Quote:
Originally Posted by roob1
Have had 2 claims denied recently by UHC TV HMO Dental with non network providers. Providers state they will file as a courtesy to patients. Both claims now have to be appealed. One is for a crown; other CT scan by endodontist.
Anyone else experiencing dental claim denials with UHC dental?
Any experiences with Florida Blue Premier Dental coverage?
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If your dental plan is an HMO, there is typically ZERO coverage at out of network providers. You need to see your assigned primary general dentist for all routine care and if you need to see a specialist like an endodontist, you need to have a referral from your assigned dentist. That usually allows ONLY for a consultation with the specialist. If treatment is needed, it must generally be pre-authorized by your HMO to receive benefits.
PPOs work differently. Some may allow you to see out-of-network providers at a higher cost, some may not. Depends on the plan.