Having a hard time getting treatment with insurance....( vent )

[Mskanga]

I'm so sick of this. Months ago my dentist told me that my youngest dd would need a frenectomy , I called the insurance company to find an in network provider and to find out where to send everything in for a pre-determination.
First of all they tell me to make sure that we send that to the local chapter of BCBS because if we send it ti NJ ( which is where the plan is out of ) , it will be treated as an out of network and I will get stuck with a deductible and co-pay. We send everything to where they tell us, wait a month and then they refused to process it, why? because it was sent to the wrong place!! It needs to go to NJ, now we have to wait another month.
In the meantime the doctor doesn't want to do anything until he gets the OK from the insurance company.
I know it's not a life threatening condition, but it's frustrating when we are trying to do everything correct and the people working for the insurance company does not give out the right information which results in more delays.
In the meantime my dd's teeth are coming in wrong because her two front teeth have a huge gap.
I hate dealing with insurance companies!

 

[workinggal]

My doctors/dentists have always obtained the precertification for me. That shouldn't have been your job in the first place. It's the office's. If they want to treat it, they need to obtain the authorization for it.

 

[Eeyore1954]

Workinggal is correct ... your dentist should contact your insurance company directly for precertifications. The dentist should submit the request to the same office to which they submit/send claims. Sorry you had this problem.

 

[Mskanga]

The doctor's office is the one that submitted the pre-determination, but they sent it to where we were both told to do which was the local chapter for them in PA , that's where the insurance company also told me to submit it, they told me that if we ( doctor or myself ) sent it to NJ it would be treated as an out of network. In short, they gave us both ( doctor and me ) the wrong information.
Now we have to wait another month to hear from them!

 

[Eeyore1954]

Apologies for my misunderstanding! Then the problem lies with BCBS. Sounds like their staff managing dental claims and pre-certs need some additional training.

I'm just curious ... why do they take a month to finish a pre-cert? Is that just SOP for dental procedures? Just seems like a long time to review something that appears necessary.

 

[Mskanga]

I don't know why it takes them so long, the thing is that I don't have dental insurance through them but the frenectomy is considered part of the major medical ( because it's oral surgery I guess ).
I don't know how this is all going to turn out but I hope they don't take long.

 

[Auggietina]

I just think there is some miscommunication going -
For BILLING purposes it needs to be billed in the state that the services are performed. Its called BCBS's out of Area Program. For payment purposes, your claim will be considered an in network service.

For authorization purposes - that needs to be done with your home plan - in this case NJ.