Emergency dental covered as out of network (TX)

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Back in September of 2020, I busted my two front teeth. They were pointing backwards and I was in a lot of pain and could not bite. I found an emergency dental place that was luckily open on the Sunday and was able to get my teeth fixed. I filed the claim with my insurance (CareFirst BCBS) and was at first denied due to differences in dental vs health insurance codes. On my second attempt, they accepted the claim but placed it as out-of-network since it was an emergency office visit and not an ER visit. The thing is an ER cannot fix my teeth so the only option is the emergency office visit. I am currently in the process of working up an appeal but wanted to know any advice that y’all could offer! I’ve been told that the appeal process takes a look at all the documents and doesn’t always go by the code…so there’s some small hope…with the caveat that its an insurance company and they never want to pay out (somewhat understandable?)

Anyways, thanks for the help in advanced!

submitted by /u/AstroHTXEdu
[link] [comments]
Back in September of 2020, I busted my two front teeth. They were pointing backwards and I was in a lot of pain and could not bite. I found an emergency dental place that was luckily open on the Sunday and was able to get my teeth fixed. I filed the claim with my insurance (CareFirst BCBS) and was at first denied due to differences in dental vs health insurance codes. On my second attempt, they accepted the claim but placed it as out-of-network since it was an emergency office visit and not an ER visit. The thing is an ER cannot fix my teeth so the only option is the emergency office visit. I am currently in the process of working up an appeal but wanted to know any advice that y’all could offer! I’ve been told that the appeal process takes a look at all the documents and doesn’t always go by the code…so there’s some small hope…with the caveat that its an insurance company and they never want to pay out (somewhat understandable?) Anyways, thanks for the help in advanced!
submitted by /u/AstroHTXEdu [link] [comments]Read Morer/HealthInsurance

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