WTHR |Dentists and insurance company at odds over bill paying

Dentists and insurance company at odds over bill paying

Lynsay Clutter/ Eyewitness News

Indianapolis- Dental providers are upset about how insurers are changing the way they get paid. Wednesday they will fight it out at the Indiana Statehouse and caught in the middle of the issue are the patients.

Hundreds of dentists will urge lawmakers to pass new legislation regarding assignment of benefits, that's how insurance payments are directed.

Typically, insurance companies send the check for treatment directly to the doctor, who then bills the patient for any remaining balance.

Now, many dental insurers have decided, if your dentist is not in their network, they send the money directly to you. The insurance companies say it is to protect you from balanced billing and higher costs.

"Insurers have for many years had this provision in their contract. We have broad provider participation in excess of 90% in many cases. We believe it's the providers choice whether or not to be a part of that network, but we don't believe we should be legislating the benefits of the network to those individuals who don't want to participate," said Anne Doran, America's Health Insurance Plans. 

Dentists argue, the confusion and inconvenience is a strong arm tactic to get doctors to join networks.

"We think the contract debate should continue between the provider and the insurance company. We call foul when they drag the patients in and use the patients as leverage to get the doctor to sign a contract that the doctor may not think is in the best interest of the doctor or the patient," said Doug Bush, Indiana Dental.

Dentists also say insurers are causing patients to have to pay up front, in full, the day of service, and then wait for the reimbursement.

Dentist, Desiree Diamond, is on the fence about the issue.

"Why change something that's worked and confuse the patients, but why have the patients pay more money out of pocket. People need their money for gas, food, everything else, said Dr. Diamond said.

There are two bills up for consideration: Senate 75, and House 1299. It's "Dental Day" at the state house, but the bills up for debate also include any health provider or doctor.

"What this bill would do is to honor the patients request. If the patient wants the check to come to them, great. But if they want it to go directly to the doctor's office, so they don't have to pay up front at the time of care, this bill would require them to do so. It's been passed in 22 states and we're hoping Indiana becomes the 23rd state," Bush said.

"I believe that the bill is the wrong prescription for these economic times. We want to protect as insurers, our members, our patients, from balanced billing, and this bill would permit providers of any kind, to bill the patients in excesses of the reimbursement that the insurer would make," Doran said.