Who's responsible if the dentist neglected to file the claim?

Answer 1

Sorry if this is not what you want to hear, but you, as the patient, are still responsible for the charges. Most (but not all) insurance company will process the claim if it is made within one year of services. Get a copy of the charges from the dentist, and make sure they include the current ADA codes. Call your insurance company and ask about the claim. It is YOU the insurance has to to, since you are the covered party. (And who pays the premiums, either yourself or through an employer). The dental office only files insurance claims as a courtesy. Too many times the insurance company will tell you that a claim was never received, when in actuality it is on somebody's desk or garbage can. Regardless of that, it is still your responsibility to make sure your services were paid for.

If you have a claim that has not been filed by the dentist you first check with your insurance carrier to see if it has been received. I work with insurance companies and they are not allowed to trash or leave any claims lying around or they will be fined. There is a certain law called HIPPA that could get them in a lot of trouble. If they say that it has not been received, yes you can get the information from your dentist to file the claim. If the dentist is in your network under your insurance plan 9 chances out of 10 they have a contract with the insurance carrier to file the enrolee's claim. The reason for that contract is that when payment is made that payment will go to that contracted dentist regardless if you paid in full or not. Also, being that the insurance carrier has a contract with this dentist, have the insurance carrier contact the dentist office to see what has happen. I do it everyday.

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As the previous two s clearly stated - the responsibility falls on the insured to follow up on claims for work they had performed. Even if the office failed or neglected to file a timely claim - balance is still your responsibility. As a person who deals with insurance on a daily basis i can appreciate the patients that care about their claims and give me a hand in getting them processed. We file insurance as a courtesy to our patients not because we are mandated or required in any way by the insurance company.