By Cindi Lignell, Account Executive

It is intolerable when we have sent all the info to insurance, had a claim denied. Sent their requested additional info . . . multiple times. The claim shows as not on file after you have received a denial on the very claim, and the Pre-treatment estimate they are requesting is one they generated in house in the first place! Below is proof of time and effort expended, when the insurance had the info needed for 6 weeks!

– Jan 22, 2018 – Sent an e-claim to Metlife for a 66 year old man. He had D7210 Surgical Extraction on #30, D7953 Bone Replacement Graft, D4266 Guided Tissue Regeneration, D5821 Interim Partial Denture. X-rays were attached along with a narrative: Tooth broken to gum level, poor restorative prognosis,Surgical ext, socket allograft for ridge preservation & cytoplast RTM collagen membrane. Interim partial to replace #30. –

Tue – Feb 6, 2018 – Received an EOB denying D7953 Bone Replacement Graft and D4266 Guided Tissue Regeneration, saying only covered with eligible and covered implant It stated the patient owed $775. –

Tue – Feb 8, 2018 – A pre-treatment estimate for an implant was sent 16 days after the claim for the Grafting/regeneration on #30 along with pre-op x-rays and extraction date. –

Thu – Feb 22, 2018 – Sent Denial EOB, claim, pre-tx est and notes to ins requesting payment since implant is planned.

Thu – Mar 1, 2018 – Online – not showing the resent info yet.

Thu – Mar 8, 2018 – Online – have info processing.

Mon – Mar 19, 2018 – NOF. Ccl – Tue – Mar 20, 2018 – Received pre-auth that implant on #30 would be paid – that was 2 months after we sent the original claim and 6 weeks after we first sent the pre-treatment estimate for the implant. –

Mon – Mar 26, 2018 – Resent pre-treatment estimate for an implant on #30 along with pre-op x-rays. –

Wed – Mar 28, 2018 – Rep Alex – Just rcvd clm today – sending to process. ccl – Wed – Apr 4, 2018 – Online – Processing.

Thu – Apr 12, 2018 – Rep Antone – Claim on file – still processing – Expediting. ccl – Fri – Apr 20, 2018 – Online – Still processing.

Thu – Apr 26, 2018 – Online – still processing – Rep Jen – Under Review 30 d from 3/30.

Wed – May 2, 2018 – Rep Mae – said need pre-tx for implant. Told her I have called multiple x and was never told I needed to send that – just told processing. Demanded a super. Super, Jeff – Stated he could see it pending for pre-auth implant, but that we already had pre-auth processed. He is expediting to be pd 7-10 b d Ref #11831835. ccl PHEW!

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