WTF?
Back in March Bubba went to an oral surgeon to have his wisdom teeth pulled per our dentist. We paid well over $1000 out of pocket for that and the dental insurance was billed the balance, another $850. Today I get an EOB from our dental insurance denying the claim as it first must go through medical insurance. Frustrating, but okay. So I call my medical insurance to see how to deal with that. Well, seems we needed a prior authorization for this! So, now I have to call the primary care Dr. and get him to submit a retro request for authorization and a retro referral for the date of service. and then they'll look at the claim and decide whether or not to pay it.
I called the oral surgeon and they are just going to submit the claim to the medical insurance, who will deny it and then the dental insurance will look at it again.
It's so annoying, Wouldn't you think if your DENTIST refers you, the claim should go through dental insurance? How on earth were we to know they would require this? It's all a big scam to just get us to pay the money and not deal with the insurance I'm afraid!
posted by Marlene at 1:55 PM
3 Comments:
It is stupid, although I think that because it's surgery, that's why it has to go through the medical insurance because I think it might cover that type of dental work. I know I read somewhere that it covered certain types of oral surgery or something. HOWEVER, your dentist and/or your oral surgeon should have been talking to the insurance company and figuring it all out before the surgery even took place. That's just stupid. I get so irritated when I have to deal with the insurance company over things that the doctor's office should know. I'm sorry, but it's not our job to know all of that - we're the patients and they are serving us, therefore they need to have THEIR act together. But I think you're right that they just figure you'll get sick of fighting it and not do anything. Sort of like the bill I got from the out of network anesthesiologist, which I have not heard one single word about since I talking to his billing office. So I'm hopeful that means it's taken care of...lol! (But you never know with stupid insurance companies.)
I think it's mostly annoying that the Primary care doctor has to request the referral. Because how often does a primary care doctor refer someone to an oral surgeon for wisdom teeth? Why on earth would you even think of that? And both policies cover oral surgery at some percentage, they just want to argue over who has to pay it in this case. Stupid!
Silliness of insurance companies. and doctors offices that can't wait for insurance to pay there part, so let's just bill the paicent.
Post a Comment
<< Home