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Esteemed Contributor
Posts: 6,766
Registered: ‎05-09-2010

Dental Insurance/Bill question

Asking for your opinions here.  My son came home from college for the summer and was about to start a summer internship.  I called the dentist's office to get him in for his 6 month cleaning.  He went on June 15.  However, Cigna Dental denied the claim because it was 3 DAYS shy of his 6 month time frame.  His last cleaning was on Dec. 18.  I called the dentist's office and the woman said that if I request it, Cigna dental will cover it.  Well I appealed twice more and was denied.  I wrote letters and even had a conference call with 3 women.  After I got the 3rd denial, I got mad and cancelled the insurance.  You can bet I will follow up with letters to vent my frustrations to them.

 

In the meantime, the dentist's office is asking I pay the $91.00 balance.  I know that is not a lot.  But, I feel that they should have never offered my son this appointment since it was before the 6 months were up.  At the time however, that was all they had until my son was already back at college.  They did not tell me it was before the 6 months, and frankly if they had, I would not have thought twice about it.  But they deal with insurance everyday and know the rules.

 

Do you think I should pay the $91 in full, suggest maybe we split it, or put all the blame on them?  I think they have some responsibility here.

Always remember that you are absolutely unique. Just like everyone else. Margaret Mead
Esteemed Contributor
Posts: 5,882
Registered: ‎03-10-2010

Re: Dental Insurance/Bill question

How about a face to face with dental office administrator?  Maybe they could give you some kind of discount for cash in full.  In future dealings with doctors and dentists always ask if the appropriate time has passed for your insurance to cover the procedure.

Honored Contributor
Posts: 41,255
Registered: ‎03-09-2010

Re: Dental Insurance/Bill question

i think the bottom line is is that it is difficult for a dentists office to always have to review all terms of YOUR dental insurance, especially if they have a busy office. they must deal with many different insurance companies and policies. that is the responsibility of the insured.

 

you can discuss it with them, but they probably do have the right to demand payment and then send it to a collection agency if it is not paid. it could be a ding on your sons credit report if it doesnt get paid.

 

my suggestion is is that you pay the bill.

********************************************
"The world is a dangerous place, not because of those who do evil, but because of those who look on and do nothing." - Albert Einstein
Honored Contributor
Posts: 20,419
Registered: ‎03-12-2010

Re: Dental Insurance/Bill question

I am going to side with insurance on this one. 

 

I always ask when my 6 month check was last time before appoint is scheduled. I would have possibly called your Cigna dental ins. to check to see what would happen if the appoint was before 6 month date. They may possibly have given leeway on payment if you had notified them first.

 

I would just pay the bill and know for next time around. 6 months 1 day for next appoint.

 

I have Cigna dental myself and know they are very strict on their checks when they are done.

Respected Contributor
Posts: 2,481
Registered: ‎03-09-2010

Re: Dental Insurance/Bill question

I understand your frustration. I think that I would pay the dentist because they provided a service that I requested and should not be penalized. It is nice when they stay on top of it and tell you. My dentist schedules from cleaning to cleaning so we know it is the 6 months. It really may have been more important to get your son in when they could take him due to his schedule. If you have used this dentist for a while then you probably like them and it has not happened before.

 

doxie

Respected Contributor
Posts: 4,206
Registered: ‎08-08-2011

Re: Dental Insurance/Bill question

I know the dentist office deals with insurance all the time and maybe should have pointed out that the date would be shy of 6 months at the time of making the appointment but I feel that ultimately it’s the patient’s duty to inquire at the time of making the appointment.  I’d pay the $91.  

Honored Contributor
Posts: 16,837
Registered: ‎03-10-2010

Re: Dental Insurance/Bill question

I would pay the bill.  I do agree, though, that they shouldn't have given your son the appt. without making sure it was six months and a day after his last appt.  All insurances require that.  My dentist does that, but I make my appt. for the next visit at each visit.  When I make my appt. for a mammogram they always check to make sure it's been a year.


The Bluebird Carries The Sky On His Back"
-Henry David Thoreau





Honored Contributor
Posts: 15,345
Registered: ‎05-01-2010

Re: Dental Insurance/Bill question

I always make my next appointment before I leave the office. Once the office worker said she had to make it a certain date as insurance wouldn't pay unless it was after the sixth month mark.

Honored Contributor
Posts: 16,018
Registered: ‎06-09-2014

Re: Dental Insurance/Bill question

Good for you for cancelling @Puppy Lips.  

 

72 hours is ridiculous especially if you've been their customer paying premiums for a long time.  They should be happy you are doing prevention to save them dental costs in the future if you didn't.

 

As far as the dentist, it really isn't their responsibility but I'm with you on they should be mindful of those with insurance on file.  

 

I agree with making a call to the office and explaining the situation politely and seeing if they will do a cash discount.  Most medical offices do and we're not talking a significant amount of money here. 

 

If you've been a long time patient, they should take a step toward you even when they really don't have to.    

 

     

 

 

Valued Contributor
Posts: 783
Registered: ‎06-02-2010

Re: Dental Insurance/Bill question

I've done insurance follow up for medical providers for 21 years.  This probably won't be popular.  The contract for the terms of services is between the policy holder and the insurance company.  While it would have been nice for the office people to know when the six month time limit was, it isn't their job.  Medical providers are usually also small business owners.  If it were my son, I would pay the bill in full AND he would learn all about the limitations of the policy.