Monday, April 27, 2020

Can dental office charge for a procedure that is not covered under my insurance?  

Can dental office charge for a procedure that is not covered under my insurance?  

answers 0:My dentist charged me for my kid's sealants that is supposed to be covered under my plan. My kid is 16 and they cover sealants to 16, but they denied the claim saying that those are only covered to age 15. So my dentist charged me. Is that fair?answers 1:Yes is it. If he performed the procedure and your insurance denied it, that's a problem between you and your insurance. The dentist needs to get paid either way.answers 2:Sorry to tell you, but it is your responsibility to know your coverage and you are ultimate responsible for the payment due. Dental offices do inform you about your insurance information but they do this strictly as a courtesy.Some ins companies do deny what they should cover. In your case it seems that they should have been covered, but ins companies pull tricks like this rather often, in my opinion. ! You should consider filing a formal complaint to your states regulatory agency.I had an experience with United Health Care not covering for a preventative procedure when they said (in the enrollment information) that they would "cover the procedure to age 16", but when the claim returned denied the reason was that the procedure is only covered for those age 15 or younger. When I called to complain the representative said that "to age 16 means not including 16." It's absurd but this the language they speak.Good luck...

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