Dental Insurance and the Dentists Office?

Question

Is it the Dentists Office responsibilty to refile a claim if one has not been paid in 6 months or is it the patient who must call the dentist office after so many months and tell them to re-file it?

My insurance co. hasn't paid for my check-up from six months ago. It's suppose to be covered and I didn't know it had not been paid. I ask the office to re-file the claim, but they acted like it was a federal offense. I wished I would have know sooner.

Answer 1

It is the patient's responsibility to keep up with insurance. Although, whoever does the insurance at your dentists office may try to stay on top of things, it's absolutely impossible to keep up with everyone's claims that have not been paid yet. I do exactly this for a living, so I know it can get overlooked sometimes. If you know the claim has not been filed or has not come through to your knowledge, (you would know this because you should have received an explanation of benefits from your insurance company probably before the dental office received their copy) you can always call your insurance company and ask if the claim has been filed or processed, and if so if anything was paid. If they have processed and paid it, then it could be en route to the dental office or lost in the mail. Be sure to communicate with the office to tell them any information you found out. If the claim was not filed or processed, per your insurance company, then call the dental office and kindly remind them that you have seen no payment by the insurance company for whatever date of service it was and ask them to please re-submit it for you. Every office is different. Some offices have the policy where the patients are responsible for filing their own insurance. It's not how we work around here, and hopefully it's not for your office either. It's a lot more headache for both the staff and the patient! Hope this helped!!! :)

BTW it sounds like someone at that office just didnt want to do their job...hopefully they aren't trying to collect the money on it. The only reason they should MAKE you pay would be if the insurance company sent back an explanation saying that due to frequency limitations or expired coverage, your 6 month visit was not covered. They should have no problem re-filing the claim for you. That's just rude...seeing as how most insurance companies and offices do electronic claims...just the click of a button and they are filed!!

Answer 2

Ten points for Casey'sMom!

...she said exactly what I would have said!

Start with calling your insurance company first to see if the claim was ever processed... if they say it hasn't, you can tell the dental office so, and ask them to resubmit it. If they give you a hard time, tell them that you'll do it yourself, and that you will stop by to pick up the copy of the original claim and resubmit it yourself.... chances are they'll do it for you if you say that to them...

Best of luck!

:)

Answer 3

the insurance policy is yours and it is up to you to file the claim, the dental office usually will do this but due to the privacy act alot of insurance companies will only speak to the policy holder. remember you are responsible for the bill not the insurance company ..

Answer 4

Yes you are responsible for the whole bill. It is your responsibility to make sure of your coverage, not the dentist. You received the treatment and must pay for it.

Answer 5

Patient should call, tell them it hasn't been paid and if they would resubmit to Insurance company.

Answer 6

If they are asking you for payment, call them and ask that it be refiled. If they aren't asking for payment, maybe they already have. Are you sure it just needs to be refiled, and that the claim wasn't denied?

Answer 7

it depends on how responsive the staff is and how good they are and how well they know their job, if you're on the hook for the $$ it would behoove you to contact the insurance company to straighten things out before it goes to collections and ruins your credit