Did I get Cheated? My daughter had surgery to remove an impacted tooth.?

Question

The dentist/oral surgeon wanted to do the operation at a hospital instead of his office. Everything went great untill I had to pay for it. I got stuck with the entire bill, because my dental insurance said "it was a medical proceadure" and my medical insurance said "it was a dental proceadure. What can I do to make these dead beat insurance anancys pay their part?

Thanks! By the way this is about, Mercy Hospital in Oklahoma, BlueCross/BlueShield, and Delta Dental, in case anyone was wondering.

Answer 1

Boy, sounds like what i went through with my son when he was born. You need to talk to the dentist office and get them to change the way they are filing the claim. Tell them exactly what's going on and if you keep on them about it, they'll change the way they are filing it. You'll never get the ins. companies to change their policy.

Answer 2

Have both offices, dental and oral surgeon, re-submit the claims. They know how to "word" it and which "codes" to use for the dental insurance co. and the medical insurance co. to accept. It sounds like someone at one office didn't file it correctly, so they both denied it. You shouldn't stress over this, it happens occasionally when filed incorrectly, although it shouldn't. Let them take care of it, that's what they are paid to do and why you have insurance in the first place. Hope your daughter recovers quickly from her surgery.

Additional information: It really doesn't matter which insurance co. you are dealing with, they all will reject claims if not coded correctly. As I said, just have your Dentists and OS resubmit the claims accordingly and it will be covered based upon your policy. Don't worry, they will get it straightened out for you.

Answer 3

You can appeal to your medical insurance. Have your Dr. write a letter why this had to be done in the hospital and that will help make it a medical thing instead of a dental thing. Keep on your insurance company about this, You also need to talk to your HR person beause she knows how to deal with the insurance company.

Answer 4

I had my wisdom teeth pulled like that, and my dental insurance paid for it under major dental they only paid for 60% of the bill. Look at your policy there should be a listing of procedures they pay for. This should be under oral surgery.

Answer 5

Where the surgery was performed is irrelevent. It was a dental procedure; your dental insurance is responsible. That is why you pay your premiums. Look at the fine print in your dental plan. It probably doesn't even mention the location of the surgery.

Answer 6

in the experience that your coverage is thru your business organisation you likely can report an allure. touch your worker advantages administrator for help. The dentist/oral well being care expert has no incentive to cheat you. he or she needs to gets a commission as much as you opt to get reimbursed. probably the oral well being care expert will could desire to justify why the operation advance into proper completed inpatient vs. outpatient for scientific motives. i assume he had those. They scientific coverage ought to pay...and frequently will pay a a techniques better volume than dental coverage. i've got self assurance you will get this resolved.

Answer 7

Try to have the dentist talk to your insurance and explain to them that it was medical. I went through that when I had to have surgery on my jaw. My dentist called my insurance and explained that it was medically necessary and after fighting with them they finally covered it. If they absolutely refuse, I would get a good lawyer.







Insurance companies suck! lol

Answer 8

If the tooth was impacted and required surgical excision (not just a pulling), then it should be covered by your medical insurance. I would send it through the appeals process.

Answer 9

There should be a board of insurances in your state to file a claim and let them know you will.

Answer 10

GET YOUR DOCTOR INVOLVED. HAVE HIM COMMUNICATE WITH THE DENTAL INSURANCE. SINCE IT WAS DONE IN THE HOSPITAL IT PROBABLY IS CONSIDERED MEDICAL