Cigna dental claimed they don’t cover what I had done… Dentist says otherwise
So, I have to pick up the paperwork from my dentist tomorrow because emailing it didn't work for some reason. Not a huge deal, I have other things to do today and it's already late.
But, after some confusing back and forth with my dentist, I found out that my insurance denied 2 claims, and I supposedly owe nearly 2k.
I called the insurance to figure out what happened. They said it was denied on the grounds that they don't cover ceramic or porcelain crowns on molars. Insurance is claiming that there's a footnote in my benefits about this fact. I tracked it down, eventually.
Insurance rep offered a 3-way call with my dentist, but I wanted to talk to them myself first. Because, basically, before I had my work done my dental office inputted my insurance, punched in all the little codes, and gave me the rundown and information. The codes they inputted included the teeth numbers, 2 of which were molars that were getting zirconia crowns. I looked everything over with them, in detail, to make sure I understood everything and what my insurance was covering and what to expect.
When the insurance rep had offered the 3-way they implied that if I could prove that the dental office had reason to believe that they WOULD cover the crown, that I could potentially file a successful appeal. So the plan is to get the proof from my dental office that in their initial filing the fact that these were molars was included, and they were told insurance would cover it. Obviously if my dentist office knew that they wouldn't, they likely would have offered alternative solutions. And I am but a lowly civilian, who had no way of knowing that the zirconia crowns were porcelain/ceramic, even if I had seen the stupid little footnote in advance.
Anyways. Other raising hell with my insurance, and proving that my office inputed the information with the information about the molars and all that, is there anything else I can do with this appeal? Because, oh yeah, it gets better, because my dentist is out-of-network as of April 1st. Apparently Cigna didn't renew their contract. So now I'm doubly screwed with my dentist trying to re-file claims. I so deeply regret choosing Cigna right now… Actually I just hate American insurance companies across the board, but that's a different issue. Out new health insurance denied my wife's medication that she's been on for AGES because… reasons?! So I'm just fed up with it all, right now.
submitted by /u/Key_Balance_5537
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