This is crossposted with r/legaladvice too, at the suggestion of someone who replied to my post there.
I’m going to try to sum up this backstory as quickly and succinctly as I can.
In Sept of 2019 I had 2 wisdom teeth extracted. I gave the front desk my medical insurance card, and was told that medical insurance does not cover dental procedures. I acknowledged that I was aware of that, but said I thought since it was a surgery, it was a technically a medical procedure, and that medical insurance would be needed, on top of my regular dental. She told me I was mistaken. I shrugged, and put my card away. Got my teeth extracted and went home. All was good.
A few weeks, maybe months?, later I get a call stating that they did in fact need my medical card (had a facepalm moment when I got the call). I called them back, gave them the info and thought everything was cool.
At about this time last year (April 2020), I was sent a bill in the mail for about 1200 bucks. Confused I called the dentist and honestly, I forget exactly what happened at this point, because covid hit and everything was shut down. I couldn’t get through to the office or their billing dept. to save my life. Tried calling multiple times and each time left a message. No call backs. I shrugged
I received a few more copies of that same bill once covid things started to get a bit better. I’d say the first repeat bill I got from them was in Jan of 2021ish. I called them again, and they explained that my medical wasn’t covering the procedure. I scoffed. I have some of the best insurance in the country. It’s a personal choice plan that my employer pays out the ass for, and there’s practically nothing they don’t cover. I explained that to them. We confirmed details and billing said they’d try to get in touch with them and get it sorted, saying something about my insurance will probably cut me a check to submit to them. I thought it was good. I probably should’ve looked into it myself at this point.
I’ve again received the same bill recently. Called up the dentist / their billing and asked what was going on. They’re telling me insurance isn’t covering it, so it’s being passed on to me. Pissed off I call my insurance, and they tell me, it’s not being covered because they didn’t submit their claim for payment until over a full year had passed from the date of my oral surgery. now it all made sense to me. The person I spoke to from my insurance company told me, that If it was still close to a year past the date, I could have possibly filed a motion to get it covered (A dispute maybe? I forget the term), but now that we’re two years passed the date, it will get rejected out of hand. The dentist swears up and down that they submitted payment dec. 21st 2019, and in january, feburary, march etc of 2020, but for some reason is unable to show me that information, where as my medical insurance said the first request they received from the dentist was received in oct of 2020.
So everything I’ve read says I’m on the hook, but this is bullshit. Does anyone know what my options are here?
Sorry this post is so long, and I appreciate any help I can get. Thank you in advance
EDIT: Dentist in question is IN my dental insurance’s network, but OUT of my medical insurance’s network. Why this is allowed to be a thing, I don’t know… It’s pretty frustrating.
submitted by /u/Th3V4ndal
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This is crossposted with r/legaladvice too, at the suggestion of someone who replied to my post there. I’m going to try to sum up this backstory as quickly and succinctly as I can. In Sept of 2019 I had 2 wisdom teeth extracted. I gave the front desk my medical insurance card, and was told that medical insurance does not cover dental procedures. I acknowledged that I was aware of that, but said I thought since it was a surgery, it was a technically a medical procedure, and that medical insurance would be needed, on top of my regular dental. She told me I was mistaken. I shrugged, and put my card away. Got my teeth extracted and went home. All was good. A few weeks, maybe months?, later I get a call stating that they did in fact need my medical card (had a facepalm moment when I got the call). I called them back, gave them the info and thought everything was cool. At about this time last year (April 2020), I was sent a bill in the mail for about 1200 bucks. Confused I called the dentist and honestly, I forget exactly what happened at this point, because covid hit and everything was shut down. I couldn’t get through to the office or their billing dept. to save my life. Tried calling multiple times and each time left a message. No call backs. I shrugged I received a few more copies of that same bill once covid things started to get a bit better. I’d say the first repeat bill I got from them was in Jan of 2021ish. I called them again, and they explained that my medical wasn’t covering the procedure. I scoffed. I have some of the best insurance in the country. It’s a personal choice plan that my employer pays out the ass for, and there’s practically nothing they don’t cover. I explained that to them. We confirmed details and billing said they’d try to get in touch with them and get it sorted, saying something about my insurance will probably cut me a check to submit to them. I thought it was good. I probably should’ve looked into it myself at this point. I’ve again received the same bill recently. Called up the dentist / their billing and asked what was going on. They’re telling me insurance isn’t covering it, so it’s being passed on to me. Pissed off I call my insurance, and they tell me, it’s not being covered because they didn’t submit their claim for payment until over a full year had passed from the date of my oral surgery. now it all made sense to me. The person I spoke to from my insurance company told me, that If it was still close to a year past the date, I could have possibly filed a motion to get it covered (A dispute maybe? I forget the term), but now that we’re two years passed the date, it will get rejected out of hand. The dentist swears up and down that they submitted payment dec. 21st 2019, and in january, feburary, march etc of 2020, but for some reason is unable to show me that information, where as my medical insurance said the first request they received from the dentist was received in oct of 2020. So everything I’ve read says I’m on the hook, but this is bullshit. Does anyone know what my options are here? Sorry this post is so long, and I appreciate any help I can get. Thank you in advance EDIT: Dentist in question is IN my dental insurance’s network, but OUT of my medical insurance’s network. Why this is allowed to be a thing, I don’t know… It’s pretty frustrating.
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