I had to apply some pressure to overcome my out-of-network billing dispute. But saving hundreds of dollars and standing up for what's right is worth it.
This is so true! I read some horror stories before sending my husband (not originally from usa) to a dentist and begged him not to pay upfront. They tried. But I insisted he call me if they refused to service him without paying. When he said i only came with the cash for the co-pay. You can call my wife. they didnt. BUT then delta dental refused our claim. They claimed that the dentist was not in network. (was in network in fact the ONLY one available in network as their online list was so out of date the first 15 dr's didnt exist!) I also had called to ensure the plan they took from delta and called delta to confirm they were in the right plan and network. So the phone agent reviewing the claim finally had me re-confirm the dentist's address. Oh ok all good. I will resubmit. one month later I get a 2nd bill from the dentist office. Still the claim did not go through??? I called today armed with the agent's name date and time of the previous call - after only hanging up on me once during a transfer the 3rd agent I spoke to mentioned our claim was denied because we had not paid our premium at the time of service. NOPE - sorry I have all my records and we were paid up before the date of service. He changed tacks and said oh well the agent you spoke to in february, she sent it to the wrong department. So the claim is confirmed to be sent to the correct department now by mr Gavin. fingers crossed. As I dont want us going into collections for a dental insurance claim delay and these bull reasons! There has to be something we can do to stop this shadiness!!!
Awesome!
This is so true! I read some horror stories before sending my husband (not originally from usa) to a dentist and begged him not to pay upfront. They tried. But I insisted he call me if they refused to service him without paying. When he said i only came with the cash for the co-pay. You can call my wife. they didnt. BUT then delta dental refused our claim. They claimed that the dentist was not in network. (was in network in fact the ONLY one available in network as their online list was so out of date the first 15 dr's didnt exist!) I also had called to ensure the plan they took from delta and called delta to confirm they were in the right plan and network. So the phone agent reviewing the claim finally had me re-confirm the dentist's address. Oh ok all good. I will resubmit. one month later I get a 2nd bill from the dentist office. Still the claim did not go through??? I called today armed with the agent's name date and time of the previous call - after only hanging up on me once during a transfer the 3rd agent I spoke to mentioned our claim was denied because we had not paid our premium at the time of service. NOPE - sorry I have all my records and we were paid up before the date of service. He changed tacks and said oh well the agent you spoke to in february, she sent it to the wrong department. So the claim is confirmed to be sent to the correct department now by mr Gavin. fingers crossed. As I dont want us going into collections for a dental insurance claim delay and these bull reasons! There has to be something we can do to stop this shadiness!!!
Thanks for sharing this! Particularly enjoyed the standoff with the dentist at the end.
How would you deal with a situation of upcoding when you get into a dispute and they refuse to budge? Level 01,02 vs 03?