Kansas Not telling Dr.Office we have insurance

J

Jocker

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Kansas
A family member won't have coverage next year due to ACA cuts. In 2025, she has ACA insurance with dental coverage, however she already used all her preventive dental benefits this year. There is a (new) dentist that we haven't been to, who is advertizing New patient special for 59 dollars. There are reasons why I'd like this family member to see this new dentist at the very end of 2025. When I was making an appointment, they asked if we are claiming any insurance, I said NO
However, I just checked her 2025 insurance network and this new dentist appears to be in network with them. Do I have an obligation to tell them she has insurance where the dentist is in network? Would I violate anything not telling them? Do you recommend that we tell them about the insurance but no remaining preventive benefit? There is no option to wait till the beginning of 2026. Thank you!
 
I've seen those deals. The $59 doesn't cover much: exam, maybe Xrays, cleaning.

But if any work needs to be done, it will be at some outrageous price rather than the price they would charge for insurance.

Read the fine print of that $59 offer.
 
Jocker said:
A family member
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So...your spouse? Third cousin twice removed? Might not matter, but why be vague?


Jocker said:
I was making an appointment
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Why were you making an appointment for someone else?


Jocker said:
Do I have an obligation to tell them she has insurance where the dentist is in network? Would I violate anything not telling them?
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No.


Jocker said:
Do you recommend that we tell them about the insurance but no remaining preventive benefit?
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My only recommendation is that, if the patient is an adult, you stay out of it. If you must be involved, don't lie.
 
zddoodah said:
So...your spouse? Third cousin twice removed? Might not matter, but why be vague?




Why were you making an appointment for someone else?




No.




My only recommendation is that, if the patient is an adult, you stay out of it. If you must be involved, don't lie.
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For my child who is technically "an adult" but I am still responsible: financially, and for giving needed push to get things like this done. This said child spends very little time in close proximity to me, so I have to act fast.
 
Is it your insurance, in your name with your adult child as a dependent? Or is it your adult child's insurance? My answer might vary depending on the answer.
 
cbg said:
Is it your insurance, in your name with your adult child as a dependent? Or is it your adult child's insurance? My answer might vary depending on the answer.
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Hmmm let's see. It's a marketplace plan. There is the same application for both of us on healthcare.gov website. But then i bought a plan for myself and a plan for her. We have different plans, titles are different, different member IDs. I am not sure how to answer your question.
If I call her insurance, they won't talk to me because she is 18+, unless she fills out a special permission.
 
That answers my question. It is her insurance; you are not covered on the same policy as she is. That's right; because she is a legal adult they will not talk to you without her permission. That's absolutely the right thing to do on their end.

It also means that YOU do not tell or not tell the dentist's office anything at all about her insurance. That's for HER to do.

And if SHE were to ask me, I'd tell her to tell the dentist's office the truth; she has coverage until the end of the year but not once the new year starts.

But they're not likely to accept information from you, because your child is a legal adult, any more than the insurance carrier is.
 
cbg said:
And if SHE were to ask me, I'd tell her to tell the dentist's office the truth; she has coverage until the end of the year but not once the new year starts.
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She could also simply respond by saying that she's not going to be using any insurance if they ask.
 
It is both acceptable and legal to self-pay instead of using your insurance. Nothing in the law obligates you to use the insurance even when you have it. While I would use the insurance if I still had benefits left, that's me. If you have reasons for not wanting to use the insurance, you won't be violating any laws by failing to do so.
 
cbg said:
It is both acceptable and legal to self-pay instead of using your insurance. Nothing in the law obligates you to use the insurance even when you have it. While I would use the insurance if I still had benefits left, that's me. If you have reasons for not wanting to use the insurance, you won't be violating any laws by failing to do so.
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I thought I said that ;)

(But yours was a more thorough reply :) )
 

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