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Tina, Lawyer
Category: Legal
Satisfied Customers: 8775
Experience:  JD, BBA Over 25 years legal and business experience.
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I had dental work done by an insurance provider after the

Customer Question

I had dental work done by an insurance provider after the dental office on two occasions provided written estimates showing insurance would pay 50% of the needed treatment. I then agreed to have the treatment done. Though the dentist provided a treatment needed narrative, insurance requested supporting radio graph images numerous times beginning September through December 31, 2015. The dental office could only provide blurred images or images of teeth not needing treatment. This involved eight teeth, not just one they could not provide an appropriate image of. The insurance company extended to me two appeal stages in which the dental office basically refused to respond to written requests for proper images. Because of this I absorbed the total cost of the treatment. On May 3, the BBB notified me that my complaint had been received and forwarded to the dental office. On May 18, BBB notified me that there had been no response from the dental office. At this point I am considering small claims in an attempt to recover a refund in the amount of 50% of the costs I paid that should have been paid by the insurance if not for the apparent ineptness of this particular dental staff. Do I have a case?
Submitted: 11 months ago.
Category: Legal
Expert:  Roger replied 11 months ago.
Hi - my name is ***** ***** I'll be glad to assist.
Expert:  Roger replied 11 months ago.
If the issue that the insurer would not cover the procedure OR that the insurer would not cover because the dentist would not provide the necessary documentation for the claim to be approved?