[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?

[Babubhat]

Check to see if you have coverage for that. I had no issues with routine procedures being paid by UHC out of network

[Pugchief]

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?

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.

[Rainger99]

My UHC dental requires pre- authorization for IN NETWORK services other than routine checkup and cleaning. I prefer that because then I don’t have to wait for the Insurance company’s decision to deny it after the services!

A couple of years ago, I was denied coverage for a very expensive procedure (over $4000) because the doctor was out of network. The problem was that he WAS in network. He said he was in network and he was listed on the Insurance company’s website as being in network. It took about six months and at least 30 calls and dozens of emails to finally get it paid. Every time I contacted them, I had to explain everything from the very beginning. As far as I could tell, no one followed up on my original complaint. At one point, they asked me to send them a screenshot of their website showing that the doctor was in network!!

Based on that experience, I ALWAYS get pre-authorization for any medical or dental procedure.