medicare----insurance help please

[Dznypal]

my DH had a root canal done in Sept--didnt know we had a small dental coverage with the medicare-until our insurance said we did and should send in the claim
which we did in Oct--havent heard anything and today I called what a hot mess--called the # on the back of my card--explained everything nope wrong dept transfered me told the whole story again--they said nope wrong dept and transfered me again--right back to the first # I called

explained the whole thing again she said she would transfer me to a representive and explained the whole thing again--she at least gave me some answers and gave me a # to call for claims--she also gave me a case # so I wouldnt have to repeat everything--the # she gave me was a fax # even though I repeated it to her--so now IM back to square 1
called again was told that claims does not talk to card holders that its done internely I had asked for a supervisor at one point and after about 30 minutes got disconnected
so again called the # on my card--

and around and around we went--the one person that gave me the case # did tell me they did send a check around the 26 of OCt--ok so where is the check now that no one seemed concerned about--

now our insurance broker is going to see what he can do--
if not what other options do we have--Im not losing out on this money--
we did pay the bill when it came in there were several other charges that insurance did cover but not the root canal--

Im sure it too late to do anything with the bank as far as disputing it--

sorry to ramble but Im just so fustrated and dont know where else to turn--I suppose just to wait till our insurance guy gets back to us--somehow I feeling this is going to be long fight shouldnt they just stop payment on the check and issue a new one too easy I guess

what surprises me no one is concerned that this check was never cashed--dont they have some method to balance the books like when we balance our checkbooks

again sorry for venting--and advice would be greatly appreciated

 

[barkley]

didn't your dentist (or periodontist) handle the billing? if so they should be able to resolve this. my dh had extensive oral surgery in 2022 and we/his provider went round and round with insurance. we were finally told (wrote it down for future reference) that if we have private dental insurance and medicare dental coverage (we just have the embedded stuff in an advantage plan-we don't pay extra) that when billing the provider has to list/bill private as primary and then medicare as secondary. it took multiple submissions but the provider finally got their money (they only had us pay the estimated uncovered portion).

can the provider do another claim and see what response they get? it might serve as a means to see if there was ever a payment issued.

side note-i was glad to see that our advantage plan started in 2023 to simply load the small amount they will pay ($250 per year) on our OTC visa card so we can just use that and avoid the whole billing nightmare.


good luck-it's so frustrating.

 

[Dznypal]

thanks for the reply and yes the provider did send it to insurance cause there were some other things on the same bill such as cleaning that insurance did cover
thanks for the suggestion to re submit--
that will be my next plan

it was just such a mess 2 and a half hrs I spent and nothing got done
the one rep that gave me a case # that she said if I have to call back give them that # so I dont have to start all over but no one seemed to want the number

 

[MrsCobraBubbles]

With a medicare plan you can file a grievance. You can file it against the healthplan, either with the healthplan or you can call 1800medicare. It could end up backfiring on you though and tie everything up longer while you wait out the grievance process. But at least the grievance dept. will do the legwork for you and then you don't have to waste hours on the phone tracking down the money.

 

[anjuan]

I also suggest calling 1-800-Medicare so then they will have the information on the complaint and require the plan to resolve the issue. In general for complaints (grievances) under Medicare Advantage plans have 30 days to resolve them but if they need more information they can take up to 14 more days for a total of 44 days.

 

[Dznypal]

thanks for the phone number--however there seems to be too many numbers (letters)
since phone numbers are 10 digits
if you put it in as medicare that would be 8 plus the prefix

thanks havent heard back yet from our insurance guy but that will be my next option

 

[Denise W]

thanks for the phone number--however there seems to be too many numbers (letters)
since phone numbers are 10 digits
if you put it in as medicare that would be 8 plus the prefix

thanks havent heard back yet from our insurance guy but that will be my next option

It doesn’t matter if there are too many letters. Just punch it in and it will still direct the call.