My first question to the practice was “is it covered under our insurance plan?” The office manager called into the carrier and received confirmation that it was covered. I assumed that it was a “slam dunk” to process the claims and make co-payments. I could not have been more wrong.
After the service was complete, a claim was promptly rejected. I became upset and the dental office said “don’t get upset, this happens all the time”. The office manager stated that she will submit an EOB (Explanation of Benefit) with x-rays and that it would be accepted.
Upon completing that submission, the claim was rejected a second time. I asked why it was rejected and the reason I was told is that it was voluntary treatment and not required. I reminded the office manager that we had approval and the doctor’s diagnosis was that it was necessary because the teeth would eventually break and be lost.
After a many discussions with the office manager and the carrier, my last conversation with the dental office was they sympathized with me but was told “if the insurance company doesn’t pay for their portion of their cost, I would have to pay all of it”. Being really upset, I left the dental office, never to come back. I found out later, the office was eventually paid and the issue was dropped.