The person who posted this mentioned that their husband’s insurance changed from UnitedHealthcare dental HMO to PPO this year. They recently took their son for a six month dental check-up, which should be covered. But the dentist’s office tried to charge them the full amount. It took three calls to get the claim handled and during the last call, they learned that “oral hygiene instructions” aren’t covered at all. The person is shocked that they’re being charged $106 because the dentist reminded their son to brush and floss. They’re looking for advice on how to file a grievance.
It sounds like the issue might stem from how the dentist is filing the claim. If the plan covers the check-up, it could be that the dentist is using the wrong code. This doesn’t really fall on the insurance if things are getting submitted incorrectly.
Remember, being covered doesn’t mean no cost at all. The $106 could be what you owe after the insurance pays their part.
@Kelsey
How should I handle this with the dentist? They’ve billed in the same way for years, and the only change is to PPO. Our benefits sheet still shows a $0 copay for these visits.
It’s just really frustrating because it feels like UnitedHealthcare is giving us a hard time about everything. I asked them how to avoid charges next time when the dentist tells my son to brush, and they told me, “your benefits just don’t cover that.” 
@Wynn
Is the dentist in-network? If it’s billed the same way as before, have you compared the codes? Either the plan changed or something with the codes is different. What does your EOB say? Do you have a deductible now? There are usually some changes when switching from HMO to PPO.
@Wynn
You should talk to the dentist or their billing team to go over the codes used for the claims.
You could say something like, “I brought my son in for a check-up that insurance covers, but you submitted a code for reminding him to brush his teeth, which isn’t covered. Can you remove that charge or offer a cash price for it? Also, please note in my son’s chart that I don’t want this advice given to him again.”
@Wynn
Looks like some people aren’t comfortable with the truth since we’re getting downvoted. Just call your dentist and say, “We’ve been coming to see you for years, but since changing our insurance, this code isn’t covered anymore. Can you help me with that?” If they can help, great! If not, you might need to think if it’s worth staying with them. Many dentists are good, but insurance companies are cutting the payments to them each year, not keeping up. They need to make money somehow or it’ll cost them to treat us. Just saying, I’m a dentist.
@Wynn
Have you thought about trying Medicare… it’s even worse.
Dru said:
@Wynn
Have you thought about trying Medicare… it’s even worse.
I think what you mean is Medicaid since Medicare doesn’t cover dental.
Unless you’re talking about one of the Advantage Plans, which are HMO and come with all the issues that HMOs do. They are for-profit plans.
@Remy
I’m not really sure. My wife works at the hospital, and she says one of those two tends to deny coverage more often than the others.
@Kelsey
Looks like the in-network dentist could be trying to make up for poor reimbursements from the insurance. Alternatively, they could just clean your teeth and ignore any talking about how to take care of them. But they usually advise on findings and other ways to care for your teeth.
@Yule
My dental hygienist always includes advice on dental care during cleanings. The dentist just does the oral check-up, and I never get charged anything extra.
River said:
@Yule
My dental hygienist always includes advice on dental care during cleanings. The dentist just does the oral check-up, and I never get charged anything extra.
Seems like you have a dentist who gets paid better by insurance than the one the person who posted this has.
It’s not UnitedHealthcare causing the problem, it’s the dentist. I went to a dentist that tried billing me for “oral hygiene instructions” because they reminded me to floss daily. I went to their office and warned them I would report fraudulent billing to my insurance company. They dropped the charge and I switched to a different dentist who doesn’t do that.
Your dentist is charging $100+ for just telling your kid to brush his teeth. Why aren’t you concerned about that?
A dentist I visited last year wanted to charge me $20 each for two phone calls. And they called me! They informed me my appointment was canceled due to the dentist being sick and promised to call back to reschedule. That was a quick call. They called again two days later to reschedule, but I had already received a bill for the first call, so I said no thanks!
I later got another bill with charges for both calls. I wrote that I’d never heard of such charges and refused to pay. That settled it.
I had the same experience with Aetna, but it was only $11 so I just paid it. Still, it’s ridiculous! I would have definitely called the dentist if it had been a larger amount.
Dentists often charge for silly things and upcode small procedures to make more cash. You should tell them you’ll report them for fraudulent billing.
Just appeal it.
Dentists are notorious for upcoding, unnecessary procedures, and outright fraud.
Your dentist is definitely shady. You should ask them to remove the charge from the claim and then look for a new dentist.
The issue is with the dental coder, not UnitedHealthcare.