@Edward1955
As a dental underwriter, I guarantee that your Schedule of Benefits/Summary of Plan Design documents specifically mentions that any time you are receiving benefits over ($250-300), you are obligated to inform the plan UP FRONT. This is actually standard language nearly universal in the industry. The problem is that most dentist offices check this up front for their patients, so people overlook this.
Appeal your claim. If it gets denied, escalate it to the next level. Ask the office manager at your dentist's office to help you with this. If the office is a big provider, they may carry some weight with the insurer.
39
@Edward1955
As a dental underwriter, I guarantee that your Schedule of Benefits/Summary of Plan Design documents specifically mentions that any time you are receiving benefits over ($250-300), you are obligated to inform the plan UP FRONT. This is actually standard language nearly universal in the industry. The problem is that most dentist offices check this up front for their patients, so people overlook this.
Appeal your claim. If it gets denied, escalate it to the next level. Ask the office manager at your dentist's office to help you with this. If the office is a big provider, they may carry some weight with the insurer.