More debt piled on by Insurance

iVillage Member
Registered: 07-04-2009
More debt piled on by Insurance
6
Mon, 08-31-2009 - 10:35pm

I just acquired more debt, I think this one is illegitimate. Please advise:

A couple of months ago DS had a tooth 90% knocked out in an accidental run in with a friend. I rushed him to the Dentist where he took an X ray to make sure the tooth didn't break off in DS's jaw. Once we saw that the tooth was intact and almost out we decided to yank it quickly (DS was numbed and happy to have it out so he could collect $$$ and bonus Bakugans from me)

I just received a bill from the Dentist for $250. This is because the X ray is covered but the "extraction?" is not! Today I called my dental insurance company (which is same insurance company as my medical coverage) and they said that the X ray was a dental procedure and the rest was "medical". So that should be filed with my medical side of the insurance company and since my Dentist only participates with the dental side of my company I am liable for this.

The insurance rep was kind and clear and I got off the phone so I could think about this. Upon reflection I think I should contest this with my insurance company (both Dental and Medical sides of if necessary)...how was I to know that this fell under multiple coverages!? The Dentist's office didn't tell me this coverage catch before the procedure and it was logical that since it was all about my son's TOOTH that I went TO THE DENTIST!!!!! Are they saying that I needed to go to the dentist for the Xray and then the Dr for the extraction? Rep says I should have gone to the hospital but when I consulted the dentist (TOOTH) he said bring DS right in.

I believe that I should not have to eat this bill.

What do you guys suggest I say when I call the insurance tomorrow?















iVillage Member
Registered: 08-04-2008
Tue, 09-01-2009 - 2:16am

The really bad thing about coverage in the US is that if you would have gone to a local emergency room, they most likely would have paid the entire thing - and it would have cost over $1000 dollars!

=Marie




iVillage Member
Registered: 04-10-2003
Tue, 09-01-2009 - 8:03am
Hugs! I have no wisdom since I am in Canada and we don't have to deal with these insurance companies (well, we do for prescriptions and dental I guess). I just hope you get it sorted out!

Bex -


"Yesterday is history, tomorrow is a mystery, today is a gift -thats why its called the present."


Bex -

iVillage Member
Registered: 01-25-2009
Tue, 09-01-2009 - 9:20am

Even though your dentist is not within the network for "medical", there should be some provision in most insurance policies for using out of network providers especially in an emergency. I would look closely at the policy, and perhaps see if your dentist could help as sometimes it is just a matter of coding. They *may* be able to tweak things a little bit.

Try calling the dentist first, because he has a vested interest (to get paid). At this point he does not know if you have money or not, but he knows you have insurance, so it is to his advantage to get the bill through. The insurance company, already got your money (the premium you paid and keep paying). It is to their advantage to s#$%^ you as much as they can.

iVillage Member
Registered: 03-27-2005
Tue, 09-01-2009 - 6:37pm

Just have the dentist bill your regular medical insurance for the extraction portion.

iVillage Member
Registered: 07-04-2009
Tue, 09-01-2009 - 10:18pm
yeah i checked into out of network, but my deductible was 300 bucks, then insurance would have paid 70%! Work was crazy as usual today but I will start with trying to work with the Dentist, good idea about the coding...














iVillage Member
Registered: 07-10-2003
Wed, 09-02-2009 - 11:54am
I would appeal the denial.