Cigna Dental Claim/Appeal Help

For context, I have used Cigna Dental insurance for years because it is all that my Texas school district employer offers.

In April, I had a cleaning/checkup/x-rays done at the same dentist's office I have been going to for the past few years. This is the same place where I had my wisdom teeth removed two years ago.

I just received a bill from the dentist for the appointment/services. Curious to see if it was spam/fake, I logged into Cigna to check my claims record. It shows that the claim was denied because the provider is now out of network. When I made my appointment, they took my insurance info and never mentioned being out of network. (Forgive my naiveté, but I assumed that would be something they would mention – especially since I was a previous patient – and I would not have followed through with the appointment if I knew it wasn't covered by my insurance.)

I chatted with Cigna customer service, and they said I need to file an appeal since the provider is now considered out of network.

When I looked at the EOB for the claim, I noticed that the name of the dentist listed on the claim is “Cypress Dental of Excellency” — however, my dentist office is actually called “Cypress Dental Excellence.” A Google search provided 0 results for Cypress Dental of Excellency, if that matters at all.

Overall, I just want some advice on what I need to do next and the probable outcomes:

If I file an appeal, what are my realistic outcomes? Will I end up having to pay it anyway, or is there a chance it could be covered? What should I write in the appeal to help plead my case, considering I had no idea they were out of network? Does the dentist name discrepancy give me any leverage? Is this a Cigna issue or a dentist office issue?

Thank you in advance for any help – I'm an underpaid teacher and really wasn't expecting this extra expense.

submitted by /u/Significant_Try_35K
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