01 May Worst Claim Story- May 2019
I had a claim that Aetna kept denying, perio maint, due to lack of perio history. Aetna paid on perio maint prior in 2018 – just under a different group. The rep kept stating since no perio history on the new group they couldn’t pay out on the claim. I called every week, arguing the decision, informing them they do have prior perio history (from other dental office) and they even have it on file under the old group. Finally – the rep agreed to send the claim back into processing so I stopped calling on the claim every week. A week later – I checked on the claim and it reprocessed and paid out the full benefit!
Squeaky wheel – Always gets the attention – also, just pay us. We know what we are doing!
Dental Billing Tips and News for Pros; Edition #135