AboutTricia Expertise Has your medical insurance company denied your claim and refuses to pay? Have
you received a pre-authorization and still your insurance company
refuses to pay? How can you get your insurance company to reverse a
denied claim? How do you get a provider to waive your copayment if you
are financially unable to pay? Can a provider sue you for a unpaid bill and
will they? Can a provider send me to a collection agency for a medical bill?
If my insurance company does not pay, am I responsible? If you have these questions or others on why your insurance company is not paying your bills, I can help. I can give you "tricks of the trade" to get your insurance company to pay.
I have limited knowledge on Medicare and Medicaid and that is not my expertise. Each state is very different regarding Medicare and Medicaid so you need to review their website when you have questions. So please no Medicare or Medicaid questions!!
Experience In the medical field for over 20 years spending majority of time in the collections aspect.
Question Last July my dentist supplied the required info to my insurance co's website for a printed treatment plan (for bridgework). The treatment plan stated my portion of payment & theirs. After the work was completed & my dentist applied for payment (I payed my portion up front)we were told my claim was denied because of a missing tooth clause. The sole purpose of the bridgework was to replace a missing tooth. No one at the dentist office new of the clause, nor did I. Nowhere on the treatment plan (printed from the insurance website) did it discuss this issue or deny the claim because of the missing tooth. Had they denied the treatment from the start, which I think they should have done, my dentist would not have proceeded. They have just denied my 1st appeal saying it is past the 180 day limit to file an appeal. How do I go about filing my 2nd appeal to hopefully get my dentist paid?
Answer Hi Melissa!
You have to give them a good reason why your appeal was past their time limit to file the appeal...such as just notified by my dentist, or something like that. Once you get over that huddle then you need to prove that they made the mistake by not advising you --stating to them that you would not have gotten the work done if they advised you correctly. Hopefully you have some proof and names to prove that they gave you the wrong info.
Sometimes if they make the mistake they may reverse their denial-----
