Wisdom Teeth Removal Claim Denied due to lack of information when the Consultation was approved – Should I ask my provider if I have any bills?
In November 2023, I had consultation for my all 4 of my wisdom teeth removal with an in-network provider where my claim was approved by my insurance and on my EOB it listed the following for the service date:
Oral Exam: $0 Gen Anesthesia 1st 15 minutes: $16.70 Gen Anesthesia addl 15 minutes: $16.70 Gen Anesthesia addl 15 minutes: $16.70 Surgical Extraction* for Tooth#/Quad/Arch: 16: $22.40 Extraction, Comp-Bony Impacted* for Tooth#/Quad/Arch: 17: $40.80 Extraction, Comp-Bony Impacted* for Tooth#/Quad/Arch: 32: $40.80
From the insurance claim: I was responsible for $154.10 for this service date (which is what I was told to be final cost of everything from speaking with the provider prior to my consultation) and the $154.10 charge was the total from other services listed that I did not receive that day (in bold) as I only receive the consultation.
I paid the $154.10 on my extraction day in January 2024 where the following was listed on the January 2024 EOB (extraction day):
Gen Anesthesia 1st 15 minutes* (see note N4) Gen Anesthesia addl 15 minutes* (see note N4) Gen Anesthesia addl 15 minutes* (see note N4) Gen Anesthesia addl 15 minutes* (see note N4) Surgical Extraction* for Tooth#/Quad/Arch: 01 (see note N4) Surgical Extraction* for Tooth#/Quad/Arch: 16 (see note N4) Extraction, Comp-Bony Impacted* for Tooth#/Quad/Arch: 17 (see note N4) Extraction, Comp-Bony Impacted* for Tooth#/Quad/Arch: 32 (see note N4)
On my EOB – "N4 – This claim is denied due to lack of information. If you would like to have the claim reconsidered, please submit the information requested."
On my insurance it said that I am responsible for $5,400 for the services in January 2024 as my claim for these services was denied even though on a prior EOB they were approved.
Should I reach out to the provider if I have any outstanding bills with them? I have yet to receive any bills from my provider since paying my $154.10. It's been almost 2 months and I haven't heard anything back.
I did not change insurance plans as I stayed with my companies plan for both 2023 and 2024.
submitted by /u/EatGym
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