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Appealing dental claim?
Has anyone fought a bill? How did you do it ? What was the outcome?
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Posted 7/27/16 7:40 PM  |
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clotheshorse
LIF Adult
Member since 5/12 1294 total posts
Name:
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Re: Appealing dental claim?
Yes I have.
A few things: Ask the office rep if she billed the right insurance co. Sometimes the lady that sends mine out hit the wrong button & sent it to my insurance from 5 years ago. So no wonder it got denied & I got billed.
I learned that I have to schedule exams & cleanings exactly 6 months apart. Within 6 months, the charge is on you. Check with your insurance. You could still go through the appeal process though.
Was this for a cleaning or for something else?
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| Posted 7/27/16 8:22 PM |
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Diane
Hope is Contagious....catch it
Member since 5/05 30683 total posts
Name:
D
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Re: Appealing dental claim?
What are you trying to appeal? I appealed a bill from my insurance company... Took a long time , but won.
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| Posted 7/27/16 8:58 PM |
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Appealing dental claim?
I've never fought an insurance bill. At least not in recent memory.
I have dental insurance. It's a PPO.
In 2015, I went to an oral surgeon. I had X-rays. It was for a consult for my wisdom tooth. Panoramic X-ray.
Now it's 2016. I went for my basic check and cleaning with my regular dentist. Had X-rays (not panoramic). Had a cleaning.
Insurance won't cover the X-rays for this year because I had them done last year even though it was for a specialist and for a totally different reason.
I think this is ridiculous. I can see if I had went to another dentist for X-rays too but I went to an oral surgeon. For a completely different issue than basic dental care.
I'm just annoyed. I'm going to call again tomorrow.
Message edited 7/27/2016 9:08:53 PM.
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| Posted 7/27/16 9:08 PM |
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clotheshorse
LIF Adult
Member since 5/12 1294 total posts
Name:
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Re: Appealing dental claim?
Posted by EatingMyVeggies
I've never fought an insurance bill. At least not in recent memory.
I have dental insurance. It's a PPO.
In 2015, I went to an oral surgeon. I had X-rays. It was for a consult for my wisdom tooth. Panoramic X-ray.
Now it's 2016. I went for my basic check and cleaning with my regular dentist. Had X-rays (not panoramic). Had a cleaning.
Insurance won't cover the X-rays for this year because I had them done last year even though it was for a specialist and for a totally different reason.
I think this is ridiculous. I can see if I had went to another dentist for X-rays too but I went to an oral surgeon. For a completely different issue than basic dental care.
I'm just annoyed. I'm going to call again tomorrow.
Those x rays should have been covered. Once a year you are entitled to x-rays. Cleanings/exams are every 6 months, xrays are yearly. That seems to be the norm. Def call tomorrow and ask for supervisor /director. Sorry you are dealing with this.
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| Posted 7/27/16 9:14 PM |
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Re: Appealing dental claim?
Posted by clotheshorse
Posted by EatingMyVeggies
I've never fought an insurance bill. At least not in recent memory.
I have dental insurance. It's a PPO.
In 2015, I went to an oral surgeon. I had X-rays. It was for a consult for my wisdom tooth. Panoramic X-ray.
Now it's 2016. I went for my basic check and cleaning with my regular dentist. Had X-rays (not panoramic). Had a cleaning.
Insurance won't cover the X-rays for this year because I had them done last year even though it was for a specialist and for a totally different reason.
I think this is ridiculous. I can see if I had went to another dentist for X-rays too but I went to an oral surgeon. For a completely different issue than basic dental care.
I'm just annoyed. I'm going to call again tomorrow.
Those x rays should have been covered. Once a year you are entitled to x-rays. Cleanings/exams are every 6 months, xrays are yearly. That seems to be the norm. Def call tomorrow and ask for supervisor /director. Sorry you are dealing with this.
Thanks. Definitely a pain! i gave a check to the doc office, do you think that'll work against me? I paid it because I felt put on the spot
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| Posted 7/27/16 9:18 PM |
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gina409
TWINS!
Member since 12/09 27635 total posts
Name:
g
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Re: Appealing dental claim?
What's the time frame between the x rays?
Like nov of 15 and den of 16?
Was the general dentist told you had recently had a pano?
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| Posted 7/27/16 9:22 PM |
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Re: Appealing dental claim?
Posted by gina409
What's the time frame between the x rays?
Like nov of 15 and den of 16?
Was the general dentist told you had recently had a pano?
December 2015 for oral surgeon
End of June 2016 (21st I think) for regular X-rays at dentist
Yes, my general dentist was told I had panos done at the oral surgeon guy because i was having issues with my wisdom tooth.
It just seems crazy to me because they were for two different things and enough time between.
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| Posted 7/27/16 9:38 PM |
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clotheshorse
LIF Adult
Member since 5/12 1294 total posts
Name:
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Re: Appealing dental claim?
Posted by EatingMyVeggies
Posted by clotheshorse
Posted by EatingMyVeggies
I've never fought an insurance bill. At least not in recent memory.
I have dental insurance. It's a PPO.
In 2015, I went to an oral surgeon. I had X-rays. It was for a consult for my wisdom tooth. Panoramic X-ray.
Now it's 2016. I went for my basic check and cleaning with my regular dentist. Had X-rays (not panoramic). Had a cleaning.
Insurance won't cover the X-rays for this year because I had them done last year even though it was for a specialist and for a totally different reason.
I think this is ridiculous. I can see if I had went to another dentist for X-rays too but I went to an oral surgeon. For a completely different issue than basic dental care.
I'm just annoyed. I'm going to call again tomorrow.
Those x rays should have been covered. Once a year you are entitled to x-rays. Cleanings/exams are every 6 months, xrays are yearly. That seems to be the norm. Def call tomorrow and ask for supervisor /director. Sorry you are dealing with this.
Thanks. Definitely a pain! i gave a check to the doc office, do you think that'll work against me? I paid it because I felt put on the spot
No because i think you can get a paid receipt from the doc and have it resubmitted to your insurance claims processing.
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| Posted 7/27/16 9:39 PM |
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gina409
TWINS!
Member since 12/09 27635 total posts
Name:
g
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Re: Appealing dental claim?
Posted by EatingMyVeggies
Posted by gina409
What's the time frame between the x rays?
Like nov of 15 and den of 16?
Was the general dentist told you had recently had a pano?
December 2015 for oral surgeon
End of June 2016 (21st I think) for regular X-rays at dentist
Yes, my general dentist was told I had panos done at the oral surgeon guy because i was having issues with my wisdom tooth.
It just seems crazy to me because they were for two different things and enough time between.
If they did what they call a full series at the general dentist and you recently had a pano,it may not be covered
Bc that's is a year time frame.
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| Posted 7/28/16 12:02 AM |
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limamaof2
LIF Toddler
Member since 1/12 493 total posts
Name:
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Re: Appealing dental claim?
Posted by gina409
Posted by EatingMyVeggies
Posted by gina409
What's the time frame between the x rays?
Like nov of 15 and den of 16?
Was the general dentist told you had recently had a pano?
December 2015 for oral surgeon
End of June 2016 (21st I think) for regular X-rays at dentist
Yes, my general dentist was told I had panos done at the oral surgeon guy because i was having issues with my wisdom tooth.
It just seems crazy to me because they were for two different things and enough time between.
If they did what they call a full series at the general dentist and you recently had a pano,it may not be covered
Bc that's is a year time frame.
If your company's insurance plan (or your own) doesn't specify that the plan runs on a calendar year basis, then the x-rays were done within the same year and won't be covered. It's annoying - I know. It's similar to your annual exam - it must be (unless your plan states otherwise) one year to the date after your last annual exam. So, if you go to the PCP for an annual exam on 7/28/16 you cannot go for another one in 2017 until after 7/28/17.
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| Posted 7/28/16 7:50 AM |
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Appealing dental claim?
Thanks everyone.
I just called again. I was informed I only have X-rays every 3 years because "cavities can generally be seen" and I don't need X-rays yearly.
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| Posted 7/28/16 9:17 AM |
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ali120206
2 Boys
Member since 7/06 17796 total posts
Name:
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Re: Appealing dental claim?
Posted by EatingMyVeggies
Thanks everyone.
I just called again. I was informed I only have X-rays every 3 years because "cavities can generally be seen" and I don't need X-rays yearly.
Wow - that's odd. Most insurance companies allow for preventative treatments/x-rays more frequently since it saves them $$ in the end.
Who is your insurance company?
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| Posted 7/28/16 9:37 AM |
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Re: Appealing dental claim?
Posted by ali120206
Posted by EatingMyVeggies
Thanks everyone.
I just called again. I was informed I only have X-rays every 3 years because "cavities can generally be seen" and I don't need X-rays yearly.
Wow - that's odd. Most insurance companies allow for preventative treatments/x-rays more frequently since it saves them $$ in the end.
Who is your insurance company?
Aetna PPO. I laughed. I asked, "so next year when I visit my dentist for a cleaning and check up, no X-rays are covered?"
"No, they won't be. Being you just had them, you shouldn't need any for 3 years."
"But how can they tell if I have a cavity?"
"Oh, cavities can be seen."
"...... Ok.."
I'm going to call my dentist when they get in. I love my dentist, he's great. I just want to prevent this for next year.
(And the best part is I hadn't been to the dentist since like 2012 or something before this. I was trying to get on top of stuff I've been neglecting haha!)
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| Posted 7/28/16 9:47 AM |
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