I’ve always enjoyed good dental health, having just one cavity in my 33 years. Some of this I attribute to having the same dentist since I was 4.
Throughout my adulthood, my dental office felt like the only medical environment where I never had to worry about coverage through my ever-changing insurance providers or getting a massive bill in the mail.
That changed when my well-meaning husband recently suggested I find a dental office closer to our new house. It made sense to forgo a 45-minute commute to my appointments, and I was intrigued by the promises of more modern practices equipped with sleek offices and luxuries like ceiling-mounted TVs.
It was a pleasant experience until I was hit with a massive bill I didn’t expect. I turned to AI for help fighting it.
After my first appointment at a new office, I was presented with a $3,320.49 bill
I’d only gone in for a cleaning. To the provider’s benefit, I’m an easy upsell, especially for anything health-related. When they recommended an at-home treatment for gum disease, a retainer for my teeth grinding, and a ‘full mouth irrigation’ for gum health, I agreed, despite them not being covered by insurance and requiring high out-of-pocket costs.
It added up quickly, and before leaving the office, I regretfully paid the $2,111.29 I owed for the items not covered by insurance, which included tax and a credit card fee. I wished I had waited before agreeing to the extra services and done more research before moving forward; however, I naively had no concerns about the remaining balance that would be sent to my insurance company.
A few weeks later, I was floored when my dental insurance informed me that my responsibility was $1,201.80
The primary issue was that, despite finding the dental office on my insurance site, I was paired with the only doctor at the practice who didn’t accept my insurance — even after I provided my insurance information both by phone and via an electronic form prior to my appointment.
In my panic, I decided to look over the bill more closely and used ChatGPT to get insights into what I was actually being billed for.
I quickly found multiple instances of bad-faith billing
The first offender was an oral cancer screening test that I didn’t consent to, and that isn’t recommended or covered by insurance for patients in my age group.
I was also billed for both a periodontal evaluation and a comprehensive oral evaluation — two services that my insurance would not allow to be billed on the same day because they are so similar. Using AI even helped me by flagging that my ‘facial photographic images’ were charged at seven times my insurance’s allowed rate.
ChatGPT also assured me that it’s not standard practice to charge a 32-year-old woman $35 for ‘oral hygiene instruction’ just because the dental assistant reminded me to brush with my toothbrush at a 45-degree angle.
At first, I addressed my grievances the old school way
I called my insurance company, and the representative validated some of my findings but could only direct me to submit an appeal.
I used Otter.ai to transcribe my calls, then uploaded the transcripts of my calls with the insurance company, the receipt from my appointment, my explanation of benefits, and instructions on how to file an appeal into ChatGPT. In under a minute, it had my appeal letter written.
I did go through five revisions — a couple due to me clarifying certain elements of the experience, one because I didn’t like how a sentence was worded, and a couple more because I thought of more information I hadn’t previously considered including.
Using AI made the whole process feel less daunting
AI was especially helpful when doing the math on things like co-insurance based on allowable amounts. ChatGPT helped me speak the language of insurance companies and convey my thoughts in an industry-appropriate way.
Plus, it formatted everything according to my insurance company’s strict instructions and even provided mailing instructions so I could use as little brainpower as possible.
My first appeal was denied
When my insurance company denied my appeal — because the provider scheduled my appointment with an out-of-network dentist — I wasn’t happy, but I did feel more confident in dealing with the issue thanks to ChatGPT. I took pictures of the four-page letter and uploaded them into my previous chat conversation.
ChatGPT summarized the letter and suggested I submit a formal second-level appeal and a complaint to the Arizona Department of Insurance. It also advised that I could contact the dental board for my state, as well as my insurance company’s grievance department.
I prompted ChatGPT to draft both the second-level appeal and complaint for me, and I submitted them.
After my second-level appeal, my case was never formally resolved, but the dental office never sent me a bill for what wasn’t covered. I believe this is because the office had been contacted by my insurance about the billing issues, and they were aware of my appeals and my complaint to the Arizona Department of Insurance.
Ultimately, I never paid the $1,200.
Using AI made the whole process a lot easier
There’s a lot of criticism of outsourcing tasks to AI, and I can understand the argument that the instant fixes it provides can make us less equipped to think critically about our problems. However, I think we’ve all experienced the dread of opening a piece of mail after a long day and finding purposely confusing language that delivers bad news, a big bill, or both.
I don’t see the glory in wasting time and mental energy on tasks like researching dental codes or laboring over formatting. I’d rather save my energy for the things I enjoy, or driving the 45 minutes back to my childhood dental office, where I’m now happily receiving dental services again.
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