Insurance billing question

I called the number on the back of my insurance card to find an oral surgeon that was in-network. Now over a month later I am getting billed for almost the full amount because they are saying that the provider I went to was out-of-network. I am so mad that they can do this. I called the number to make sure I went in-network. I am getting no where arguing with the insurance company. It's a lot of $ ... is there anything I can do?

Insurance billing question

Is the Dr listed on the ins website? What does the Dr office say? Are they participating?

I recently had to appeal to the state ins commissioner for a bunch of claims paid as out of network but we are in network.

Re: Insurance billing question

The insurance company website doesn't allow me to search online for a provider, which is why I had to call the number on the back of the card. The doctors office said they are in-network and even called the ins company while I was there to find out exactly whats covered (since it's part of my new dental coverage and I didn't know how much I would be responsible for). The insurance company told the doctors office that it was all covered. I haven't called the doctor yet but they are billing me for thousands. How can I prove the insurance company told me this provider was in-network?

Insurance billing question

I would contact the doctor... it's unfortunate but a lot of doctors make mistakes with their billing. Also, with dental work and oral surgery (covered under dental insurance, typically separate from regular medical) it's a whole other ballgame.

Re: Insurance billing question

you can call again and ask. They should also have the persons name they spoke to when they called to do an eligibility. Unfortunately, when chekcing benefits the first thing the insurance company says is "nothing is a guaranteed" did your surgeon send out a Pre- D?


May I ask what dental ins it is?
Did the insurance pay anything to the provider?

Re: Insurance billing question

Is it an EOB (Explanation of Benefits) from the insurance company or an actual bill from the doctor? Unless it was a bill from the doctor, I wouldn't get too worried. The doctor may write-off a lot of "non-covered" expenses.

Message edited 3/3/2014 11:35:06 PM.