Insurance company confirmed dentist was in-network, then denied my claim
I recently had my wisdom teeth extracted and before the appointment, I contacted my insurance company to verify if the dentist was in-network. The representative assured me that the dentist was in-network, so I went ahead with the procedure. However, when I reviewed my claim today, I noticed that the dentist was listed as out-of-network. Has anyone else faced a similar situation?
I’m sorry to hear about your experience—it’s definitely frustrating when you rely on information from your insurance company and then run into issues. This kind of situation isn’t uncommon; sometimes, there may be miscommunication or outdated information in the insurance system.
I recommend taking the following steps:
Contact Your Insurance Company Again: Call them back and explain the situation in detail. Have any reference numbers or names of the agents you spoke with ready. Sometimes, escalating the issue to a supervisor can help.
Talk to Your Dentist’s Office: They might have dealt with similar issues before and could assist in getting the claim reprocessed correctly. They can also confirm whether they are contracted with your insurance.
Request a Claims Review: If you have documentation that shows the agent confirmed the dentist was in-network, ask if they can review your claim based on that information.
File an Appeal: If your insurance company still denies the claim, you can formally appeal the decision. Be sure to include all relevant documentation that supports your case.
Document Everything: Keep track of all your communications—dates, times, names of the representatives you spoke with, and what was discussed. This can be useful if you need to escalate the issue further.
Hopefully, this gets resolved quickly for you!