Filing a dental claim after the fact.
I went to the dentist yesterday for a crown thinking that the insurance I have would cover me since it stated it cover 50% of the cost for crowns. However after the work was started I found out that I had a waiting period for the crown and I still have two more months to go before the company will pay out on one.
I have a temp crown right now but here is my two part question. If I wait two months before I go into my next appointment to get the real crown will that make the claim valid? After all the work was started but was not finished until after the waiting period.
Otherwise can not the dentist just file the claim after the two months I have left to wait? I do not want to have to pay for a crown in full when I have been paying for dental insurance for the last ten months and this is the first time I am really using it besides having just a cleaning.
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Thursday, May. 27th 2010 2:16 PM at 2:16 pm
Many dentist will make you pay in full for your dental services at the time the are render. What you may want to do next time is ask the dental office how they handle claims so that you are not hit by a billing you thought you did not have to pay.
When filing the claim the dental office staff will fill out the claim form. Make sure they fill it out. Only they would know the correct ADA codes and services to list. After they fill out the claim for you write on it that you paid the claim in full and premiums due would be send to you and not your dentist. Without doing that the insurance company may pay the premium to your dentist.
You may want to call your insurance company and ask for the correct claims address if you do not know it. Some times they may let you fax the claim to them. If so get the fax number the faster you get the claim to them, the faster the process is for you.
Thursday, Jun. 3rd 2010 2:25 PM at 2:25 pm
Here is the problem you may run into. The work was stated before your waiting period was up. That is why it is so important that you read and understand your policy terms.
Now since the work was started before services are to be covered the insurance company can reject the claim for the crown even if the dentist does not put the real one on until after two month later. It is not when the work was finish but when it was started that counts.
Another thing normally dentist will not file claims showing incorrect date of services that would be insurance fraud and this is something most dentist would always try to avoid doing.
You may want to call you insurance company as tell them what is going on. In order to if you wait would you still get any type of coverage for the crown. At least that way you will know if you are going to have to pay for it our not.