Did an Anthem dental insurance customer service agent just flat out lie to me?

[I'm in VA; Self-employed; I can't remember the details of my insurance plan because we cancelled it several months ago after having too many issues like this with Anthem.]

I got a bill for a routine dental cleaning from way back in April '23. It should've been covered by our plan, but when I checked the EOB, it said, "This service is only allowed 2 times in a 12 month period." Since I hadn't had more than two cleanings in that 12 month period, I called Anthem.

The customer service agent I spoke to told me that the service date doesn't matter; what matters is the claim date. And since they had received claims for 3 cleanings within a 12 month period, they would only approve two of them. (The dates for those cleanings were 10/6/22, 4/11/23 and 10/26/23. They received all of those claims within a five month period.) After some back and forth about how ridiculous that is and how he must be mistaken, I asked to speak to a supervisor. Fifteen minutes later, the agent came back and said he couldn't get a supervisor but that "just this one time we'll cover these costs and re-process the claim, even though your benefits are based on claim date and not service date."

I thanked him, and asked, "So if I go get 4 cleanings this week, but I tell the dentist to only file claims for 2 a year, they'll all be approved?" "Yes," he said. "And if I get one cleaning a year for the next 3 years, and the dentist files claims for all 3 at once, one of them will be denied?" "Yes."

That seems insane to me. Was he just lying or am I totally misunderstanding something about how insurance works?

submitted by /u/Jolech
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