Apparently even if I private pay the medical part I am not allowed to be billed for the biopsy. Even though I am not using medical insurance. So the office has to eat the cost of the biopsy which they don’t want to do. So I am about to be cancelled on regardless most likely.
Update 2: Tina worked some magic so apparently the surgery is still on. OMG. Office lady said we are taking a loss on it, and I was like let me pay you, and she was like we can't bill you sorry. So anyway, I offered even though technically I can't be billed.
waverly, you are so diligent about this. Can you elaborate on the "No Surprises Act" part? Like you just sent a complaint online or how? And if I'm understanding correctly, your complaint is against Aetna and not the oral surgeon?
waverly, you are so diligent about this. Can you elaborate on the "No Surprises Act" part? Like you just sent a complaint online or how? And if I'm understanding correctly, your complaint is against Aetna and not the oral surgeon?
Yes my complaint is against Aetna. I sent it through my state website. Insurance is state regulated. They have an online portal for insurance complaints. I don’t think anything will happen with it but I tried. There is not a single oral surgeon that they have listed as in network that is actually in network.
ETA- they have stated there is no out of network coverage.
waverly , you are so diligent about this. Can you elaborate on the "No Surprises Act" part? Like you just sent a complaint online or how? And if I'm understanding correctly, your complaint is against Aetna and not the oral surgeon?
Yes my complaint is against Aetna. I sent it through my state website. Insurance is state regulated. They have an online portal for insurance complaints. I don’t think anything will happen with it but I tried. There is not a single person that they have listed as in network that are actually in network.
Not sure what state you're in but in two instances in recent years I've had to contact WA state insurance commissioner and they were helpful in getting a resolution in my favor--which was the correct interpretation of the laws/regs.
Yes my complaint is against Aetna. I sent it through my state website. Insurance is state regulated. They have an online portal for insurance complaints. I don’t think anything will happen with it but I tried. There is not a single person that they have listed as in network that are actually in network.
Not sure what state you're in but in two instances in recent years I've had to contact WA state insurance commissioner and they were helpful in getting a resolution in my favor--which was the correct interpretation of the laws/regs.
Surgery is back on again, but if they cancel it again this will be my next step. I’m not allowed to pay out of pocket because they have to send a biopsy to the lab. Sending it is not covered but once it gets to pathology it’s fully covered under medical. Make it make sense.
Are you anywhere near a dental school that has a professional program? These are dental schools that not only train dentists, but also have residency programs in dental specialties…..including oral and maxillofacial surgery.
While most programs are out on break now, IME there are faculty practices where the professors who teach get a chance to practice (and supplement their income). This usually runs into high gear during the summer, when things are slower.
I had a hard lump on my gum, and was referred to an oral surgeon. It went through my medical insurance. As it turned out, for me it was nothing but I know it was wholly covered under medical. I also had an advantage that I worked in the dental school and knew most of the faculty who practiced. But dental schools frequently cover most insurances, and if they don’t, the prices are more reasonable.
Are you anywhere near a dental school that has a professional program? These are dental schools that not only train dentists, but also have residency programs in dental specialties…..including oral and maxillofacial surgery.
While most programs are out on break now, IME there are faculty practices where the professors who teach get a chance to practice (and supplement their income). This usually runs into high gear during the summer, when things are slower.
I had a hard lump on my gum, and was referred to an oral surgeon. It went through my medical insurance. As it turned out, for me it was nothing but I know it was wholly covered under medical. I also had an advantage that I worked in the dental school and knew most of the faculty who practiced. But dental schools frequently cover most insurances, and if they don’t, the prices are more reasonable.
Yes my complaint is against Aetna. I sent it through my state website. Insurance is state regulated. They have an online portal for insurance complaints. I don’t think anything will happen with it but I tried. There is not a single person that they have listed as in network that are actually in network.
Not sure what state you're in but in two instances in recent years I've had to contact WA state insurance commissioner and they were helpful in getting a resolution in my favor--which was the correct interpretation of the laws/regs.
I've done this in my state as well. I'm so glad to have an option to fight back against shady insurance practices that actually worked well without me having to hire a lawyer.
Not sure what state you're in but in two instances in recent years I've had to contact WA state insurance commissioner and they were helpful in getting a resolution in my favor--which was the correct interpretation of the laws/regs.
I've done this in my state as well. I'm so glad to have an option to fight back against shady insurance practices that actually worked well without me having to hire a lawyer.
Another possibility is to call your state representative in Congress.
Several years ago, I was covered by both my husband’s medical insurance through his employer, and Medicare via disability. When double insured like this, Medicare is primary unless there is more than 100 employees on the other insurance. There were less than 100 employees, so Medicare should have covered me.
For a year, we went back and forth with Medicare telling me BCBS should cover me, and BCBS telling me it was Medicare’s responsibility. No one paid and I was getting threatened with collections. We filed through our congressional rep, and with a few phone calls the mess was taken care of. Unfortunately, I had paid some of the bills to keep my credit intact and I got none of the $$ back. Luckily, it wasn’t that much but it was still annoying.
I've done this in my state as well. I'm so glad to have an option to fight back against shady insurance practices that actually worked well without me having to hire a lawyer.
Another possibility is to call your state representative in Congress.
Several years ago, I was covered by both my husband’s medical insurance through his employer, and Medicare via disability. When double insured like this, Medicare is primary unless there is more than 100 employees on the other insurance. There were less than 100 employees, so Medicare should have covered me.
For a year, we went back and forth with Medicare telling me BCBS should cover me, and BCBS telling me it was Medicare’s responsibility. No one paid and I was getting threatened with collections. We filed through our congressional rep, and with a few phone calls the mess was taken care of. Unfortunately, I had paid some of the bills to keep my credit intact and I got none of the $$ back. Luckily, it wasn’t that much but it was still annoying.
I had some issues signing up for insurance one year through the marketplace (Obamacare) insurance that were not my fault, and I was pregnant and had a million appointments. They hadn't sent me an insurance card or any info, so the doctors were making me pay upfront and assured me I could get reimbursed through insurance. Insurance company kept denying my claims once it was all sorted out, saying they could only reimburse the provider and the provider said I had to do it, and so I went to my state SCC and filed a complaint and they handled it. I got every penny back, and I actually got some out of network stuff reimbursed too that I otherwise probably wouldn't have. Not sure how long it's been, but you might still be able to get reimbursed for some of that!
Update: Surgery was today and all went well. I do like the surgeon. I’m not a fan of his front office staff but I’m thinking now that we got the mass out everything else is dental insurance so there shouldn’t be any other issues. Fingers crossed.
I hope nothing else weird pops up on an x ray for my other kid. But for now, we are good. Just in the managing pain stage.