Provider was late in submitting claim, so insurance denied based on patient’s age.

New York State Child Health Plus

I'm hoping there is some recourse here. My son needed major dental work including root canals. He was three months shy of aging out of his plan that would have covered it in full. This should have been enough time to complete the work if they received authorization.

We warned the provider of this deadline, but they insisted he would be ok until 21. We warned them this would NOT be the case. They told my son they requested authorization back in January or February ( I can't recall exactly when) and they were just waiting.

Time goes by and they are supposedly still waiting. I get the call today that he was denied because he aged out of his plan. I call them up because treatment started before he aged out and they told me they only got the auth request yesterday! And the provider must have put it in as an emergency for her to even have it already.

So the provider dropped the ball big time. OR something somewhere prevented the request from going through until now.

Can this be appealed? How? I'm looking at thousands in dental work out of pocket because of this.

submitted by /u/butterflypup
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