Have an insurance question the internet is not very helpful answering so I'm seeking CF mind input.
I changed dental insurance companies in June. I have two dentists I'm using right now - one I've been with for 10+ yrs and the other that I'm doing orthodontia work with. I had previously changed dental insurance in January of this year with no issue. Both providers in network, covered at the % I expected. I did my same cursory search on the new insurance doctor finder site in June, both providers showed us as preferred providers in network. Awesome, I moved over to that during my hiring enrollment period and did NOT go on my spouse's insurance which also would have covered both, though at a lower rate on the orthodontia.
A couple months in, I had cavities to deal with as well as a regular dental appt. When the claims came in, problems began to unfold. I could see things being resubmitted and reprocessed over the fall. I checked with my primary dental and she said she was getting it worked out. Cut to the chase, it turns out my primary dental is NOT in network. This was not discovered until my dentist office admin called in to find out what was wrong with the processing and asked about in-network. The insurance said "yes, you've been in network since XXXX year" office admin replied "Dentist was not yet born in that year so that's impossible." After that, insurance realized my dentist was NOT in network, they had mixed with someone else and reprocessed everything as out of network which of course then cost me several hundred dollars! To be clear, insurance originally processed the claim as in network. The problem was the dentist wasn't receiving payment because it wasn't the right contact info. Sure enough when I now use their search tool, that dentist no longer comes up.
I can see claims sitting not processing for my orthodontist and I'm very concerned a similar problem awaits. I've taken a screenshot to show that he DOES currently show as in-network.
My question is do I have any recourse with the insurance seeing as they provided incorrect information that was not realized until my dentist office pointed it out. I.e., if I had called the insurance in June to verify in network, they would have said yes. I'm sure it's easier to get blood out of a stone but didn't know if there is anything I can do other than jump ship at the next open enrollment.
I changed dental insurance companies in June. I have two dentists I'm using right now - one I've been with for 10+ yrs and the other that I'm doing orthodontia work with. I had previously changed dental insurance in January of this year with no issue. Both providers in network, covered at the % I expected. I did my same cursory search on the new insurance doctor finder site in June, both providers showed us as preferred providers in network. Awesome, I moved over to that during my hiring enrollment period and did NOT go on my spouse's insurance which also would have covered both, though at a lower rate on the orthodontia.
A couple months in, I had cavities to deal with as well as a regular dental appt. When the claims came in, problems began to unfold. I could see things being resubmitted and reprocessed over the fall. I checked with my primary dental and she said she was getting it worked out. Cut to the chase, it turns out my primary dental is NOT in network. This was not discovered until my dentist office admin called in to find out what was wrong with the processing and asked about in-network. The insurance said "yes, you've been in network since XXXX year" office admin replied "Dentist was not yet born in that year so that's impossible." After that, insurance realized my dentist was NOT in network, they had mixed with someone else and reprocessed everything as out of network which of course then cost me several hundred dollars! To be clear, insurance originally processed the claim as in network. The problem was the dentist wasn't receiving payment because it wasn't the right contact info. Sure enough when I now use their search tool, that dentist no longer comes up.
I can see claims sitting not processing for my orthodontist and I'm very concerned a similar problem awaits. I've taken a screenshot to show that he DOES currently show as in-network.
My question is do I have any recourse with the insurance seeing as they provided incorrect information that was not realized until my dentist office pointed it out. I.e., if I had called the insurance in June to verify in network, they would have said yes. I'm sure it's easier to get blood out of a stone but didn't know if there is anything I can do other than jump ship at the next open enrollment.
. And the second guy that hit me sent his dash cam video. I’m at least smart enough to know I can’t watch that. I do want a friend to watch it because I’m pretty sure it didn’t happen like I initially thought.
