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Old 03-28-2013, 09:48 AM   #11
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Re: Doctor question

It is and it isn't I guess? I went without care for so long (kids were more important) that I need a deep cleaning which is what this procedure is. I would be put under, and all of my teeth scraped to remove plaque below the gumline. Some of my teeth were graded back pretty far 5-6. This could lead to gingivitis which is why I'm so mad that they aren't helping me carry out this treatment plan at all. And no, I don't want to do $200 a quadrant plus the anesthesia out of pocket. I could take it out of savings, but with my dh being furloughed it's not a good idea. We have great insurance anyway, why should I have to? I owe them $100 from the last kid visit and I've put off paying it to see if they even called. Nope. I guess I'm going in to pay, and to complain. T

Thanks everyone for the opinions, I wasn't sure if I was expecting too much or not. I've never had a doctor's office NOT handle this side of it. The insurance rep that I spoke to seemed bewildered that I called to discuss it. She said a lot of it she just couldn't explain to me because it was all billing codes and technical stuff.

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Old 03-28-2013, 11:57 AM   #12
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Re: Doctor question

Yeah, in that case I would expect more from them for sure. I have had to run rings with insurance stuff before and all our docs have been right there with me, communicating and working with me.
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Old 03-28-2013, 04:33 PM   #13
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Re: Doctor question

I didn't read all of the replies, but has the doctor taken pocket depths on your teeth? I know when we submit claims or pre-auths for scaling we have to include the pocket readings to show the need for scaling. Just a thought.

We always call our patients when we send in a pre-auth to let them know either way if it was accepted. I'd say that's bad practice to not call. I would be upset myself if I didn't get a call.

Good luck. I hope you get it approved.
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Old 03-28-2013, 04:45 PM   #14
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I don't think this is all on the dentist. Did your insurance company not send you a denial. Imo they are more responsible than the dentist office.
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Old 03-28-2013, 04:53 PM   #15
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I'm a little confused as to which insurance plan you're questioning. Medical and dental insurance are different. Keep in mind that dentists are not as regulated as physicians.
I would ask the office staff to resubmit the bill to your insurance if your plan does cover the procedures or treatment.
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Old 03-28-2013, 05:34 PM   #16
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Re: Doctor question

Sometimes you just have to put your foot down. I went off on my Ped's nurse more or less to get a referral i needed for my DD. It was between them and her psychiatrist. So frustrating. I even called Medicaid to find out exactly who I should be yelling at.
I would call and let them know you will be shopping around to see who has best pricing since it isn't covered. I would do it to.
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Old 03-28-2013, 09:16 PM   #17
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Re: Doctor question

Quote:
Originally Posted by AVDesigns View Post
I didn't read all of the replies, but has the doctor taken pocket depths on your teeth? I know when we submit claims or pre-auths for scaling we have to include the pocket readings to show the need for scaling. Just a thought.

We always call our patients when we send in a pre-auth to let them know either way if it was accepted. I'd say that's bad practice to not call. I would be upset myself if I didn't get a call.

Good luck. I hope you get it approved.
yes, I was a 3 on most, 5-6 on all my back molars. They've gotten everything, tons of xrays actual digital photos, pocket depths done twice (ow) and a detailed report from the doctor himself. Still refused. I don't understand why but with the 3rd denial we are done. They still should have called me to let me know and to move forward on alternate solutions.

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Originally Posted by CarrieMF View Post
I don't think this is all on the dentist. Did your insurance company not send you a denial. Imo they are more responsible than the dentist office.
Yes, I got a denial. Three times actually. Adding to my irritation, I got yet another refusal in the mail today proving that the office staff submitted my authorization a THIRD time and didn't bother to call me to give me any information on what was being done. I've been calling and keeping up with the insurance company to whatever extent that I can. They really needed more information from the doctor and couldn't tell me much of anything. It's not something *I* can do much about.

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Originally Posted by susan6070 View Post
I'm a little confused as to which insurance plan you're questioning. Medical and dental insurance are different. Keep in mind that dentists are not as regulated as physicians.
I would ask the office staff to resubmit the bill to your insurance if your plan does cover the procedures or treatment.
I'm not questioning my insurance. I'm questioning the business practices of the dental office I went to.

Quote:
Originally Posted by mommy2kaitlyn View Post
Sometimes you just have to put your foot down. I went off on my Ped's nurse more or less to get a referral i needed for my DD. It was between them and her psychiatrist. So frustrating. I even called Medicaid to find out exactly who I should be yelling at.
I would call and let them know you will be shopping around to see who has best pricing since it isn't covered. I would do it to.
That's a good idea. I have to go in and pay the bill tomorrow. I will make it known I'm not happy about waiting 4.5mos on this.

Last edited by 3lilbubs; 03-28-2013 at 09:18 PM.
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