I went in for a crown and based upon the information and on some discomfort, this made a great deal of sense.
I found out the claim was denied, so contacted the insurance company and they told me they need to resubmit with additional information. No one from the office called, so I called them and they said it was denied, but they were doing it again. Then after hearing nothing, finally called yet again and was told it was denied yet a third time and the appeals were exhausted.
So I called the insurance company again and they told me that they were never sent clinical notes or sent additional information with symptoms. They said they could appeal with additional information.
This directly contradicts what I was told. Now on the flip side, if I did not have symptoms, they said that the crown would not be covered. The danger is that as a patient you are on the hook for the bill. They said they received information that the procedure would be covered, but the insurance company said it would not. Wow, so if I had no symptoms, but followed their recommendation, I am getting a crown that I am paying full price for.
I have a client who is a dentist and talking to his wife, who runs their practice, was told that the information the insurance company was giving me told me that indeed it is a documentation issue.
Submitting the same information again and again but not adding the discomfort is like running into a wall over and over.
On the flip side, my client said if it was them, they would eat the difference as losing an entire family is not worth a bit.
This office seems to lack the relatopinship focus that the previous dentist had.
We are looking for a new dentist.