Dental Bills

[triciamek]

I'll try to make a long story short. I had my wisdom teeth removed in January and paid a little oop that was the difference between what was pre-approved by my dental insurance. Fast forward 8 months and I am now getting bills from the dentist due to the insurance denying the claim. My insurance informed me that it was denied because it was not submitted until June. I understand that I agreed to pay anything not paid by the insurance but it was the dentist office that caused the claim to be denied. Is there anything I can do to fight the bills?

 

[tvguy]

I'll try to make a long story short. I had my wisdom teeth removed in January and paid a little oop that was the difference between what was pre-approved by my dental insurance. Fast forward 8 months and I am now getting bills from the dentist due to the insurance denying the claim. My insurance informed me that it was denied because it was not submitted until June. I understand that I agreed to pay anything not paid by the insurance but it was the dentist office that caused the claim to be denied. Is there anything I can do to fight the bills?

Any insurance experts? I thought claims could be filed up to a year after service was rendered.

 

[ellochka]

Call the dentist and ask to speak with their billing person. It is unlikely that their office did not submit the claim in time. If so, then ask to speak with the doctor him/herself.

 

[triciamek]

When they got the pre-approval they were made aware that claims had to be filed within 90 of the service.

 

[scrapquitler]

I'll try to make a long story short. I had my wisdom teeth removed in January and paid a little oop that was the difference between what was pre-approved by my dental insurance. Fast forward 8 months and I am now getting bills from the dentist due to the insurance denying the claim. My insurance informed me that it was denied because it was not submitted until June. I understand that I agreed to pay anything not paid by the insurance but it was the dentist office that caused the claim to be denied. Is there anything I can do to fight the bills?

Call the Dentist office, tell them what happened and ask them to follow up with the insurance company. Sometimes if they resubmit things like this it goes thru the second time. The dentist office probably is very familiar with this situation.

 

[Sadie22]

My dentist's office submits claims electronically. They get back something showing they submitted. Sometimes for whatever reason the insurance company will state they did not get the claim. I won't know this until I get a bill from the dentist and ask them to resubmit the bill, at which time it goes through.

 

[bumbershoot]

Call the Dentist office, tell them what happened and ask them to follow up with the insurance company. Sometimes if they resubmit things like this it goes thru the second time. The dentist office probably is very familiar with this situation.

Yes.

And also talk to the insurance people to see if you have to pay. If their agreement with the insurance company means that you shouldn't have to pay (no matter what they had you sign), they aren't going to destroy that agreement/contract with the insurance company just to get that money. Especially when they are possibly the ones that didn't file the claim.

 

[tvguy]

When they got the pre-approval they were made aware that claims had to be filed within 90 of the service.

So sounds like your Dentist's problem.

I went round and round with my insurance about a crown. They insisted the had already paid for a crown on that tooth, and new crowns are only covered once every 5 years. Ah, what part of the xray of the tooth without a crown don't you get? Write the check.

 

[cjbcam]

My dentist's office submits claims electronically. They get back something showing they submitted. Sometimes for whatever reason the insurance company will state they did not get the claim. I won't know this until I get a bill from the dentist and ask them to resubmit the bill, at which time it goes through.

Mine submits electronically as well. But we have to pay oop for the appointment, then the insurance company sends us a check. We have always received the money back within a week.

 

[Shelly F - Ohio]

I would not pay it. I would go to the office and throw a fit. If they knew it needed to be submitted in 90 days its their fault. Why should you have to pay for their mistake.

 

[disneyfab]

I had this happen once with my child's well child visits. The office filled the visit incorrectly, but did not submit the corrected claim until more than a year after the visit.

I was sent a bill and contacted my insurance company. My insurance sent me a letter stating that the office was outside of the terms of their agreement by not filing by a certain period and that I did not have to pay.

I spoke with someone in billing at the ped's office and they confirmed that this was correct and sent me a corrected bill showing an zero balance after office adjustments as my copay was paid at the visit.

 

[toofache]

Lot's of assumptions here that it's the fault of the dental office. I have seen this a few times in my dental office. The claim is subitted and it takes a month for insurance to tell us that they have a new policy on the way the forms must be filled out. Then we submit it again and another month goes by until they tell us we have to submit our written documentation. So we submit it and another month goes by until they ask for pre-op xrays. Then we submit it again and now it's past th 90-day mark and they deny the claim. The only thing the insurance company tells the patient is "they did not file within 90 days." Therefore the patient is responsible since the insurance doesn't pay because of their own games. The patient is ALWAYS responsible when the insurance doesn't pay and the the prudent office has a form with the patient's signature accepting this responsibility. It's the PATIENT'S insurance, not the doctors. Insurance companies are not the patient's friend.

 

[tamman]

It's not always the patients responsibility. Mistakes do happen on the end of the dental/medical office. Try to find some type of documentation on when the claim was originally submitted. I definitely would not pay the bill until you find out exactly what happened. I received a bill from a hospital for $2400 for a surgery that happened 15 months earlier. When I called insurance company they said it was denied because they submitted the bill after a year. When I called hospital, they said they were switching computer systems that the claim got lost. Was I responsible to pay for their error....um... NO WAY!! They agreed to pay for it.

 

[ceecee]

We have more than 90 days to submit in Ohio, it may vary state to state. Call the dentist's office, then your insurance company. It sounds like you have a pre-determation done? Sometimes with extractions and other more involved treatment, you can not submit electronically, but when you try it tells you that.