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