I'm normally pretty good at math, and this may seem silly, but it's driving me crazy.
The member (in this case, my father) has an MAPD with a dental reimbursement benefit. In January he gets a routine cleaning/checkup. Total cost $149, which he pays out of pocket. He then files the claim with the carrier. The carrier accidently sends the check to the dentist. The dentist's office calls, wanting to know what to do with it. He advises them to give him a credit for the $149 toward his next cleaning/checkup.
He goes in again in July. This time, due to X-rays, etc. the total bill is $224. But the billing statement from the dentist shows a net balance of $75 owed because of the $149 credit. He pays the $75 out of pocket and files the claim himself, with a note to the carrier stating that the reimbursement should be $224 because that's the amount of the second bill excluding the credit. The carrier reimburses him the $75 and says the dentist owes the additional $149, not the carrier.
I'm having a mental block because it's clear that there were $149 + $224 = $373 in total charges, and the dentist received that amount in full, $224 from the member and $149 from the carrier. Yet the member has $149 less than he did when started, and the carrier has only paid out $224. So it would seem to me that the carrier still owes $149 to the member.
Who owes whom in this case?
The member (in this case, my father) has an MAPD with a dental reimbursement benefit. In January he gets a routine cleaning/checkup. Total cost $149, which he pays out of pocket. He then files the claim with the carrier. The carrier accidently sends the check to the dentist. The dentist's office calls, wanting to know what to do with it. He advises them to give him a credit for the $149 toward his next cleaning/checkup.
He goes in again in July. This time, due to X-rays, etc. the total bill is $224. But the billing statement from the dentist shows a net balance of $75 owed because of the $149 credit. He pays the $75 out of pocket and files the claim himself, with a note to the carrier stating that the reimbursement should be $224 because that's the amount of the second bill excluding the credit. The carrier reimburses him the $75 and says the dentist owes the additional $149, not the carrier.
I'm having a mental block because it's clear that there were $149 + $224 = $373 in total charges, and the dentist received that amount in full, $224 from the member and $149 from the carrier. Yet the member has $149 less than he did when started, and the carrier has only paid out $224. So it would seem to me that the carrier still owes $149 to the member.
Who owes whom in this case?