Amy’s son – a high school senior – has four wisdom teeth that need to go. Two are impacted and causing considerable pain.

Fortunately, they have comprehensive medical and dental insurance. (Of course; I’m her agent!)

Following a consultation with an oral surgeon at Pulham, Kwik and Acheless, they received a document entitled “Acceptance of Insurance Assignments” which, unfortunately, stated “This is non-covered service for this (both the medical and dental) insurance.”

That’s when I got a call.

The fact is, this IS a covered service. The proper protocol is for the provider to submit the claims first to the health insurer. What’s considered medically necessary would be paid, then the balance is sent to the dental carrier for payment under the terms and limitations of that contract.

I insisted my client return to the oral surgeon and ask for clarification. Only then, did they change their form to reflect the fact it would be covered.

What’s going on here?

Is it possible the provider hoped to collect the full retail cost vs the insurer’s discounted (+/- 40%) rate?

Cynical, I am. But, probably right!

Amy and her son are looking for a new in network oral surgeon.

 

P.S. Shouldn’t there be just a little fanfare for Tip # 500? “C’mon, Man!”