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

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Wiki User
2015-07-14 16:46:33

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.


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