My dental office assured me my insurance would take care of most of the cost for a tooth removal procedure. I payed the premium and went on my way but a month later the dental office called me saying the insurance didn't cover anything and I have to pay the remainder. What should I tell them? What would you tell them?
2006-12-05 14:31:38 · 12 answers · asked by Anonymous in Business & Finance ➔ Insurance
"Quote of benefits is NOT a guarantee of payment. Actual benefits are determined when a claim is received." This is the disclaimer given every time a provider calls an insurance company. Meaning, an insurance rep can tell you (or a doctor or dentist) that "Sure.... Whatever procedure you're doing is covered. Yada, yada yada." But, when the insurance company gets the claim, they can do whatever they want with it.
Tell the dentist you're going to try to fight it out with the insurance and you'll keep them in the loop. Get a copy of the denial from your insurance company from the dentist - it will state exactly why the claim was denied. If it was denied for being filed past the allotted time frame, and your dentist had your insurance info when you had the procedure done - tell the dentist to pack salt. They screwed up and you're not taking the fall for it! If it was denied for any other reason - call your member services number at your insurance company and ask them to reconsider the claim. More often than not, because you're the one paying the insurance company and the service provider is the one trying to suck money out of the insurance, your opinion matters more.
Be aware though - you may have to jump thru some hoops - do not back down!!!
Whatever you do - DO NOT ignore it. You can end up getting sued for the money or at the very least, sent to collection and have your credit shredded.
2006-12-06 01:21:30 · answer #1 · answered by zippythejessi 7 · 0⤊ 0⤋
I would say ..Hold up hey...You assured me my insurance would pay this and I wouldn't have had it done if they didn't. Argue the case and in the end, agree to split it if they don't offer a better deal. After all, you did get service but it was a drag they didn't pay it.
Check with the insurance, that should have been covered as a neccessary procedure and not cosmetic in the least...maybe they filed it wrong too. Maybe they are double dipping eh?
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2006-12-05 22:32:43 · answer #2 · answered by MN-Mike 4 · 0⤊ 0⤋
Been there, done that, and I'm an insurance agent. Sigh. The bottom line is, you have to pay the dentist.
They can make a courtesy call to see if the insurance will cover it, then they submit the bill and find out FOR SURE.
Sorry.
2006-12-05 23:11:00 · answer #3 · answered by Anonymous 7 · 1⤊ 0⤋
tell them the truth, you were under the impression that the dental office was going to recieve most of the fee from your insurance. SInce you were under that impression (and you have proof of it, or at least the conviction to see it through), you are liable for that fee. You should only pay what you were told you were responsible for (you did ask for a bill in writing right?), and if they harass you, seek legal council (a few questions with a lawyer isn't too expensive).
Or you can pay off the balance and make it all go away, I wouldn't.
Check
2006-12-05 22:39:28 · answer #4 · answered by antsam999 4 · 0⤊ 1⤋
why didn't they pay. You should have got a notice from your insurance agency if not call them and see.
If dentist did not supply an zray or something it is his fault.
If your insurance co does not cover it than you pay
2006-12-05 22:34:47 · answer #5 · answered by G L 4 · 1⤊ 0⤋
Excuse me, Dr. ....., can you put the cavities back in? If there a problem, try taking up with your insurance. Dentist may not make you pay it all at once...ask about your options.
2006-12-05 22:34:48 · answer #6 · answered by yarble 1 · 0⤊ 0⤋
File in Small Claims section of District Court. The dentist won't want to spend the time to show up and defend.
However, this is a view from a novice with a bit of a legal background.
2006-12-05 23:59:05 · answer #7 · answered by D L 2 · 0⤊ 2⤋
Call them up and remind them what they told ya and tell them they shouldn't tell people things unless they know it is true. That was wrong on them to do that. I would tell em what i thought. Hummmmmmm maybe thats why I get into so much trouble lol Good Luck Do hope tooth is better
2006-12-05 22:53:48 · answer #8 · answered by Babie 3 · 0⤊ 1⤋
Well, doesnt your insurace have to approve the cost before you acutally get the procedure done? Call them up too
2006-12-05 22:33:03 · answer #9 · answered by J 3 · 0⤊ 0⤋
Pay the premium & never go back.
2006-12-05 22:33:21 · answer #10 · answered by Conservative Texan 3 · 0⤊ 0⤋