Dental insurance?

Question

I have been for two visits to my primary dentist and he has refered me to a oral surgeon to have a wisdom tooth taken out, I ahd the consultation with my oral surgeon and he took x rays and it came to $85 each one total 170. I got a thing from aetna insurnace saying the x-rays was denied, I called them up and questioned them about it and they said it was becasue i already had x rays done this year with my primary dentist. I had called like two weeks before THe insurance, and i talked to a guy and he said that a specialist visist would be covered at 100% and not counted in the two visits, However i said WEll why did you cover the visit but not the x rays when i called today, SHe then says well I think we made an error, I"ll need to process this one again, I said well i was told that i have a specialist benefit, SHe looks for a while and then says "oh yeah i guess you do. Do you think i just screwed myself out of the office visit, Or do a lot of ins. comp. have this unadvertised benifit?

Answer 1

Ugh. Insurance companies are not there to help you - they are there to make money and will do what they can to not pay. If you call them on it, they will often come up with..."Oh, yes...hang on..."

It would have been NICE if the specialist had called your GP to see if xrays existed or if the GP had offered to send copies to the specialist for you....

I myself would be tempted to ask the specialist to write the charge off since it was technically uneccesary - or was it...are you sure the xrays were duplicates? maybe it was a different kind of xray....

Answer 2

Whenever you use your insurance at different offices you should check what will be done and then check with the insurance if they will pay for your treatment. When you called to ask about your visit, maybe you should have asked about x-rays too. You are really responsible to find out your benefits and the office as a courtesy bills the insurance for you, they are really not responsible for your benefits. Your insurance pays the claims as they come in and if your benefits allow this procedure then they pay but if not they deny the payment and you are told on your explanation your portion you are to pay.

Answer 3

ONE THING THAT MUST BE UNDERSTOOD IS THAT ANY INSURANCE COMPANY OUT THERE CONSIDERS THEIR "PATIENTS" AS A "LOSS", AND DO NOT EXIST TO MAGICALLY SOLVE ALL OF YOUR DIFFICULTIES. THEY DO NOT HAVE A FIDUCIARY RESPONSIBILITY TO YOU. THEY ARE IN BUSINESS BECAUSE YOUR EMPLOYER CONTRACTED WITH THEM.
THEY ARE NOT HERE TO SAVE YOU MONEY.