Going to the doctors, a dentist or any provider is a challenge and calls for all to pay attention to the details of the plan of care as well as the cost of our care. In this weeks post, I talk about a lesson I learned and the importance of following up with providers and payers.

Here is what happened.

On September 11, 2018, I had some dental work done. My dentist billing person went over the cost and said that my dental insurance carrier would not cover the cost of the procedure. I was told to submit the claim through my medical insurance.  I paid the bill in full (which was over $1600.00) with my credit card.

I was given a claim form that showed my dental insurance company rejected the claim. I was told I could submit the claim to my Medicare Advantage Plan for payment if I had a dental benefit. As I was not sure, I went home and called the insurance company and was told that I had a $700.00 dental benefit per year that could be applied to this bill. The customer service person told me where to send the claim and what to write on the cover letter so it could be processed.

On October 19th, I realized I had not heard back from my Medicare Advantage carrier, so I called them to ask about the claim. I was told that they had mailed a check to my dentist for $700.00 and that the check was cashed.  I asked the customer service person I was talking to, “shouldn’t I have gotten the check, as I had paid my bill in full at the time of the procedure?  The customer service provider said yes and I should call the dentist office.

I knew talking to the dentist billing person was going to be a challenge so I asked the customer service person from my Managed Care Plan to stay on the line while I called the dentist in case they had questions. When we connected, the customer service person explained the problem. The dentist billing person checked the computer and said yes, they had received the check and it was cashed!

The Medicare Advantage Plan customer service person explained that the check should have been sent to me and they had made a mistake in sending it to the dentist. The dentist billing person saw the mistake and said she would send me a check for $700.00 in 10-15 days. I thanked her and asked her how this could happen as my account did not show a balance. She said she could not explain the mishap, that the error occurred due to a glitch in their system. She said they have two different systems and the two don’t always talk to each other. I said I wanted the incident reported to the office manager as they should have recognized the payment was not for them as my account showed a zero balance. They should have investigated further by calling me or the insurance company.

Lesson Learned

As a result of this incident, I learned a few important lessons that I want to share:

  1. Keep track of all invoices and correspondences you have with providers and payers.
  2. Many providers’ offices do not file insurance claims and require you to file the claim if you want to be reimbursed. Calling your insurance company will allow you to find out if you can be reimbursed and how to file a claim. If you paid the cost of the claim in full with your provider, be clear in your cover letter that the check should go to you and not to the provider.
  3. If you file a claim with your insurance company, make a note on your calendar to follow-up in a timely manner to see what the outcome is. Thirty days is usually a good time frame in which you can follow-up to see the progress of the request.
  4. Follow up on any outstanding question/claims. Don’t ‘assume’ they will follow up with you.
  5. In the case above, my Medicare Advantage Program did their job, they sent out a check. Unfortunately, they sent it to my dentist and not to me, but they closed the case as in their eyes the claim was paid. If I had not made a note to follow-up, I would be out $700.00, and my doctor’s office would have been paid an addition $700.00! The system is not perfect and mistakes happen, so it is important to follow up and ask questions.
  6. Read your Member Handbook or call your insurance if you have any questions about coverage. I was not aware of my dental benefit till I called my Medicare Advantage carrier and found out there was a $700.00 dental benefit per year.

I hope this experience shows the importance of being an active participant in your own health and healthcare. Feel free to share your experience or a mishap that you discovered that could have cost you if you did not follow up. Also, please share this post with your family and friends as this lesson learned will make you aware of the importance of follow-up!

 

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