What to do if my daughter had extensive dental work performed at the beginning of this year but prior to that her dentist went out-of-network without informing us?

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What to do if my daughter had extensive dental work performed at the beginning of this year but prior to that her dentist went out-of-network without informing us?

The appointment was scheduled and the insurance was pre-approved a month before the procedure (it was performed in a hospital setting due to anesthesia being needed). I was informed at her post-op checkup that our dentist was going out of network (and immediately started looking for a new dentist, incidentally). Now our insurance has informed us that the dentist actually went out of network at the end of last year. We were never informed of this, not at the pre-op appointment nor during any of my several pre-appointment calls. Our out-of-network coverage is far less than iWhat to do if mnetwork ($1000 limit instead of $2500) and the dentist is trying to bill us for the total balance remaining.

Asked on March 3, 2013 under Bankruptcy Law, Pennsylvania

Answers:

MD, Member, California Bar / FreeAdvice Contributing Attorney

Answered 8 years ago | Contributor

If you have the pre-approval and no one told you, file a complaint against the insurance company for this and inform the insurance company that it must pay because it failed to inform you of the out-of-network status and you need to inform your dentist in writing and provide proof of the pre-approval. You must indicate it must eat the remaining overage cost because his office also failed to inform you he went out of the network.


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