My question involves insurance law for the state of: New Jersey
A couple months ago I went to the dentist for a crown, he noticed my jaw clicking and he said that I would need a "occlusal adjustment" to help fix this.
Based on what I was told, I was under the impression that my insurance would cover this. I then got a notice from my insurance stating that they need additional information from the dentist before they can approve this claim. My dentist's office assured me that this is part of the process and they would have to send it paperwork so they can approve.
Well my insurance didn't approve it because of the following reason:
Based on the diagnostic materials provided by your dentist, this service does not meet this requirement for coverage. You should not be billed for this service.
The amount billed on my insurance claim shows $500, the member rate shows $319, and if this claim got approved I would have just owed $95.
Today I get a bill in the mail from my dentist at $594 and the receptionist stated that my insurance did not allow any benefits for this procedure so the dentist gave me a ($150) discount so the bill is for $444.
Is this legal, can he send me a bill when he's an "in-network" dentist and my insurance denied his claim?
I would have never done this procedure if my insurance didn't cover it but since they made me believe it was part of the process I thought they had experience with this sort of thing before.
Since my insurance says "You should not be billed for this service.", does that mean he is not allowed to bill me as an "in-network" dentist?
Thank you!
A couple months ago I went to the dentist for a crown, he noticed my jaw clicking and he said that I would need a "occlusal adjustment" to help fix this.
Based on what I was told, I was under the impression that my insurance would cover this. I then got a notice from my insurance stating that they need additional information from the dentist before they can approve this claim. My dentist's office assured me that this is part of the process and they would have to send it paperwork so they can approve.
Well my insurance didn't approve it because of the following reason:
Quote:
Based on the diagnostic materials provided by your dentist, this service does not meet this requirement for coverage. You should not be billed for this service.
Today I get a bill in the mail from my dentist at $594 and the receptionist stated that my insurance did not allow any benefits for this procedure so the dentist gave me a ($150) discount so the bill is for $444.
Is this legal, can he send me a bill when he's an "in-network" dentist and my insurance denied his claim?
I would have never done this procedure if my insurance didn't cover it but since they made me believe it was part of the process I thought they had experience with this sort of thing before.
Since my insurance says "You should not be billed for this service.", does that mean he is not allowed to bill me as an "in-network" dentist?
Thank you!
Health Insurance: Is It Legal for “in-Network” Dentist to Send Me a Bill when Insurance Denied Claim
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