Having an issue with my dentist office... any advice?

[SarahLiz]

I got a call from my dental office mid-January. Apparently a procedure that I had done in April 2008 had been sent to my dental insurance multiple times and had been denied because my dental insurance claimed that I was “not enrolled” at that time. So Delta Dental refuses to pay their portion (around $1,100) of the claim. My dental office had called Delta about it and apparently they were told that I was not enrolled as a member until June of 2008. However, I had made the switch from PMI (the fully state-paid plan) to Delta Dental (the nicer self-paid plan). I called Delta Dental myself and they reported that they had an effective enrollment date of (I believe it was) March 1st. So I was definitely enrolled during the time I had the procedure in question.

My dental office is trying to help me figure all this out and the lady I talked to, Diana, said that I needed to figure out what to do by the end of January, which I did. I agreed to her resubmitting the claim with an explanation, and in the meantime to charge the $1,100 to the line of credit I established solely to pay for my dental work. We agreed that if the claim went through, they would credit the money back to my account. Since then (last few days of January) I gave them a little time, and have called the dental office multiple times in the last week and a half to try to talk to Diana again to get a status update. Each time she has either been sick or unavailable, and has not returned my calls. I’ve called Delta Dental to ask if they have received the resubmitted claim and they haven’t. I am starting to wonder if my dental office is being honest. The lady I spoke to at Delta recommended that I print out a claim form from their website, fill it out and attach a copy of the bill from that procedure, and mail it in myself. I plan to do this. However I only have two months to get it all figured out before the dental insurance company is no longer obligated to pay their portion, and I will be stuck with the bill.

Is there anything that I might not be seeing, or any action that I should take apart from mailing the claim myself? I would really appreciate any advice.

[QuarterLiferAmy]

The lady I spoke to at Delta recommended that I print out a claim form from their website, fill it out and attach a copy of the bill from that procedure, and mail it in myself. I plan to do this. - do this immediately. Also make sure you get the name of the representative that you spoke with at Delta so that you cover all your basis.

It sounds like you have taken all the correct steps. I can understand why the dentist office doesn't care - frankly, they already have their money & are sitting tight. You already paid the dentist's office through your line of credit - either which way they got the money they needed for the procedure.

Also, I would recommend that Delta fax your confirmation of enrollement to the Dentist's office. You want to ensure that both parties can cover their basis. Or perhaps , speak with a Delta representative while at the Dentist's office and then give the phone to Diane (or whoever else handles payment situations). I do believe the latter would be more effective since all companies/businesses prefer to have things in writing.

I would personally go down to the dentist's office (even if you have to take an morning off) and wait until Diane shows up or talk to anyone else that handles the payments etc. and explain your situation to them. Perhaps get them to draft a letter regarding the payment situation and attach to your claim. Maybe you can draft up the letter yourself (saves the dentist's office time) and get them to reprint on their letterhead and have someone sign it. I guess you have to make a stink about it, make a stink about it. After all the dentist's office lack of organization is not your fault. You were considerate enough to get a line of credit out to pay them rather than sorting out the matters with Delta first. Don't leave the dentist's office without an answer.

I do think you have done everything right - but, you need to be a little bit more aggressive here.