Basically the title, it's insurance offered by my new employer, but they don't pay anything. It'd be $41/month for me. I've also seen a lot of bad reviews on BEAM, so I'm a little nervous. I've heard of getting in-house insurance through your dentist and I'm not sure if that would be a better option?

I have dental insurance which sucks, although I guess they all do. My annual limit is $1,500. Today I was told I'm going to need 2 root canals and I'm guessing I might end up needing 2 crowns on them because that's how it goes. And the practitioner doing the root canals will be an endodontist so they aren't even the same practitioner as the dentist. Right there you're already blowing past $1,500 and I also have a filling on a separate tooth they need to put in, I guess caused by a previous filling.

Anyway, I'm clearly going to hit $1,500 well before that is done, who knows maybe before I even get back to the original dentist. I'm just wondering, will I go all the way up to cash prices once that is done or are they at least required to honor their agreed-upon rates with the insurer since it's in-network? Bear in mind that some of the procedures like the filling are probably going to happen once they know that I've hit the limit and the insurance won't pay anything else.

I've had ambetter for I think 2 years now and almost anyone I call regarding dental, which shows on their website as being "In-Network" does not actually accept my insurance. I just moved so I was trying to find a closer dentist, as my other location was already an hour and a half away, and it seems that's the only place in my new that'll accept it is my old dentist. I called over a dozen places in a 100 mile radius that shows in network on their website.