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I know we have several people on this board that are versed in insurance claims, I need your help!
R had his tooth extracted in May. We chose to have it extracted at an outpatient surgical center rather then having it done in office with laughing gas. We received a letter from our health insurance stating, that the anesthesia would be covered, the operating room charge the day of procedure, general pharmacy charges including IV solutions, anesthesiologist and anesthetist fees.
The surgeons fee was covered by our dental insurance, we only paid him $60.
So the anesthesia charge was adjusted to our member rate - no problem, I get that. We haven't met our deductible so we have to pay the full member adjusted rate.
They have denied the charges from the surgical center saying, "Charges for dental related services are excluded from coverage under your plan. U96" yet my coverage documents state "Oral and Maxillofacial Treatment (Mouth, Jaws and Teeth): Payable in accordance with the type of expense incurred and the place where service is provided." No where do my plan documents say that dental related services are excluded.
The other issue is we are $645 short of meeting our deductible yet I made a $1500 deposit to the surgical center the day of the surgery which should have been our contribution when the insurance approved it, which they now are denying. So how do I get that $1500 applied to my deductible so that I don't have to pay as much for the anesthesia?
I don't even know where to start, I can now see why people get so frustrated with big piles of medical bills...
R had his tooth extracted in May. We chose to have it extracted at an outpatient surgical center rather then having it done in office with laughing gas. We received a letter from our health insurance stating, that the anesthesia would be covered, the operating room charge the day of procedure, general pharmacy charges including IV solutions, anesthesiologist and anesthetist fees.
The surgeons fee was covered by our dental insurance, we only paid him $60.
So the anesthesia charge was adjusted to our member rate - no problem, I get that. We haven't met our deductible so we have to pay the full member adjusted rate.
They have denied the charges from the surgical center saying, "Charges for dental related services are excluded from coverage under your plan. U96" yet my coverage documents state "Oral and Maxillofacial Treatment (Mouth, Jaws and Teeth): Payable in accordance with the type of expense incurred and the place where service is provided." No where do my plan documents say that dental related services are excluded.
The other issue is we are $645 short of meeting our deductible yet I made a $1500 deposit to the surgical center the day of the surgery which should have been our contribution when the insurance approved it, which they now are denying. So how do I get that $1500 applied to my deductible so that I don't have to pay as much for the anesthesia?
I don't even know where to start, I can now see why people get so frustrated with big piles of medical bills...
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