Dental Billing Issue
I am so confused and frustrated with Aetna about a recent dental claim. This is in Colorado
TLDR; Got Invisalign, paid estimated patient share up front, Aetna denied the claim AND said my owed share was $0. Dentist doesn't want to refund, Aetna giving runaround to all of us with conflicting info to both me & dental office. Now dentist wants to bill me full amount even though EOB says they can't.
Timeline:
Started new Aetna dental DMO that covers 50% orthodontia Found in-network dentist to do cleanings & start Invisalign Got estimate from dentist (they spoke with Aetna on the phone, but this was NOT a pre-approval), paid $3350 out of pocket Claim sent to Aetna for $8120, Aetna DENIED claim, saying they would cover $0 AND my share was $0 (?? How is this possible?) Aetna reps give all kinds of conflicting info, first directly telling dentist to refund me and now telling dentist I should pay the full amount billed to insurance EOB to me states "You do not have to pay this. This dentist is not contracted to provide this service for DMO/DNO members." EOB to dentist states "therefore the member cannot be billed”
There's a lot more to this entire convoluted journey including an unresolved mailed-in inquiry to Aetna, as well as 10+ calls to both Aetna and the dental office. We've gotten on a 3-way call where the dentist was told to refund me, and then the following week the dentist says they've spoken to Aetna again and I am actually on the hook for the full amount beyond my original paid estimate.
Questions:
Do I owe the full amount? Does the dentist owe me a refund based on EOB? Are they obligated to abide by EOB at all? What do I do next? Should I call Aetna again and beg to speak to the highest level possible rather than getting a representative who might give further conflicting information? Should I reach out to an external party such as an ombudsman or attorney general or some other person/group?
Thank you for any help! I can answer any further questions!!
submitted by /u/EmClare969
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