i cant seem to find this info...

So my boy had dental work done. he had to have this done at a hospital because of his artifical heart valve, concerns about anesthesia.

the dental office failed to get pre-authorization from my insurance company. They never told me and went ahead with the dental work.

now my insurance denies the claim because they did not get pre-authorization.

and i got stuck with a 7,000 bill. (yes, 7,000 not 700)

ive been trying to get this resolved with the dental office and the insurance company, so far im getting nowhere

i will probably have to sue the dental office.

does anyone know what type of attourney would handle this kind of case?

 

Insurance lawyer? Debt settlement lawyer? You could call a local law office and explain to them what has happened and they may be able to to direct you to what type of lawyer you need.

 

I am going through something like this too over the last few years. I had a crown done and the dental company never sent the insurance company the xrays and whatever else they needed to approve the claim.

The dental ppl want me to pay $1800. I have already paid $700 (that was my out of pocket)

I told the dental ppl that its not my fault they didnt do what they needed to do in order to get paid.

I'm ignoring the bills... and checking my credit report...if I ever see a negative mark from this...I will sue.

not sure what type of lawyer I'd need either..probably same as what you'd need. Id just call a law office and ask like Sntbakos said.

 

Only thing I can think of; I will call a good friend of mine who works where I used to work. They have a lot of clients who are lawyers and I'm sure they would let me know what's up. I'll try to get an answer for you sometime today, Chris.

Edit: I just texted my friend. She texted me back and told me to e-mail her your post. She's going to call a lawyer she used to work for and that she is still on good terms with.

 

I think most counties or regions have a local Bar Association that probably could tell you what kind of lawyer you need.

 

A good one!!

May I reccomend...

 

your reccommending 'account inactive'?

 

Chris, I talked to my friend today and she can't get ahold of the lawyer. She is going to try a few more. Do you have any lawyer referral hotlines you could call in your area?

 

I was gonna...but I resisted. Now in retrospect...I shoulda. LOL

 

well good news, if worst comes to worst the amount of debt is just a little more than 7.5% of my income which is the required amount for me to be eligible for a penalty free 401K hardship withdrawl.

im still gonna try to get this paid out by the goddamn dental office if nothing else.


so far though things arent looking good.

Dental office submits the pre-authorization request to Insurance. I(nsurance claims they never got it. The hospital assumed it would be covered due to the nature of logans heart, and are not required to get pre-authorization confirmation. so they allowed the dental office to book the OR for the surgery assuming the dental office DID get prior approval from insurance.

insurance is denying it outright, last time i talked to them it was because of lack of pre-authorization means they dont have to pay **** and refuse to.

this has already been appealed with logans medical records justifying the added expence of having this done at the hospital. once again they denied it.

I am going to check with the insurance tomorrow to get an official reason for rejecting it this time, lack of medical need should not be the reason, it will probably once again be the lack of pre-authorization.

The hospital is going to reffer my plea to thier insurance rep to see if there is anything they can do. However im not sure if anything WILL be done. If they require pre-authorization and never recieved the request, they can deny this all they want and i wont have much of a chance getting them to pay out.

if im totally shut out by the insurance and hospital, im going after the dentist because they never confirmed the pre-authorization, and the insurance company said they never got it. The dental office fucked up, they should have confirmed pre-authorization. They should have an Error and Omissions insurance policy that might pay this, but i will have to sue them to get it.

first step if i dont see possible resolution by the beginning of next week is to contact the dental office, inform them that i expect them to handle this bill, and tell them i want a responce within a week and that i will be immediatly filling out a BBB complaint and writing a 1 star review on them for the google search explaining how thier incompetance left me a 7,000 bill. Once they do something to fix it i will drop the complaint and remove the bad review.

if that does nothing then ill sue them and take them to court.

this is just rediculous. i have too much **** going on my plate to deal with tthis.

and my wife moves out on tuesday. im glad she is going, but im gonna miss the kids... seeing logan on the mornings.. but still.. im used to him waking up when i get home from work and putting him back to bed.

 

There I fixed it!

Seriously, we've had to deal with pre-authorizations all the time with tricare and the dental office should have gotten a letter stating it had bee approved before they did the procedure. If they submitted it then it is their responsibility to follow up. Insurance rat bastards will look for any excuse not to pay out and the dental office should know that.